Ehsan Rahimy

All Publications

• Impact of Obstructive Sleep Apnea on Diabetic Retinopathy Progression and Systemic Complications. American journal of ophthalmology Rahimy, E., Koo, E. B., Wai, K. M., Ludwig, C. A., Kossler, A. L., Mruthyunjaya, P. 2024

  Abstract

  Evaluate the risk of diabetic retinopathy progression and systemic vascular events, including death, in patients with non-proliferative diabetic retinopathy (NPDR) with obstructive sleep apnea (OSA).Retrospective cohort study.Electronic chart query using TriNetX (Cambridge, MA, USA), an electronic health records network comprising data from over 124 million patients. Patients with NPDR with and without OSA were identified. Patients were excluded if they had history of proliferative disease (PDR), diabetic macular edema (DME), or prior ocular intervention (intravitreal injection, laser, or pars plana vitrectomy). Propensity score matching was performed to control for baseline demographics and comorbidities. Rate of progressing to vision threatening complications (VTCs), need for ocular intervention, and systemic events was measured at 1, 3, and 5 years.11,931 patients in each group were analyzed after propensity score matching. There was elevated risk of PDR in the OSA cohort at 1 (RR: 1.34, P<0.001), 3 (RR: 1.31, P<0.001), and 5 years (RR: 1.28, P<0.001). There was elevated risk of DME in the OSA group at all time points: 1 (RR: 1.31, P<0.001), 3 (RR: 1.19, P<0.001), and 5 years (RR: 1.18, P<0.001). With respect to ocular interventions, there was an increased risk of intravitreal injection in OSA patients at 1 (RR: 1.59, P<0.001), 3 (RR: 1.58, P<0.001), and 5 years (RR: 1.54, P<0.001), and similar trends were noted with laser photocoagulation, but not vitrectomy. Regarding systemic events, NPDR patients with OSA had a greater risk of stroke (1 year RR: 1.80, P<0.001; 3 year RR: 1.56, P<0.001; 5 year RR: 1.49, P<0.001), myocardial infarction (1 year RR: 1.51, P<0.001; 3 year RR: 1.46, P<0.001; 5 year RR: 1.43, P<0.001), and death (1 year RR: 1.31, P<0.001; 3 year RR: 1.19, P<0.001; 5 year RR: 1.15, P<0.001).There is an increased rate of DR progression to VTCs, need for ocular intervention, and systemic complications, including death, for patients with OSA. We emphasize the need for improved screening measures of patients with NPDR and potential OSA.

  View details for DOI 10.1016/j.ajo.2024.07.021

  View details for PubMedID 39089360

• Endogenous Fusarium Endophthalmitis after Bone Marrow Transplant: A Case Report and Literature Review. Vision (Basel, Switzerland) Zhao, C. S., Wai, K., Koo, E. B., Rahimy, E., Mruthyunjaya, P., Mahajan, V. B., DeBoer, C. M. 2024; 8 (3)

  Abstract

  We aim to present a case of disseminated fusariosis that occurred in the setting of immunosuppression and presented with bilateral endogenous endophthalmitis, along with a literature review of Fusarium endophthalmitis, highlighting management strategies.A 70-year-old male with acute myeloid leukemia who had recently undergone a bone marrow transplant noted bilateral floaters and decreased vision. He was found to have bilateral Fusarium endophthalmitis, with subsequent evidence of fungemia and fusariosis in his skin and joints. Despite aggressive local and systemic treatment, he succumbed to the disease. Endophthalmitis was initially stabilized with pars plana vitrectomy and intravitreal amphotericin and voriconazole until the patient transitioned to comfort measures. A review of 31 cases demonstrates that outcomes are poor and that the disease must be treated aggressively, often both systemically and surgically.This case highlights the recalcitrance of Fusarium bacteremia and Fusarium endophthalmitis.

  View details for DOI 10.3390/vision8030044

  View details for PubMedID 39051230

• Progression to Pars Plana Vitrectomy in Patients With Proliferative Diabetic Retinopathy. JAMA ophthalmology Alsoudi, A. F., Wai, K. M., Koo, E., Parikh, R., Mruthyunjaya, P., Rahimy, E. 2024

  Abstract

  Importance: The Diabetic Retinopathy Clinical Research Network Protocol S suggested that vitrectomy for vitreous hemorrhage (VH) or tractional retinal detachment (TRD) was more common among eyes assigned initially to panretinal photocoagulation (PRP) vs anti-vascular endothelial growth factor (anti-VEGF) for proliferative diabetic retinopathy (PDR). These clinical implications warrant further evaluation in the clinical practice setting.Objective: To explore outcomes of PDR treated with PRP monotherapy compared with matched patients treated with anti-VEGF monotherapy.Design, Setting, and Participants: Retrospective cohort study using an aggregated electronic health records research network. Patients with PDR who received PRP or anti-VEGF monotherapy between January and September 2023 were included before propensity score matching. Patients were excluded with 6 or fewer months' follow-up after monotherapy or with a combination of PRP and anti-VEGF. Data were analyzed in September 2023.Exposures: Patients with new PDR diagnoses stratified by monotherapy with PRP or anti-VEGF agents using Current Procedural Terminology code.Main Outcome Measures: Incidence of pars plana vitrectomy (PPV), VH, or TRD.Results: Among 6020 patients (PRP cohort: mean [SD] age, 64.8 [13.4]; 6424 [50.88%] female; 3562 [28.21%] Black, 6180 [48.95%] White, and 2716 [21.51%] unknown race; anti-VEGF cohort: mean [SD] age, 66.1 [13.2]; 5399 [50.52%] male; 2859 [26.75%] Black, 5377 [50.31%] White, and 2382 [22.29%] unknown race) who received treatment, PRP monotherapy was associated with higher rates of PPV when compared with patients treated with anti-VEGF monotherapy at 5 years (RR, 1.18; 95% CI, 1.05-1.36; RD, 1.37%; 95% CI, 0.39%-2.37%; P<.001), with similar associations at 1 and 3 years. PRP monotherapy was associated with higher rates of VH at 5 years (relative risk [RR], 1.72; 95% CI, 1.52-1.95; risk difference [RD], 7.05; 95% CI, 5.41%-8.69%; P<.001) and higher rates of TRD at 5 years (RR, 2.76; 95% CI, 2.26-3.37; RD, 4.25%; 95% CI, 3.45%-5.05%; P<.001), with similar magnitudes of associations at 6 months, 1 year, and 3 years, when compared with patients treated with anti-VEGF monotherapy.Conclusions and Relevance: These findings support the hypothesis that patients with PDR treated with PRP monotherapy are more likely to develop VH, TRD, and undergo PPV when compared with matched patients treated with anti-VEGF monotherapy. However, given the wide range in relative risk, confounding factors may account for some of the association between PRP vs anti-VEGF monotherapy and outcomes evaluated.

  View details for DOI 10.1001/jamaophthalmol.2024.1844

  View details for PubMedID 38842828

• Impact of anti-VEGF treatment on development of proliferative diabetic retinopathy in routine clinical practice. BMC ophthalmology Moshfeghi, A. A., Khurana, R. N., Moini, H., Sherman, S., Reed, K., Boucher, N., Rahimy, E. 2024; 24 (1): 229

  Abstract

  This study evaluated impact of anti-vascular endothelial growth factor (VEGF) treatment on proliferative diabetic retinopathy (PDR) development among patients with non-proliferative diabetic retinopathy (NPDR) in US real-world clinical practice.This was a retrospective analysis of electronic medical records (Vestrum Health; January 2013 to June 2019) of eyes with baseline NPDR, without DME, and naïve to anti-VEGF treatment at index DR diagnosis. Eyes that received anti-VEGF and/or laser treatment over the course of study before development of PDR constituted the treated cohort while the remaining including those treated with laser constituted the anti-VEGF naïve cohort. Survival analysis via Kaplan-Meier method evaluated time to DME and PDR development by baseline NPDR severity, with anti-VEGF treatment as censoring variable. Baseline factors affecting PDR development were analyzed using Cox multivariable regression, censoring for anti-VEGF treatment.Among anti-VEGF-naive eyes, cumulative incidence of DME in eyes with mild (n = 70,050), moderate (n = 39,116), and severe NPDR (n = 10,692) at baseline was 27.1%, 51.2%, and 60.6%. Multivariable regression analysis identified baseline NPDR severity as the most significant predictor of PDR development over 48 months (hazard ratio [HR] [95% confidence interval {CI}] of 2.69 (2.65-2.72) for moderate vs mild NPDR and 6.51 (6.47-6.55) for severe vs mild NPDR). Cumulative incidence (95% CI) of PDR was 7.9% (7.4%-8.3%), 20.9%, (20.0%-21.7%) and 46.8% (44.4%-49.2%) over 48 months in eyes with mild, moderate, and severe NPDR at baseline, respectively. Among treated eyes with baseline severe NPDR, cumulative incidence of PDR at 48 months was 50.1% in eyes treated with laser (n = 546; HR [95% CI] vs no treatment: 0.8 [0.7-1.0]), 27.4% in eyes treated with anti-VEGF (n = 923; HR [95% CI]: 0.4 [0.4-0.5]), and 25.6% in eyes treated with anti-VEGF plus laser (n = 293; HR [95% CI]: 0.5 [0.4-0.7]) compared with 49.9% in eyes with no treatment (n = 8930).DME and PDR development rates increased with increasing baseline NPDR severity. Approximately half of anti-VEGF‒naive eyes with severe NPDR progressed to PDR within 4 years in US clinical practice. The progression rate from severe NPDR to PDR was approximately halved with anti-VEGF versus no treatment.

  View details for DOI 10.1186/s12886-024-03491-w

  View details for PubMedID 38822279

  View details for PubMedCentralID 4106080

• Agreement of Serial iCare HOME2 and Goldmann Applanation Tonometry. Ophthalmology. Glaucoma Kuo, D. S., Rahimy, E. 2024

  Abstract

  To assess agreement of iCare HOME2 and Goldmann applanation tonometry over a wide range of IOP.A prospective, observational cohort study.Twenty-six adult patients undergoing intravitreal injection, which temporarily raises IOP, were recruited from the Palo Alto Medical Foundation Retina Clinic between October 2022 and February 2023.Subjects had serial iCare HOME2 (IOPI) and Goldmann applanation (IOPG) IOP measurements before and at 0 and 5-10 minutes after injection. Baseline IOPs and pachymetry were taken in both eyes.Correlation between IOPI and IOPG was tested by within-subjects Intraclass Correlation Coefficient (ICC) for repeated measures. Agreement between IOPI and IOPG was evaluated by a Bland-Altman plot with correction for multiple measurements. The difference between IOPI and IOPG was evaluated between eyes at baseline (Pearson's r) and within the injected eye over different timepoint (ICC for absolute agreement). Linear regression was used to evaluate the effect of age, sex, glaucoma, and corneal thickness.The mean IOPI and IOPG were 25.3 (range: 9 - 55) and 23.5 (range: 8 - 56) mmHg, respectively. Correlation between IOPI and IOPG was 0.99 (p<0.001). The mean difference (IOPG - IOPI) was 2.2 mmHg (95% limits of agreement: -3.4 to 7.8 mmHg). The bias in measurements was correlated between eyes (r: 0.68, p<0.001) and in the injected eye across all timepoints (ICC: 0.86, 95% CI: 0.75 to 0.93), but did not show a relationship with age, sex, glaucoma or corneal thickness.IOPI and IOPG showed excellent correlation, however there was a stable bias toward IOPG being higher than IOPI over a large range of IOP.

  View details for DOI 10.1016/j.ogla.2024.04.007

  View details for PubMedID 38679327

• Impact of GLP-1 Agonists and SGLT-2 Inhibitors on Diabetic Retinopathy Progression: An Aggregated Electronic Health Record Data Study. American journal of ophthalmology Wai, K. M., Mishra, K., Koo, E., Ludwig, C. A., Parikh, R., Mruthyunjaya, P., Rahimy, E. 2024

  Abstract

  PURPOSE: To examine the effects of GLP-1 agonists compared to SGLT-2 inhibitors on diabetic retinopathy.DESIGN: Retrospective clinical cohort study using TriNetX (Cambridge, MA, USA), a federated electronic health records network comprising multiple healthcare organizations.METHODS: Patients with an International Classification of Diseases, Tenth Revision (ICD-10) code of non-proliferative diabetic retinopathy and monotherapy treatment, excluding insulin, with GLP-1 agonists or SGLT-2 inhibitors. Patients with history of proliferative diabetic retinopathy prior to initiation of treatment were excluded. Rate of progression to proliferative diabetic retinopathy and rate of development of diabetic macular edema were compared between patients on GLP-1 agonists compared to those on SGLT-2 inhibitors. The groups were propensity score matched for age, gender, ethnicity, race, type of diabetes, and severity of non-proliferative diabetic retinopathy. Main outcomes included rate and relative risk of progression to proliferative diabetic retinopathy and risk of diabetic macular edema in the GLP-1 agonist group versus the SGLT-2 inhibitor group.RESULTS: A total of 6481 patients were identified in the GLP-1 cohort and the SGLT-2 inhibitor cohort after propensity score matching. At 1 year and 3 years after initiation of therapy, a higher rate of progression of proliferative diabetic retinopathy was noted (RR: 1.26, CI 1.04-1.51, p=0.017 at 1 year, RR: 1.284, CI 1.1-1.499, p=0.002 at 3 years) in the GLP-1 agonist cohort compared to the SGLT-2 inhibitor cohort. There was a higher rate of diabetic macular edema noted at 3 months (RR: 1.192, CI 1.059-1.276, p=0.002), 6 months (RR: 1.22, CI 1.13-1.32, p<0.001), 1 year (RR: 1.24, CI 1.15-1.33, p<0.001), and at 3 years (RR: 1.29, CI 1.21-1.38, p<0.001) in the GLP-1 agonist cohort compared to the SGLT-2 inhibitor cohort.CONCLUSIONS: A higher rate of progression of proliferative diabetic retinopathy and risk of new-onset diabetic macular edema was observed in patients on monotherapy with GLP-1 agonists compared to those on SGLT-2 inhibitors. It is important for clinicians to be aware of these potential effects and to consider the current retinopathy status when initiating treatment with newer hypoglycemic agents to ensure these patients are appropriately monitored for developing potential vision threatening complications.

  View details for DOI 10.1016/j.ajo.2024.04.010

  View details for PubMedID 38636788

• Association of ocular manifestations of Marfan syndrome with cardiovascular complications. American journal of ophthalmology Tran, E. M., Wai, K. M., Kossler, A. L., Mruthyunjaya, P., Rahimy, E., Koo, E. B. 2024

  Abstract

  To evaluate associations between ocular manifestations of Marfan syndrome and cardiovascular complications.retrospective cohort study METHODS: Setting: TriNetX Analytics platform, a federated health research network of aggregated deidentified electronic health record data of over 119 million patients.Patients diagnosed with Marfan syndrome.Univariate logistic regression models were used to evaluate the association of ocular manifestations of Marfan syndrome (such as retinal tears/detachment, lens dislocation, and myopia), with cardiovascular comorbidities. Additional sensitivity analyses were performed using propensity matching.Odds ratio and 95% confidence intervals for incidence of cardiovascular comorbidities (including aortic dissection, valvular disease, and arrhythmias) following diagnosis of Marfan syndrome.19,105 patients were identified that were diagnosed with Marfan disease without ocular manifestations, and an additional 3,887 Marfan patients with ocular comorbidities. Patients who were diagnosed with ocular disease included 883 with ectopic lens, 417 with retinal tear or detachment, 683 with aphakia, 534 with pseudophakia, and 2,465 with myopia. Patients with any ocular manifestations of Marfan were significantly more likely to be diagnosed with all cardiovascular comorbidities modeled including aortic aneurysm and dissection (OR=2.035; p=<0.0001), mitral valve prolapse (OR=2.725; p= p=<0.0001), tricuspid valve disorders (OR=2.142; p=<0.0001), cardiac arrhythmias (OR=1.836; p=<0.0001), and all cardiovascular outcomes combined (OR=2.194; p=<0.0001).In a large and diverse cohort of patients with Marfan syndrome, ocular manifestations of the disorder appear strongly associated with cardiovascular comorbidities.

  View details for DOI 10.1016/j.ajo.2024.02.023

  View details for PubMedID 38403098

• Association of Cutaneous Keloids, Hypertrophic Scarring, and Fibrosis with Risk of Post-operative Proliferative Vitreoretinopathy. Ophthalmology Mammo, D. A., Wai, K., Rahimy, E., Pan, C. K., Srivastava, S. K., Mruthyunjaya, P. 2024

  Abstract

  PURPOSE: To assess an association between cutaneous keloids, hypertrophic scarring, and fibrosis (KHF) with risk of post-operative proliferative vitreoretinopathy (PVR) after rhegmatogenous retinal detachment (RRD) repair.DESIGN: Retrospective population-based cohort study PARTICIPANTS: Patients ≥ 18 years who underwent initial RD repair with pars plana vitrectomy with or without scleral buckle (SB) (Current Procedural Terminology (CPT) 67108), pneumatic retinopexy (67110), and primary SB (67107) from January 1, 2003 - March 1, 2023.METHODS: A de-identified electronic health record database through TriNetX, a global health research network, was used to analyze patients. Patients were queried for International Statistical Classification of Diseases (ICD)-10 codes L91.0 (hypertrophic scar) and L90.5 (scar conditions and fibrosis of skin). Frequency of subsequent diagnosis of PVR (H35.2), and CPT codes for secondary surgery including complex RD repair (67113) was determined. Proliferative diabetic retinopathy (PDR) (ICD-10 H10.35/H11.35) patients were excluded. Descriptive statistics (Z-test) and propensity score matching (PSM) was used to match for age, sex, and race.MAIN OUTCOME MEASURES: Prevalence of H35.2 and CPT 67113 within 180 days after RRD repair in KHF cohort versus non-KHF cohort.RESULTS: Among patients with CPT 67108, 1,061 patients in each cohort (KHF and non-KHF) were analyzed after PSM. The mean (SD) age was 60.7 (15.2) years. Within 180 days, 10.1% of patients in the KHF cohort and 3.4% in the non-KHF cohort had a diagnosis of PVR (H35.2) (p=0.00, OR 3.2; 95% CI, 2.13-4.71). 8.3% of patients in the KHF cohort and 5.4% of patients in the non-KHF cohort underwent complex RD repair (CPT 67113) (p=0.008; OR 3.2; 95% CI, 1.13-2.25). When including all RD repair types (CPT 67108, 67110, 67107), the rate of PVR diagnosis was still significantly greater in the KHF vs non-KHF cohort (9.0% vs 4.2%, p < 0.01; OR 2.28 (1.64-3.16).CONCLUSION: A dermatologic history of keloids, hypertrophic scarring, or fibrosis may be a risk factor for proliferative vitreoretinopathy after retinal detachment repair.

  View details for DOI 10.1016/j.ophtha.2024.01.032

  View details for PubMedID 38296203

• Progression of Geographic Atrophy: Retrospective Analysis of Patients from the IRIS® Registry (Intelligent Research in Sight). Ophthalmology science Rahimy, E., Khan, M. A., Ho, A. C., Hatfield, M., Nguyen, T. H., Jones, D., McKeown, A., Borkar, D., Leng, T., Ribeiro, R., Holekamp, N. 2023; 3 (4): 100318

  Abstract

  To evaluate disease progression and associated vision changes in patients with geographic atrophy (GA) secondary to age-related macular degeneration (AMD) in 1 eye and GA or neovascular AMD (nAMD) in the fellow eye using a large dataset from routine clinical practice.Retrospective analysis of clinical data over 24 months.A total of 256 635 patients with GA from the American Academy of Ophthalmology (Academy) IRIS® Registry (Intelligent Research in Sight) Registry (January 2016 to December 2017).Patients with ≥ 24 months of follow-up were grouped by fellow-eye status: Cohort 1, GA:GA; Cohort 2, GA:nAMD, each with (subfoveal) and without subfoveal (nonsubfoveal) involvement. Eyes with history of retinal disease other than AMD were excluded. Sensitivity analysis included patients who were managed by retina specialists and had a record of imaging within 30 days of diagnosis.Change in visual acuity (VA), occurrence of new-onset nAMD, and GA progression from nonsubfoveal to subfoveal.In total, 69 441 patients were included: 44 120 (64%) GA:GA and 25 321 (36%) GA:nAMD. Otherwise eligible patients (57 788) were excluded due to follow-up < 24 months. In both GA:GA and GA:nAMD cohorts, nonsubfoveal study eyes had better mean (standard deviation) VA at index (67 [19.3] and 66 [20.3] letters) than subfoveal eyes (59 [23.9] and 47 [26.9] letters), and 24-month mean VA changes were similar for nonsubfoveal (-7.6 and -6.2) and subfoveal (-7.9 and -6.5) subgroups. Progression to subfoveal GA occurred in 16.7% of nonsubfoveal study eyes in the GA:GA cohort and 12.5% in the GA:nAMD cohort. More new-onset study-eye nAMD was observed in the GA:nAMD (21.6%) versus GA:GA (8.2%) cohorts. Sensitivity analysis supported the robustness of the observations in the study.This retrospective analysis describes the natural progression of GA lesions and the decline in VA associated with the disease.Proprietary or commercial disclosure may be found after the references.

  View details for DOI 10.1016/j.xops.2023.100318

  View details for PubMedID 37274013

  View details for PubMedCentralID PMC10232896

• Risk of Stroke, Myocardial Infarction, and Death After Retinal Artery Occlusion. JAMA ophthalmology Wai, K. M., Knapp, A., Ludwig, C. A., Koo, E., Parikh, R., Rahimy, E., Mruthyunjaya, P. 2023

  Abstract

  Importance: Patients with retinal artery occlusions (RAOs) are recommended to have emergent stroke workup, although the true risk of death and subsequent vascular events post-RAO is not clear.Objective: To determine short-term and long-term rates of stroke, myocardial infarction (MI), and death in patients after RAO compared with a control cohort.Design, Setting, and Participants: This retrospective cohort study used aggregated electronic health records from January 1, 2003, through April 14, 2023, from TriNetX, a network with data from more than 111 million patients. Patients with RAO and a cataract control group were identified and matched for age, sex, race, and comorbidities, including hypertension, diabetes, hyperlipidemia, and smoking status. Patients were excluded if they had a stroke or MI within 2 years before the diagnosis of RAO or cataract.Exposure: International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, diagnosis code for RAO or age-related cataract.Main Outcomes and Measures: Rate of death, stroke, and MI at 2 weeks, 30 days, 1 year, 5 years, and 10 years after RAO compared with matched controls.Results: There were a total of 34 874 patients with at least 1 year of follow-up in the RAO cohort. The mean (SD) age at the RAO event was 66 (15.2) years. The rate of death after RAO diagnosis was higher than after cataract diagnosis at 2 weeks (0.14% vs 0.06%; relative risk [RR], 2.45; 95% CI, 1.46-4.12; risk difference [RD], 0.08%; 95% CI, 0.04%-0.13%; P<.001), 30 days (0.29% vs 0.14%; RR, 2.10; 95% CI, 1.49-2.97; RD, 0.15%; 95% CI, 0.08%-0.22%; P<.001), 1 year (3.51% vs 1.99%; RR, 1.78; 95% CI, 1.61-1.94; RD, 1.41%; 95% CI, 1.17%-1.66%; P<.001), 5 years (22.74% vs 17.82%; RR, 1.28; 95% CI, 1.23-1.33; RD, 4.93%; 95% CI, 4.17%-5.68%; P<.001), and 10 years (57.86% vs 55.38%; RR, 1.05; 95% CI, 1.02-1.07; RD, 2.47%; 95% CI, 1.25%-3.69%; P<.001). Risk of stroke after RAO was higher at 2 weeks (1.72% vs 0.08%; RR, 21.43; 95% CI, 14.67-31.29; RD, 1.64%; 95% CI, 1.50%-1.78%; P<.001), 30 days (2.48% vs 0.18%; RR, 14.18; 95% CI, 10.94-18.48; RD, 2.31%; 95% CI, 2.14%-2.47%; P<.001), 1 year (5.89% vs 1.13%; RR, 5.20; 95% CI, 4.67-5.79; RD, 4.64%; 95% CI, 4.37%-4.91%; P<.001), 5 years (10.85% vs 4.86%; RR, 2.24; 95% CI, 2.09-2.40; RD, 6.00%; 95% CI, 5.50%-6.50%; P<.001), and 10 years (14.59% vs 9.18%; RR, 1.59; 95% CI, 1.48-1.70; RD, 5.41%; 95% CI, 4.62%-6.21%; P<.001). Risk of MI after RAO was higher at 2 weeks (0.16% vs 0.06%; RR, 3.00; 95% CI, 1.79-5.04; RD, 0.11%; 95% CI, 0.06%-0.16%; P<.001), 30 days (0.27% vs 0.10%; RR, 2.61; 95% CI, 1.78-3.83; RD, 0.17%; 95% CI, 0.10%-0.23%; P<.001), 1 year (1.66% vs 0.97%; RR, 1.72; 95% CI, 1.51-1.97; RD, 0.59%; 95% CI, 0.42%-0.76%; P<.001), 5 years (6.06% vs 5.00%; RR, 1.21; 95% CI, 1.12-1.31; RD, 1.07%; 95% CI, 0.64%-1.50%; P<.001), and 10 years (10.55% vs 9.43%; RR, 1.12; 95% CI, 1.04-1.21; RD, 1.13%; 95% CI, 0.39%-1.87%; P=.003).Conclusions and Relevance: This study showed an increased risk of death, stroke, and MI in patients with RAO at both short-term and long-term intervals after RAO compared with a matched control population diagnosed with cataract. These findings suggest a potential need for multidisciplinary evaluation and long-term systemic follow-up of patients post-RAO.

  View details for DOI 10.1001/jamaophthalmol.2023.4716

  View details for PubMedID 37883068

• Ophthalmology at the Forefront of Big Data Integration in Medicine: Insights from the IRIS Registry Database. The Yale journal of biology and medicine Knapp, A. N., Leng, T., Rahimy, E. 2023; 96 (3): 421-426

  Abstract

  Ophthalmology stands at the vanguard of incorporating big data into medicine, as exemplified by the integration of The Intelligent Research in Sight (IRIS) Registry. This synergy cultivates patient-centered care, demonstrates real world efficacy and safety data for new therapies, and facilitates comprehensive population health insights. By evaluating the creation and utilization of the world's largest specialty clinical data registry, we underscore the transformative capacity of data-driven medical paradigms, current shortcomings, and future directions. We aim to provide a scaffold for other specialties to adopt big data integration into medicine.

  View details for DOI 10.59249/VUPM2510

  View details for PubMedID 37780991

  View details for PubMedCentralID PMC10524808

• Risk of Stroke, Myocardial Infarction, Deep Vein Thrombosis, Pulmonary Embolism, and Death after Retinal Vein Occlusion. American journal of ophthalmology Wai, K. M., Ludwig, C. A., Koo, E., Parikh, R., Mruthyunjaya, P., Rahimy, E. 2023

  Abstract

  To examine rates of stroke, myocardial infarction (MI), deep vein thrombosis (DVT), pulmonary embolism (PE), and death in patients after retinal vein occlusion (RVO) compared to controls.Retrospective cohort study.An aggregated electronic health records research network, TriNetX (Cambridge, MA, USA), was used to identify patients with diagnosis of RVO and a control group of patients with cataract. Patients were excluded if they had history of stroke, MI, DVT, or PE within 2 years of diagnosis of RVO or cataract. Propensity score matching was performed to control for baseline demographics and medical comorbidities. Main outcomes included relative risk (RR) of death, stroke, MI, DVT, and PE after RVO compared to matched controls.45304 patients were included in each cohort. There was elevated risk of death in the RVO cohort compared to the control cohort at 1 (RR: 1.30, p<0.01), 5 (RR: 1.22, p<0.01), and 10 years (RR:1.08, p<0.01). There was elevated risk of stroke at 1 (RR:1.61, p<0.01), 5 (RR:1.31, p<0.01), and 10 years (RR: 1.18, p<0.01). There was elevated risk of MI at 1 (RR:1.26, p<0.01) and 5 years (RR:1.13, p<0.01), but not at 10 years (RR:1.06, p=0.12). There was mildly elevated risk of DVT at 1 year (RR: 1.65, p<0.01), but not at 5 (RR: 0.94, p=0.94) or at 10 years (RR: 1.05, p=0.37), There was no elevated risk of PE at 1 (RR: 0.98, p=0.80), 5 (RR: 0.95, p=0.42), or 10 years (RR: 0.85, p=0.40).There is an increased rate of death, stroke, and MI after RVO compared to matched controls. We emphasize the need for long term systemic evaluation after RVO.

  View details for DOI 10.1016/j.ajo.2023.08.022

  View details for PubMedID 37660963

• Toward safer ophthalmic artificial intelligence via distributed validation on real-world data. Current opinion in ophthalmology Nath, S., Rahimy, E., Kras, A., Korot, E. 2023

  Abstract

  The current article provides an overview of the present approaches to algorithm validation, which are variable and largely self-determined, as well as solutions to address inadequacies.In the last decade alone, numerous machine learning applications have been proposed for ophthalmic diagnosis or disease monitoring. Remarkably, of these, less than 15 have received regulatory approval for implementation into clinical practice. Although there exists a vast pool of structured and relatively clean datasets from which to develop and test algorithms in the computational 'laboratory', real-world validation remains key to allow for safe, equitable, and clinically reliable implementation. Bottlenecks in the validation process stem from a striking paucity of regulatory guidance surrounding safety and performance thresholds, lack of oversight on critical postdeployment monitoring and context-specific recalibration, and inherent complexities of heterogeneous disease states and clinical environments. Implementation of secure, third-party, unbiased, pre and postdeployment validation offers the potential to address existing shortfalls in the validation process.Given the criticality of validation to the algorithm pipeline, there is an urgent need for developers, machine learning researchers, and end-user clinicians to devise a consensus approach, allowing for the rapid introduction of safe, equitable, and clinically valid machine learning implementations.

  View details for DOI 10.1097/ICU.0000000000000986

  View details for PubMedID 37459329

• Effect of Next Generation Oral Hypoglycemic Agents on Diabetic Retinopathy Progression: A National Cohort Study Wai, K., Ahluwalia, A., Abrant, A., Ludwig, C., Parikh, R., Mruthyunjaya, P., Rahimy, E. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2023

  View details for Web of Science ID 001053758307286

• Tracking Online Interest in Artificial Intelligence in Ophthalmology Using Google Trends. Seminars in ophthalmology Ahuja, A. S., Rahimy, E., Sridhar, J. 2023: 1-4

  Abstract

  To examine trends in internet search queries related to artificial intelligence (AI) in ophthalmology and determine the correlation between online interest in AI, capital investment in AI, and peer-reviewed indexed publications regarding AI and ophthalmology.Online search trends for "AI retina", "AI eye", and "AI healthcare" were obtained via Google Trends from 2016 to 2022 on a relative interest scale in 1-week intervals. Global venture financing of AI- and machine learning (ML)-focused companies in healthcare was tracked from 2010 to 2019 from the consulting company, Klynveld Peat Marwick Goerdeler (KPMG), and the technology market intelligence company, CB Insights. Citation count from pubmed.gov was determined using the search query "artificial intelligence retina" from 2012 to 2021.An increasingly linear growth in online search trends for "AI retina", "AI eye", and "AI healthcare" keyword searches was observed between 2016 and 2022. Global venture financing of AI and ML companies in healthcare also increased exponentially over the same time frame. There was an exponential increase in citations with nearly a 10-fold increase as reported by PubMed from 2015 onwards for the "artificial intelligence retina" search query. There was a significant and positive correlation between online search trends and investment trends (correlation coefficients of 0.98-0.99 and p-values <0.05) and between online search trends and citation count trends (correlation coefficients of 0.98-0.99 and p-values <0.05).These results demonstrate that the applications of AI and ML in ophthalmology are increasingly being investigated, financed, and formally researched, suggesting a prominent role for AI-derived tools in ophthalmology clinical practice in the near future.

  View details for DOI 10.1080/08820538.2023.2204919

  View details for PubMedID 37095683

• Novel oral medications for retinal disease: an update on clinical development. Current opinion in ophthalmology DeBoer, C. M., Agrawal, R., Rahimy, E. 2023

  Abstract

  Intravitreal and periocular injections for retinal disease provide a targeted delivery of medication to the eye. However, given risks of injections, including endophthalmitis, pain and treatment burden for both patients and retina specialists, there has been significant interest and effort in developing oral medications for the management of retinal disease. This article provides clinical and preclinical details of new oral medications in the pipeline for management of retinal disease.Several new oral medications show clinical and preclinical promise for the management of retinal disease, including macular degeneration, diabetic retinopathy and Stargardt disease.Oral medications provide promise for treating retinal disease, possibly increasing compliance, and reducing side effects of intravitreal or periocular injections. However, difficulties in this approach include systemic side effects and efficacy targeting the eye. There are multiple medications that are currently under investigation with the potential to act as stand-alone treatment or as an adjunct treatment for management of retinal diseases such as diabetic retinopathy, macular degeneration and Stargardt disease.

  View details for DOI 10.1097/ICU.0000000000000948

  View details for PubMedID 36943473

• An Evaluation of Popular Online Eye Health Products on Amazon Marketplace OPHTHALMIC SURGERY LASERS & IMAGING RETINA Alsoudi, A. F., Loya, A., Abouodah, H., Koo, E., Rahimy, E. 2023; 54 (3): 147-152

  Abstract

  To investigate popular eye health supplements available on Amazon Marketplace to increase awareness about their efficacy, safety, and the validity of their purported benefits.An observational quantitative and qualitative analysis of the top 100 eye health products was performed in March 2019. To determine the popular online eye health products on Amazon Marketplace, eight keywords were used for the search: "Eye Health," "Eye Health Supplements," "Eye Health Vitamins," "Retina Vitamins," "Macular Degeneration," "Macular Degeneration Vitamins," "Macular Health," and "Vision Health." The active ingredients, cost, and customer rating were all recorded.No statistically significant association was found between product type and price of the product, number of supplements, average rating, number of customer reviews, or number of verified customer reviews. The average daily cost of the eye health supplements was $0.72 ± $0.55 (range, $0.05 to $2.67).This study evaluated popular eye health supplements publicly available on Amazon Marketplace. The findings of this study help both patients and physicians better understand the safety and efficacy of these products so they may make more informed choices when supporting their eye health with commercially available supplements. [Ophthalmic Surg Lasers Imaging Retina 2023; 54(3):147-152.].

  View details for DOI 10.3928/23258160-20230221-03

  View details for Web of Science ID 000970627800002

  View details for PubMedID 36944073

• Evaluating the Effect of Hypoglycemic Agents on Diabetic OPHTHALMIC SURGERY LASERS & IMAGING RETINA Wai, K. M., Saroj, N., Boucher, N., Aggarwal, N., Ho, A. C., Rahimy, E. 2023; 54 (3): 158-165

  Abstract

  Newer hypoglycemics such as dipeptidyl peptidase 4 (DPP-4) inhibitors, sodium-glucose cotransporter-2 (SGLT-2) inhibitors, glucagon-like peptide-1 (GLP-1) receptor agonists have been increasingly used in diabetes. This study aimed to assess the relationship between usage of these hypoglycemic agents and effect on diabetic retinopathy (DR).Using the Vestrum Health Retina Database, patients with DR with 1 year follow-up after use of a hypoglycemic agent were included and stratified by agent, including no pharmacotherapy.Of 60,649 eyes, in 1 year after hypoglycemic agent usage, progression rates from severe nonproliferative diabetic retinopathy (NPDR) to proliferative diabetic retinopathy (PDR) were the following: DPP-4 (17%), SGLT-2 (12%), GLP-1 (21%), metformin (18%), and none (20%). Progression rates from moderate NPDR to severe NPDR or PDR were the following: DPP-4 (11%), SGLT-2 (10%), GLP-1 (11%), metformin (10%), none (13%). Progression rates from mild NPDR to moderate/severe NPDR or PDR were the following: DPP-4 (6%), SGLT-2 (9%), GLP-1 (9%), metformin (7%), and none (10%).Within a large real-world database, patients prescribed GLP-1 agonists were found to have DR progression rates comparable to those of patients receiving no hypoglycemic agents. [Ophthalmic Surg Lasers Imaging Retina 2023; 54(3):158-165.].

  View details for Web of Science ID 000975451300001

  View details for PubMedID 36944068

• Acute Macular Neuroretinopathy and Coronavirus Disease 2019 OPHTHALMOLOGY RETINA Dinh, R. H., Tsui, E., Wieder, M. S., Barash, A., Park, M. M., Rahimy, E., Mruthyunjaya, P., Lu, L. J., Michalak, S. M., Shah, R. J., Sierpina, D., Winter, T. W., Shields, R. A., Uchiyama, E., Lee, G. D., Komati, R., Lee, E., Kasi, S. K., Do, B. K. 2023; 7 (2): 198-200

  View details for Web of Science ID 000964933500001

• Acute Macular Neuroretinopathy and Coronavirus Disease 2019 OPHTHALMOLOGY RETINA [Anonymous] 2023; 7 (2): 198

  View details for Web of Science ID 000946461000002

• Quality, Readability, and Accessibility of Online Content From a Google Search of "Macular Degeneration": Critical Analysis JOURNAL OF VITREORETINAL DISEASES Hua, H., Rayess, N., Li, A. S., Do, D., Rahimy, E. 2022; 6 (6): 437-442

  View details for DOI 10.1177/24741264221094683

  View details for Web of Science ID 000894162800002

• Feasibility and Potential for Real-Time 3D Vitreoretinal Surgery Telementoring. Retina (Philadelphia, Pa.) Seddon, I. A., Rahimy, E., Miller, J. B., Charles, S., Kitchens, J., Houston, S. K. 2022

  Abstract

  To demonstrate the potential for real-time, three-dimensional (3D) surgical telementoring to enhance vitreoretinal surgical education.The 3D video feed from an HDR surgical camera (NGENUITY) was run through a 4k video capture device (Magewell USB 4k) and set as the video input for a video conferencing application (Zoom). Remote surgical viewing was then performed either in two-dimensions (2D) on a computer or in 3D with a virtual reality (VR) headset (Oculus Quest 2).Ten surgical cases were successfully live streamed in real-time to two separate surgeons in the United States. Specific details of the case were visualized with low latency and interaction with the operating surgeon was possible without affecting the surgical display quality. Excluding the NGENUITY system and personal computers, ancillary equipment costs (video capture card and VR headset) were kept to below $1000.Our study demonstrates that 3D surgical video streaming can be achieved in real-time with minimal latency through the use of low-cost video capture equipment and video conferencing/streaming software. The use of this technology gives educators the ability to mentor trainees without the traditional geographic and physical constraints of in-person surgical viewing.

  View details for DOI 10.1097/IAE.0000000000003656

  View details for PubMedID 36731001

• Acute macular neuroretinopathy and COVID-19 infection. Ophthalmology. Retina Dinh, R. H., Tsui, E., Wieder, M. S., Barash, A., Park, M. M., Rahimy, E., Mruthyunjaya, P., Lu, L. J., Michalak, S. M., Shah, R. J., Sierpina, D., Winter, T. W., Shields, R. A., Uchiyama, E., Lee, G. D., Komati, R., Lee, E., Kasi, S. K., Do, B. K. 2022

  Abstract

  Acute macular neuroretinopathy (AMN) and coronavirus disease 2019 (COVID-19) infection both have been shown to be associated with microvascular ischemia. We present 25 eyes in 15 patients who have coinciding diagnoses of AMN and COVID-19.

  View details for DOI 10.1016/j.oret.2022.09.005

  View details for PubMedID 36216223

• Henle Fiber Layer Hemorrhage in Macular Telangiectasia Type 2: Is Right Eye Dominance Coincidence or Consequence? American journal of ophthalmology Au, A., Jung, J., Johnson, M. W., Baumal, C., Daily, M. J., Gomolin, J. E., Gupta, R. R., Rahimy, E., Wu, L., Sadda, S. R., Sarraf, D. 2022; 241: 80-86

  Abstract

  To summarize all reported cases of Henle fiber layer (HFL) hemorrhage in the absence of subretinal neovascularization (SRNV) in patients with macular telangiectasia type 2 (MacTel2) and to propose a mechanism for the right-sided predominance of this unique presentation.Perspective.Collection, review, and analysis of all cases in the literature and in the authors' databases of HFL hemorrhage in MacTel2, including analysis of baseline and follow-up multimodal retinal imaging findings of selected cases. Elucidation of the complex interplay of systemic venous pressure with the deep retinal capillary plexus and hypothesis regarding the right-sided predilection of HFL hemorrhage complicating MacTel2.Ten patients presented with a unilateral, characteristic radial macular hemorrhage within the HFL that affected only the right eye in all cases. Absence of SRNV was confirmed by fluorescein angiography and/or optical coherence tomography angiography. The hemorrhage resolved spontaneously in at least 7 of the 10 eyes. The HFL hemorrhage may plausibly be explained by dysfunction of the deep capillary plexus in MacTel2 combined with an acute rise in central venous pressure, for which the right side may be at increased risk.HFL hemorrhage can complicate MacTel2 in the absence of SRNV, and the radial pattern of blood affecting only the right eye is remarkable. The right eye predominance may be multifactorial in etiology. Related factors may include the right-sided predilection of MacTel2 and/or increased right-sided dural sinus drainage related to normal anatomical variation.

  View details for DOI 10.1016/j.ajo.2022.04.002

  View details for PubMedID 35469791

• Vitreofoveal Traction Associated With Pilocarpine for Presbyopia OPHTHALMIC SURGERY LASERS & IMAGING RETINA Amarikwa, L., Michalak, S. M., Caul, S., Mruthyunjaya, P., Rahimy, E. 2022; 53 (7): 410-411

  Abstract

  Vuity (pilocarpine HCL ophthalmic 1.25%) was approved for the treatment of presbyopia in October 2021. Previous case series have reported the presence of vitreofoveal traction and retinal detachment following pilocarpine administration, but this was not reported in the recent randomized control trials assessing the efficacy of Vuity. The authors report a case of a woman of 65 years who developed vitreomacular traction immediately following the first administration of Vuity, review the literature, and present considerations regarding screening and management of patients starting Vuity. [Ophthalmic Surg Lasers Imaging Retina 2022; 53:410-411.].

  View details for DOI 10.3928/23258160-20220629-01

  View details for Web of Science ID 000827880200009

  View details for PubMedID 35858231

• Quality, Readability, and Accessibility of Online Content From a Google Search of "Macular Degeneration": Critical Analysis. Journal of vitreoretinal diseases Hua, H. U., Rayess, N., Li, A. S., Do, D., Rahimy, E. 2022; 6 (6): 437-442

  Abstract

  This work aims to assess the quality, accountability, readability, accessibility, and presence of Spanish translation in online material through a Google search of "macular degeneration".In this retrospective cross-sectional analysis of website results from a Google search of "macular degeneration", the quality and accountability for each website were assessed using the DISCERN criteria and the Health on the Net Foundation Code of Conduct (HONcode) principles. All 31 sites were independently graded by 2 ophthalmologists. Readability was evaluated using an online tool. The presence of accessibility features on the website and Spanish translation was recorded. The primary outcome measure was the DISCERN and HONcode quality and accountability scores of each website. Secondary outcome measures included the readability, accessibility, and presence of Spanish translation.The mean ± SD of each criterion across all 15 DISCERN questions was 2.761 ± 0.666 (out of 5). The mean HONcode score for all websites was 7.355 ± 3.123. The mean consensus reading grade level was 10.258 ± 2.49. There were no statistically significant differences in any score between the top 5 websites and the bottom 26 websites evaluated. Accessibility was available on 10 of 31 websites. Spanish translation was available on 10 of 31 websites.The top 5 websites that appeared on a Google search did not have better quality or readability of online content. Improving quality, accountability, and readability can help improve patients' health literacy regarding macular degeneration.

  View details for DOI 10.1177/24741264221094683

  View details for PubMedID 37009540

  View details for PubMedCentralID PMC9954772

• Retrospective cohort analysis of patients with geographic atrophy (GA) secondary to age-related macular degeneration followed for 3 years in clinical practice Khan, M., Rahimy, E., Ho, A. C., Corley, R., Gallivan, M., Jones, D., Ribeiro, R., Leng, T., Holekamp, N. M. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2022

  View details for Web of Science ID 000844401300299

• Baseline Characteristics and Outcomes After Anti-Vascular Endothelial Growth Factor Therapy for Macular Edema in Participants With Hemiretinal Vein Occlusion Compared With Participants With Central Retinal Vein Occlusion: Study of Comparative Treatments for Retinal Vein Occlusion 2 (SCORE2) Report 18. JAMA ophthalmology Scott, I. U., Oden, N. L., VanVeldhuisen, P. C., Ip, M. S., Blodi, B. A. 2022; 140 (5): 458-464

  Abstract

  Intravitreal anti-vascular endothelial growth factor (VEGF) injections are commonly used to treat eyes with macular edema secondary to hemiretinal vein occlusion (HRVO) or central retinal vein occlusion (CRVO). Information on whether differences exist in outcomes after anti-VEGF therapy can help guide treatment for each of the different disease types.To compare baseline characteristics, treatment burden, and outcomes of macular edema treatment in participants with HRVO with those of participants with CRVO.This post hoc outcome analysis from the Study of Comparative Treatments for Retinal Vein Occlusion 2 randomized clinical trial included 362 participants with macular edema caused by HRVO or CRVO treated at 66 US sites. Randomization began in September 2014, and the last month 24 follow-up visit occurred in February 2018. Data were analyzed from April 2020 to May 2021.Eyes were initially randomized to 6 monthly intravitreal injections of aflibercept or bevacizumab and were treated according to protocol between months 6 to 12 depending on 6-month outcome. After month 12, patients were treated per investigator discretion and observed through month 60.Mean visual acuity letter score (VALS).Of 362 included patients, 157 (43.4%) were female, and the mean (SD) age was 68.9 (12.0) years. Outcome data were analyzed up to month 24 owing to substantial missing data at later visits. A significantly greater proportion of participants with HRVO than those with CRVO were Black (37% vs 11%). Treatment rates between months 12 to 23 were 0.36 (95% CI, 0.32-0.40) injections per month for patients with CRVO and 0.28 (95% CI, 0.19-0.36) for patients with HRVO (P = .11). The mean VALS from months 1 to 24 of an HRVO study eye exceeded that of a CRVO study eye by 5.5 (95% CI, 1.5-9.5; P = .01), consistent with the magnitude of the VALS difference between eyes with CRVO and HRVO at baseline. Eyes with CRVO presented at baseline with more macular edema than eyes with HRVO (difference in central subfield thickness [CST], 86 μm; 95% CI, 48-124; P < .001), with no difference in CST between the groups throughout months 1 to 24.Black race was more prevalent among participants with HRVO than CRVO, and no differences were observed in the frequency of treatments for macular edema between eyes with CRVO and HRVO. Although eyes with CRVO presented with worse visual acuity and more macular edema on average than did eyes with HRVO, the magnitude of VALS improvement, central retinal thickness in response to anti-VEGF therapy, and treatment burden were similar between the groups.

  View details for DOI 10.1001/jamaophthalmol.2022.0352

  View details for PubMedID 35323843

  View details for PubMedCentralID PMC8949717

• Intraocular Pressure-Related Events After Anti-Vascular Endothelial Growth Factor Therapy for Macular Edema Due to Central Retinal Vein Occlusion or Hemiretinal Vein Occlusion: SCORE2 Report 16 on a Secondary Analysis of a Randomized Clinical Trial. JAMA ophthalmology Aref, A. A., Scott, I. U., VanVeldhuisen, P. C., King, J., Ip, M. S., Blodi, B. A., Oden, N. L. 2021; 139 (12): 1285-1291

  Abstract

  Intravitreal anti-vascular endothelial growth factor (anti-VEGF) injections are used to treat a variety of posterior segment conditions, including some associated with glaucoma, such as macular edema due to central retinal vein occlusion (CRVO). Therefore, information regarding intraocular pressure (IOP)-related events associated with anti-VEGF therapies is important to help balance the risks and benefits over the course of therapy.To investigate IOP-related events among participants in the Study of Comparative Treatments for Retinal Vein Occlusion 2 (SCORE2).Secondary analysis of a randomized clinical trial that included 312 participants with macular edema secondary to CRVO or hemiretinal vein occlusion (HRVO) who were not taking IOP-lowering medications at baseline. First randomization occurred on September 14, 2014, and contained data through data freeze on April 1, 2020. Analysis took place from April 2020 through December 2020.Study participants were initially randomized to 6 monthly intravitreal injections of aflibercept or bevacizumab. At month 6, protocol-defined good responders were rerandomized to continued monthly or treat-and-extend dosing of their originally assigned study drug, and protocol-defined poor or marginal responders were switched to alternative treatment. After month 12, participants were treated as per investigator discretion.Three different outcomes: (1) IOP elevation more than 10 mm Hg from baseline, (2) IOP to a level higher than 35 mm Hg, and (3) IOP-lowering incisional or laser surgery.Of the 312 participants meeting inclusion criteria (138 [44.2%] were female; mean [SD] age, 67.8 [12.1] years), 25 (8.0%) had IOP elevation more than 10 mm Hg over baseline through month 60, and 5 (1.6%) had IOP higher than 35 mm Hg. The 60-month Kaplan-Meier cumulative incidence of IOP elevation more than 10 mm Hg over baseline was 0.13 (95% CI, 0.08-0.19), and the 60-month Kaplan-Meier cumulative incidence of IOP higher than 35 mm Hg was 0.02 (95% CI, 0.01-0.06), and did not differ among participants initially randomly assigned to receive aflibercept or bevacizumab. Three participants (1.0%) underwent IOP-lowering incisional surgery, and 3 participants (1.0%) underwent IOP-lowering glaucoma laser surgery.Intravitreal anti-VEGF injections are used to treat some conditions associated with glaucoma, such as macular edema due to CRVO, and the rates of IOP-related events in this trial support monitoring IOP in eyes treated with anti-VEGF therapy for macular edema associated with CRVO or HRVO for up to 60 months.ClinicalTrials.gov Identifier: NCT01969708.

  View details for DOI 10.1001/jamaophthalmol.2021.4395

  View details for PubMedID 34709363

  View details for PubMedCentralID PMC8554687

• Spontaneous Conversion of Lamellar Macular Holes to Full-Thickness Macular Holes: Clinical Features and Surgical Outcomes. Ophthalmology. Retina Chehaibou, I., Hubschman, J. P., Kasi, S., Su, D., Joseph, A., Prasad, P., Abbey, A. M., Gaudric, A., Tadayoni, R., Rahimy, E. 2021; 5 (10): 1009-1016

  Abstract

  To describe the clinical features and surgical outcomes of patients experiencing a spontaneous conversion of a lamellar macular hole (LMH) to a full-thickness macular hole (FTMH).Retrospective, multicenter, observational case series.Patients with LMH who experienced a spontaneous conversion to FTMH and underwent FTMH surgery.Clinical charts and OCT features of 20 eyes of 20 patients were reviewed.OCT features and surgical outcomes of FTMH derived from LMH.The mean baseline visual acuity (VA) was 0.21 ± 0.19 logarithm of the minimum angle of resolution (logMAR) (20/32 Snellen equivalent [SE]). Epiretinal proliferation was noted in 18 eyes (90%), and 14 eyes (75%) had an epiretinal membrane. At the diagnosis of FTMH, the mean VA decreased to 0.61 ± 0.50 logMAR (20/81 SE) (P = 0.001). The mean FTMH diameter was 224.4 ± 194.8 μm, with 15 (75%) small (≤250 μm), 2 (10%) medium (>250-≤400 μm), and 3 (15%) large (>400 μm) FTMHs. Eighteen (90%) FTMHs were sealed after 1 surgery, and 2 (10%) required an additional procedure. At the last follow-up, the mean VA was increased to 0.29 ± 0.23 logMAR (20/38 SE) (P = 0.003), but did not significantly differ from the baseline VA (P = 0.071).Patients with LMH may develop an FTMH with no evidence of vitreomacular traction. A tangential traction from an epiretinal membrane may contribute to its genesis, but a progressive loss of retinal tissue and an inherent weakness of the foveal architecture in LMH eyes could be sufficient. Most FTMHs derived from LMH had a small diameter, showed epiretinal proliferation, showed limited retinal hydration, and were associated with relatively poor surgical outcomes compared with idiopathic FTMH.

  View details for DOI 10.1016/j.oret.2020.12.023

  View details for PubMedID 33412307

• Macular Mobilization with a Flexible Nitinol Loop for Chronic or Recurrent Macular Holes. Ophthalmology. Retina Borkar, D. S., Berrocal, M. H., Rahimy, E., Xu, D., Regillo, C. D. 2021; 5 (10): 1056-1058

  View details for DOI 10.1016/j.oret.2021.03.017

  View details for PubMedID 33848649

• Social Media and Retinal Detachment: Perspectives of Providers and Patients on Instagram OPHTHALMIC SURGERY LASERS & IMAGING RETINA Alsoudi, A. F., Rayess, N., Khan, S., Koo, E., Rahimy, E. 2021; 52 (7): 391-395

  Abstract

  To evaluate the social media interactions of patients who experience retinal detachment and/or repair and how ophthalmic medical providers utilize social media.A cross-sectional study of public posts on Instagram was performed from September 2019 to January 2020, with filtering based on the following hashtags: #retinaldetachment, #detachedretina, #retinaldetachmentsurgery, and #scleralbuckle. A categorical classification system was used for each Instagram post to review descriptive variables.Of the 1,797 Instagram posts analyzed, 697 (39%) were made by patients, of which 395 (57%) were positive in tone and 599 (86%) were in the postoperative period. Posts by ophthalmologists were most commonly centered on colleague education (446, 81%).The majority of Instagram posts by patients were of a positive tone reflecting primarily on activities of daily living and rehabilitations. Retina specialists should consider providing more social media content directed toward patients, particularly regarding their rehabilitation course following retinal detachment repair. [Ophthalmic Surg Lasers Imaging Retina. 2021;52:391-395.].

  View details for DOI 10.3928/23258160-20210628-06

  View details for Web of Science ID 000677881000006

  View details for PubMedID 34309431

• Fundamentals of artificial intelligence for ophthalmologists. Current opinion in ophthalmology Ahmad, B. U., Kim, J. E., Rahimy, E. 2020; 31 (5): 303-311

  Abstract

  As artificial intelligence continues to develop new applications in ophthalmic image recognition, we provide here an introduction for ophthalmologists and a primer on the mechanisms of deep learning systems.Deep learning has lent itself to the automated interpretation of various retinal imaging modalities, including fundus photography and optical coherence tomography. Convolutional neural networks (CNN) represent the primary class of deep neural networks applied to these image analyses. These have been configured to aid in the detection of diabetes retinopathy, AMD, retinal detachment, glaucoma, and ROP, among other ocular disorders. Predictive models for retinal disease prognosis and treatment are also being validated.Deep learning systems have begun to demonstrate a reliable level of diagnostic accuracy equal or better to human graders for narrow image recognition tasks. However, challenges regarding the use of deep learning systems in ophthalmology remain. These include trust of unsupervised learning systems and the limited ability to recognize broad ranges of disorders.

  View details for DOI 10.1097/ICU.0000000000000679

  View details for PubMedID 32740061

• Impact of Systemic Dipeptidyl Peptidase-4 Inhibitor Use in Diabetic Macular Edema. Ophthalmic surgery, lasers & imaging retina Rahimy, E., Baker, K., Thompson, D., Saroj, N. 2020; 51 (4): 226-234

  Abstract

  To evaluate impact of baseline systemic dipeptidyl peptidase-4 (DPP-4) inhibitor use in diabetic macular edema (DME).This was a post hoc exploratory analysis of previously completed randomized, controlled clinical trials (VISTA and VIVID) in patients with DME evaluating intravitreal aflibercept injection (IAI) every 4 weeks (2q4) or every 8 weeks (2q8) or macular laser photocoagulation.Overall, a small number of patients (12.2% [n = 35], 9.7% [n = 28], and 15.4% [n = 44]) in the laser control, 2q4, and 2q8 groups reported baseline DPP-4 inhibitor use. There were no differences in changes from baseline in best-corrected visual acuity, central subfield thickness, or rates of 2-or-greater-step improvement in Diabetic Retinopathy Severity Scale score based on DPP-4 inhibitor use within each treatment group.DPP-4 inhibitor use at baseline did not influence the magnitude of visual and anatomic benefit in patients with DME being treated with IAI or laser. [Ophthalmic Surg Lasers Imaging Retina. 2020;51:226-234.].

  View details for DOI 10.3928/23258160-20200326-04

  View details for PubMedID 32348539

• Assessment of Online Sites Reliability, Accountability, Readability, Accessibility and Translation for Intravitreal Injections. Ophthalmology. Retina Rayess, N. n., Li, A. S., Do, D. V., Rahimy, E. n. 2020

  Abstract

  Patients increasingly use the internet to access health-related information to further understand their treatments and conditions. This study compares the quality, accountability, readability, accessibility and presence of translation between private and academic online source material available to the public regarding intravitreal injections.Cross-sectional analysis PARTICIPANTS: Top 20 websites on a Google search for the terms 'eye injections', 'intravitreal injections' and 'anti-VEGF injections'.Websites were classified as private or academic. Quality and accountability were assessed using the internationally recognized DISCERN criteria and the Health on the Net (HONcode). All 20 sites were independently graded by 2 retinal physicians and differences were adjudicated by a third experienced retinal physician. Readability was evaluated using an online tool that provides a consensus readability grade level. The presence of and languages available for translation were recorded. The top 5 ranked websites' content quality, accountability and readability was also compared with the other 15 websites.Primary outcome measure is comparing the DISCERN and HONcode quality and accountability scores between academic and private websites. Secondary outcome measures include evaluating readability, accessibility and presence of translation (in particular, Spanish).Eleven academic and 9 private websites were included. The overall mean score using DISCERN criteria for the academic websites (3.11±0.46) was significantly higher than that of private websites (2.23±0.61; p<0.007). Similarly, out of a possible total 14 points for the HONcode, the average quality score for academic websites (10.91±2.66) was higher compared to private websites (6.44±3.36; p<0.009). The mean consensus reading grade level was similar between academic (11.73±1.68) and private websites (11.78±1.48; p=0.94). Spanish translation was offered by only 7 of the 20 websites (5 academic and 2 private websites).The overall quality and accountability of online content for academic sites was significantly higher compared to private websites. Translation was rarely provided and the readability grade level was significantly higher for both groups than recommended. Improving the quality, accountability, readability, accessibility and incorporating translation in websites can help improve patients' health literacy regarding intravitreal injections, potentially leading to increased adherence to therapy plans and improved treatment outcomes.

  View details for DOI 10.1016/j.oret.2020.05.019

  View details for PubMedID 32497854

• LONG-TERM VISUAL OUTCOMES AND CLINICAL FEATURES AFTER ANTI-VASCULAR ENDOTHELIAL GROWTH FACTOR INJECTION-RELATED ENDOPHTHALMITIS. Retina (Philadelphia, Pa.) Rayess, N., Obeid, A., Storey, P. P., Juliano, J., Rahimy, E., Moshfeghi, A. A., Garg, S., Hsu, J. 2019; 39 (11): 2070-2076

  Abstract

  To determine long-term visual outcomes in patients who developed endophthalmitis after intravitreal anti-vascular endothelial growth factor injections and to correlate visual outcomes with clinical features.This is a retrospective, multicenter, consecutive case series of patients diagnosed with anti-vascular endothelial growth factor injection-related endophthalmitis who were treated at Mid Atlantic Retina, the Retina Service of Wills Eye Hospital, Philadelphia, PA, and the University of Southern California Roski Eye Institute, Los Angeles, CA. Patients were included if they had at least 1 year of follow-up. Primary outcome was to evaluate long-term visual outcomes up to 5 years of follow-up. The secondary outcome was to determine clinical features (e.g., culture results) that may predict long-term visual acuity outcomes.A total of 56 cases of endophthalmitis from 168,247 anti-vascular endothelial growth factor injections were identified (0.033%, 1/3,004 injections), from which 51 eyes met inclusion criteria. Mean follow-up period was 3.3 years (median 4 years; range 1-5 years). A total of 24 patients (47%) reached a maximum final follow-up of 5 years. Mean Snellen visual acuity at the causative injection visit was 20/102 and decreased to counting fingers at diagnosis (P < 0.001). At 6-month follow-up, mean visual acuity improved to 20/644 (P < 0.001) and remained stable up to 5 years (20/480, P = 0.003) follow-up compared with diagnosis. At the final follow-up, 20 eyes had visual acuity that returned to within one line of baseline visual acuity (visual recovery group), whereas 31 patients' visual acuity was at least one line worse than initial visual acuity (visual deterioration group). The cultures for the visual recovery group were more likely to grow coagulase-negative Staphylococcus, whereas the visual deterioration group primarily grew Streptococcus species, Staphylococcus aureus, and Enterococcus faecalis (P = 0.002, comparing organisms isolated in the visual recovery and deterioration group).Visual outcomes after anti-vascular endothelial growth factor injection-related endophthalmitis seem to reach peak improvement by 6 months and remain stable up to a median of 4-year follow-up. Patients who develop culture-negative endophthalmitis or endophthalmitis secondary to coagulase-negative Staphylococcus are more likely to regain baseline visual acuity compared with cases secondary to Streptococcus species.

  View details for DOI 10.1097/IAE.0000000000002300

  View details for PubMedID 30157114

• Current Practice Preferences and Safety Protocols for Intravitreal Injection of Anti-Vascular Endothelial Growth Factor Agents. Ophthalmology. Retina Uhr, J. H., Xu, D., Rahimy, E., Hsu, J. 2019; 3 (8): 649-655

  Abstract

  To assess current practice preferences and safety measures used for intravitreal injection (IVI) of anti-vascular endothelial growth factor (VEGF) medications and to assess the variability of practice patterns between academic and nonacademic and between early- and later-career ophthalmologists.Cross-sectional survey.Practicing retina specialists who administer intravitreal anti-VEGF injections from the membership pool of the American Society of Retina Specialists.Participants were contacted by e-mail to participate in an anonymous 31-question survey on a common online platform, SurveyMonkey.Preferred practices for various aspects of administering IVIs and adherence to the most recently published guidelines on IVI techniques.Preinjection antibiotic drops were used always or often by 10.9% (43/396) of participants. Antibiotics after injection were used always or often by 16.6% (66/398) of participants. Longer (>15 years) compared with shorter (0-15 years) duration of practice was associated with always or often instilling preinjection antibiotics (13.7% vs. 6.7%; P = 0.028), scrubbing eyelids or lashes with antiseptic (43.6% vs. 30.5%; P = 0.008), and being less likely to instill antiseptic immediately before injection (89.7% vs. 95.7%; P = 0.029). Practicing for more than 25 years was associated with always or often instilling antibiotics after injection (22.5% vs. 13.3%; P = 0.017). Academic compared with nonacademic providers were more likely to wear a cap (16.3% vs. 6.8%; P = 0.006), mask (43.0% vs. 29.9%; P = 0.022), and gloves (64.0% vs. 52.1%; P = 0.050) and to drape the patient (17.4% vs. 9.1%; P = 0.027).Techniques for IVIs vary widely. Use of periprocedure antibiotics has declined, consistent with new evidence demonstrating lack of efficacy in endophthalmitis prevention as well as their potential harm. However, later-career physicians were more likely to continue to use antibiotics and other techniques advised against in the most recent recommendations of expert consensus groups in the United States and Europe. Academic practitioners were more likely to use protective wear during the procedure.

  View details for DOI 10.1016/j.oret.2019.03.013

  View details for PubMedID 31068264

• Giraffe or leopard spot chorioretinopathy as an outstanding finding: case report and literature review. International ophthalmology Jabbarpoor Bonyadi, M. H., Ownagh, V., Rahimy, E., Soheilian, M. 2019; 39 (6): 1405-1412

  Abstract

  Presentation of two typical cases with characteristic leopard retinopathy secondary to bilateral diffuse uveal melanocytic proliferation (BDUMP) and idiopathic uveal effusion syndrome (IUES) and brief review of the literature about leopard spot retinopathy.A 43-year-old women, who was a known case of ovarian carcinoma, referred with gradual bilateral visual loss. In ophthalmic examination, subretinal fluid, multiple patchy subretinal hyperpigmented lesions and leopard spot chorioretinopathy were evident in her both eyes. Fluorescein angiography showed multiple nummular hyperfluorescent lesions surrounded by zones of hypofluorescence. Spectral domain optical coherence tomography revealed increased retinal thickness, subretinal fluid and RPE irregularities in both eyes. Enhanced depth imaging OCT (EDI-OCT) showed bilateral subfoveal choroidal thickening. During next 2-year follow-up, she underwent cataract surgery and later on developed neovascular glaucoma in her both eyes. The second case was a 45-year-old man who had developed decreased visual acuity in his left eye for 3 years. Anterior segment examination was unremarkable, and both eyes had normal intraocular pressure. No vitreous inflammation was observed. Fundoscopy revealed diffuse exudative retinal detachment in his left eye. Fluorescein angiography showed leopard spot retinopathy of posterior pole, and EDI-OCT disclosed subfoveal choroidal thickening. After exclusion of other causes of exudative retinal detachment and with diagnosis of IUES, he underwent intravitreal triamcinolone injection (2 mg) which improved his final vision to 20/40.Leopard spot retinopathy is an uncommon but clinically distinct manifestation of various disorders. BDUMP may present with leopard spot retinopathy, anterior uveal tract involvement and neovascular glaucoma. As EDI-OCT showed involvement and increased thickening of choroid in both cases of BDUMP and IUES, it may be better to consider such cases as leopard chorioretinopathy and categorize these entities as a member of pachychoroid pigment retinopathy disorders.

  View details for DOI 10.1007/s10792-018-0948-5

  View details for PubMedID 29948498

• Extended (Every 12 Weeks or Longer) Dosing Interval With Intravitreal Aflibercept and Ranibizumab in Neovascular Age-Related Macular Degeneration: Post Hoc Analysis of VIEW Trials. American journal of ophthalmology Khurana, R. N., Rahimy, E., Joseph, W. A., Saroj, N., Gibson, A., Vitti, R., Berliner, A. J., Chu, K., Cheng, Y., Boyer, D. S. 2019; 200: 161-168

  Abstract

  To evaluate outcomes and disease characteristics in eyes with neovascular age-related macular degeneration that received intravitreal aflibercept injection (IAI) and ranibizumab every 12 weeks or longer (≥q12 weeks) or less than every 12 weeks (

  View details for DOI 10.1016/j.ajo.2019.01.005

  View details for PubMedID 30664844

• EFFECT OF INTRAOCULAR PRESSURE-LOWERING MEDICATIONS ON NEOVASCULAR AGE-RELATED MACULAR DEGENERATION TREATMENT OUTCOMES IN THE COMPARISON OF AGE-RELATED MACULAR DEGENERATION TREATMENT TRIALS. Retina (Philadelphia, Pa.) Rahimy, E., Ying, G. S., Pan, W., Hsu, J. 2019; 39 (4): 636-647

  Abstract

  To evaluate the effect of intraocular pressure-lowering medications on treatment outcomes in the Comparison of AMD Treatments Trials.Secondary analysis of Comparison of AMD Treatments Trials data. Medication logs were reviewed for continuous 2-year use of agents that increased aqueous outflow (Group A: topical prostaglandins) or suppressed aqueous production (Group B: topical beta blockers and carbonic anhydrase inhibitors). Eyes were excluded if mixed-mechanism intraocular pressure-lowering agents or medications from more than one group were taken. Anatomical and vision responses to treatment at years 1, 2, and over the entire 2-year period in each group were compared with controls (no intraocular pressure-lowering medications).Inclusion criteria were met by 28 Group A patients, 19 Group B patients, and 857 controls. After 2 years, the control group had a mean visual acuity improvement of +6.3 letters from baseline, compared with +3.5 letters in Group A (P = 0.38), and +13.8 letters in Group B (P = 0.052). Mean retinal thickness change from baseline was -54.9 μm in controls, -80.6 μm in Group A (P = 0.26), and -96.8 μm in Group B (P = 0.13). Mean total thickness change from baseline was -163 μm in controls, -180 μm in Group A (P = 0.63), and -238 μm in Group B (P = 0.08). In longitudinal analysis with adjustment by their baseline values, anti-vascular endothelial growth factor treatment drug and regimen, Group B had more visual acuity improvement (difference of 2.6 letters, 95% confidence interval: -3.4-8.5 letters), more reduction in the retinal thickness (-17.9 μm, 95% confidence interval: -36.5 to 0.7 μm), and total thickness from baseline (mean difference of -54.7 μm, 95% confidence interval: -103 to 6.2 μm) compared with the control group.Concurrent aqueous suppressant use during anti-vascular endothelial growth factor therapy for neovascular age-related macular degeneration was associated with a trend toward greater reductions in retinal and total thickness as well as improved visual outcomes over 2 years. A similar effect was not observed to the same extent with agents that increase aqueous outflow. Because of the small sample size and secondary analysis, these findings must be cautiously interpreted and perhaps serve as a basis for future prospective studies.

  View details for DOI 10.1097/IAE.0000000000002124

  View details for PubMedID 29517580

  View details for PubMedCentralID PMC6123304

• Using a Deep Learning Algorithm and Integrated Gradients Explanation to Assist Grading for Diabetic Retinopathy. Ophthalmology Sayres, R., Taly, A., Rahimy, E., Blumer, K., Coz, D., Hammel, N., Krause, J., Narayanaswamy, A., Rastegar, Z., Wu, D., Xu, S., Barb, S., Joseph, A., Shumski, M., Smith, J., Sood, A. B., Corrado, G. S., Peng, L., Webster, D. R. 2019; 126 (4): 552-564

  Abstract

  To understand the impact of deep learning diabetic retinopathy (DR) algorithms on physician readers in computer-assisted settings.Evaluation of diagnostic technology.One thousand seven hundred ninety-six retinal fundus images from 1612 diabetic patients.Ten ophthalmologists (5 general ophthalmologists, 4 retina specialists, 1 retina fellow) read images for DR severity based on the International Clinical Diabetic Retinopathy disease severity scale in each of 3 conditions: unassisted, grades only, or grades plus heatmap. Grades-only assistance comprised a histogram of DR predictions (grades) from a trained deep-learning model. For grades plus heatmap, we additionally showed explanatory heatmaps.For each experiment arm, we computed sensitivity and specificity of each reader and the algorithm for different levels of DR severity against an adjudicated reference standard. We also measured accuracy (exact 5-class level agreement and Cohen's quadratically weighted κ), reader-reported confidence (5-point Likert scale), and grading time.Readers graded more accurately with model assistance than without for the grades-only condition (P < 0.001). Grades plus heatmaps improved accuracy for patients with DR (P < 0.001), but reduced accuracy for patients without DR (P = 0.006). Both forms of assistance increased readers' sensitivity moderate-or-worse DR: unassisted: mean, 79.4% [95% confidence interval (CI), 72.3%-86.5%]; grades only: mean, 87.5% [95% CI, 85.1%-89.9%]; grades plus heatmap: mean, 88.7% [95% CI, 84.9%-92.5%] without a corresponding drop in specificity (unassisted: mean, 96.6% [95% CI, 95.9%-97.4%]; grades only: mean, 96.1% [95% CI, 95.5%-96.7%]; grades plus heatmap: mean, 95.5% [95% CI, 94.8%-96.1%]). Algorithmic assistance increased the accuracy of retina specialists above that of the unassisted reader or model alone; and increased grading confidence and grading time across all readers. For most cases, grades plus heatmap was only as effective as grades only. Over the course of the experiment, grading time decreased across all conditions, although most sharply for grades plus heatmap.Deep learning algorithms can improve the accuracy of, and confidence in, DR diagnosis in an assisted read setting. They also may increase grading time, although these effects may be ameliorated with experience.

  View details for DOI 10.1016/j.ophtha.2018.11.016

  View details for PubMedID 30553900

• Baseline choroidal thickness as a short-term predictor of visual acuity improvement following antivascular endothelial growth factor therapy in branch retinal vein occlusion. The British journal of ophthalmology Rayess, N., Rahimy, E., Ying, G. S., Pefkianaki, M., Franklin, J., Regillo, C. D., Ho, A. C., Hsu, J. 2019; 103 (1): 55-59

  Abstract

  To evaluate the association between subfoveal choroidal thickness (SFCT) and branch retinal vein occlusion (BRVO) eyes treated with antivascular endothelial growth factor (anti-VEGF) therapy.Retrospective cohort study of treatment naïve BRVO eyes treated with 3 monthly anti-VEGF injections. All patients received enhanced depth imaging spectral-domain optical coherence tomography scans to determine SFCT and central macular thickness (CMT). Baseline predictors (particularly SFCT) for functional response (best-corrected visual acuity (BCVA) gain ≥2 lines) were assessed at 3 months using univariate and multivariate analyses.Forty eyes from 39 patients were included. Mean baseline SFCT was higher in functional responders (240.4±73.1 µm), compared with both non-responders (193.3±63.6 µm; p=0.036) and their corresponding fellow eye (202.2±67.1 µm; p=0.022). A higher baseline SFCT (for every 100 µm increase in SFCT) was found to be a positive predictor for functional response (regression coefficient: 1.1; p=0.03) on univariate analysis but not multivariate analysis. A worse baseline BCVA (for every 0.1 logMAR increase) was a positive predictor for visual improvement with an adjusted OR of 1.30 (95% CI 1.03 to 1.63; p=0.0009) on multivariate analysis.Patients with BRVO with a worse initial BCVA are most likely to achieve visual improvement following anti-VEGF therapy. Additionally, baseline SFCT may also help predict which patients with BRVO have favourable visual outcomes. Patients with an initial choroidal thickness thicker than their fellow eye are more likely to have short-term visual improvement following treatment.

  View details for DOI 10.1136/bjophthalmol-2018-311898

  View details for PubMedID 29567791

• Comparing 33-Gauge versus 30-Gauge Needles for Intravitreal Injections. Ophthalmology. Retina Aderman, C. M., Rahimy, E., Obeid, A., Gao, X., Hsu, J., Garg, S. J., Regillo, C. D., Gupta, O. P., Chiang, A. 2018; 2 (10): 1078-1079

  View details for DOI 10.1016/j.oret.2018.05.003

  View details for PubMedID 31047499

• Practice Patterns of Endophthalmitis Treatment: An International Survey of Retina Specialists. Ophthalmology. Retina Xu, D., Nagiel, A., Rahimy, E., McCannel, C. A. 2018; 2 (9): 979-980

  View details for DOI 10.1016/j.oret.2018.04.008

  View details for PubMedID 31047231

• Grader Variability and the Importance of Reference Standards for Evaluating Machine Learning Models for Diabetic Retinopathy. Ophthalmology Krause, J., Gulshan, V., Rahimy, E., Karth, P., Widner, K., Corrado, G. S., Peng, L., Webster, D. R. 2018; 125 (8): 1264-1272

  Abstract

  Use adjudication to quantify errors in diabetic retinopathy (DR) grading based on individual graders and majority decision, and to train an improved automated algorithm for DR grading.Retrospective analysis.Retinal fundus images from DR screening programs.Images were each graded by the algorithm, U.S. board-certified ophthalmologists, and retinal specialists. The adjudicated consensus of the retinal specialists served as the reference standard.For agreement between different graders as well as between the graders and the algorithm, we measured the (quadratic-weighted) kappa score. To compare the performance of different forms of manual grading and the algorithm for various DR severity cutoffs (e.g., mild or worse DR, moderate or worse DR), we measured area under the curve (AUC), sensitivity, and specificity.Of the 193 discrepancies between adjudication by retinal specialists and majority decision of ophthalmologists, the most common were missing microaneurysm (MAs) (36%), artifacts (20%), and misclassified hemorrhages (16%). Relative to the reference standard, the kappa for individual retinal specialists, ophthalmologists, and algorithm ranged from 0.82 to 0.91, 0.80 to 0.84, and 0.84, respectively. For moderate or worse DR, the majority decision of ophthalmologists had a sensitivity of 0.838 and specificity of 0.981. The algorithm had a sensitivity of 0.971, specificity of 0.923, and AUC of 0.986. For mild or worse DR, the algorithm had a sensitivity of 0.970, specificity of 0.917, and AUC of 0.986. By using a small number of adjudicated consensus grades as a tuning dataset and higher-resolution images as input, the algorithm improved in AUC from 0.934 to 0.986 for moderate or worse DR.Adjudication reduces the errors in DR grading. A small set of adjudicated DR grades allows substantial improvements in algorithm performance. The resulting algorithm's performance was on par with that of individual U.S. Board-Certified ophthalmologists and retinal specialists.

  View details for DOI 10.1016/j.ophtha.2018.01.034

  View details for PubMedID 29548646

• A PROSPECTIVE, RANDOMIZED TRIAL COMPARING PLAIN GUT TO POLYGLACTIN 910 (VICRYL) SUTURES FOR SCLEROTOMY CLOSURE AFTER 23-GAUGE PARS PLANA VITRECTOMY. Retina (Philadelphia, Pa.) Sridhar, J., Kasi, S., Paul, J., Shahlaee, A., Rahimy, E., Chiang, A., Spirn, M. J., Hsu, J., Garg, S. J. 2018; 38 (6): 1216-1219

  Abstract

  To report a prospective, randomized comparative study assessing clinical outcomes of plain gut versus polyglactin 910 (PG910) sutures for sclerotomy closure after 23-gauge pars plana vitrectomy.A single-masked, randomized, prospective study was undertaken with 49 eyes of 49 patients undergoing 23-gauge pars plana vitrectomy randomized to sclerotomy closure with either plain gut suture, PG910 (Vicryl) suture or a combination of the two. Assessment was based on both a postoperative pain scale and a standardized assessment of scleral inflammation at each suture site.No wound leakage was noted postoperatively in any patient. Across all groups, scleral inflammation was significantly higher at the PG910 suture sites compared with the plain gut suture sites at both the 1-week (P = 0.04) and 1-month postoperative visits (P < 0.001). Patients with PG910 sutures reported greater pain at the 1-month postoperative visit than those with plain gut sutures (P = 0.018).This prospective study suggests improved tolerability and reduced inflammation using plain gut suture compared with an 8-0 PG910 suture to close 23-gauge sclerotomies.

  View details for DOI 10.1097/IAE.0000000000001684

  View details for PubMedID 28492428

• Deep learning applications in ophthalmology. Current opinion in ophthalmology Rahimy, E. 2018; 29 (3): 254-260

  Abstract

  To describe the emerging applications of deep learning in ophthalmology.Recent studies have shown that various deep learning models are capable of detecting and diagnosing various diseases afflicting the posterior segment of the eye with high accuracy. Most of the initial studies have centered around detection of referable diabetic retinopathy, age-related macular degeneration, and glaucoma.Deep learning has shown promising results in automated image analysis of fundus photographs and optical coherence tomography images. Additional testing and research is required to clinically validate this technology.

  View details for DOI 10.1097/ICU.0000000000000470

  View details for PubMedID 29528860

• A RANDOMIZED DOUBLE-BLIND PLACEBO-CONTROL PILOT STUDY OF EPLERENONE FOR THE TREATMENT OF CENTRAL SEROUS CHORIORETINOPATHY (ECSELSIOR). Retina (Philadelphia, Pa.) Rahimy, E., Pitcher, J. D., Hsu, J., Adam, M. K., Shahlaee, A., Samara, W. A., Vander, J. F., Kaiser, R. S., Chiang, A., Spirn, M. J., Fineman, M. S. 2018; 38 (5): 962-969

  Abstract

  To evaluate the safety and effects of oral eplerenone in chronic central serous chorioretinopathy.Prospective, randomized, double-blind, placebo-control study at a tertiary referral academic private practice. For a diagnosis of chronic central serous chorioretinopathy, patients must have had at least 3 months clinical follow-up demonstrating persistent symptoms, subfoveal fluid on spectral-domain optical coherence tomography, and <50% reduction in fluid thickness. Patients were randomized 2:1 (treatment:placebo) to receive eplerenone (25 mg daily for 1 week, then up to 50 mg daily for 8 weeks) or placebo once daily.Fifteen patients completed the study. Ten patients (15 eyes) were randomized into the eplerenone treatment arm, while the remaining 5 patients (6 eyes) received placebo. After 9 weeks of eplerenone therapy, mean logarithm of the minimal angle of resolution visual acuity improved from 0.394 (Snellen equivalent: 20/50) to 0.330 (20/43, P = 0.04). In the placebo group, the mean logarithm of the minimal angle of resolution visual acuity slightly decreased from 0.313 (20/41) to 0.342 (20/44) during the same period (P = 0.21). With respect to anatomic changes, mean maximal subretinal fluid height in the eplerenone group improved from 139.3 μm at baseline to 51.8 μm (P = 0.02), mean subfoveal fluid height improved from 121.4 μm to 29.4 μm (P = 0.01), and mean central subfield thickness improved from 366.2 μm to 283.7 μm (P = 0.02). In comparison with the placebo group, mean maximal subretinal fluid height worsened from 135.9 μm to 172.3 μm (P = 0.32), mean subfoveal fluid height worsened from 92.1 μm to 134.0 μm (P = 0.54), and mean central subfield thickness worsened from 345.0 μm to 380.0 μm (P = 0.37). No patients in either group experienced serious adverse events to result in treatment discontinuation.These findings suggest that oral eplerenone therapy is safe and potentially effective in the treatment of chronic central serous chorioretinopathy with persistent subretinal fluid.

  View details for DOI 10.1097/IAE.0000000000001649

  View details for PubMedID 28426624

• Outer Retinal Changes on Spectral-Domain Optical Coherence Tomography Pre- and Post-Silicone Oil Removal. Ophthalmic surgery, lasers & imaging retina Durrani, A. K., Rahimy, E., Hsu, J. 2017; 48 (12): 978-982

  Abstract

  To evaluate outer retinal changes present on spectral-domain optical coherence tomography (SD-OCT) in eyes pre- and post-silicone oil (SiO) removal (SOR).Retrospective case series of patients who underwent pars plana vitrectomy with SiO instillation and had SD-OCT completed pre- and post-SOR. SD-OCT parameters included presence of subretinal fluid, epiretinal membrane, ellipsoid zone disruption (EZD), external limiting membrane disruption, central subfield thickness (CST), and choroidal thickness. Visual acuities (VAs) and duration of SiO instillation were recorded.Thirty eyes of 30 patients were included. Mean Snellen VA pre- and post-SOR was 20/762 and 20/206, respectively (P < .001). Eyes with EZD under SiO had significantly longer duration of SiO tamponade (P = .029) along with worse VA post-SOR (P = .002). EZD was noted in 20 eyes with SiO and only 10 eyes post-SOR. Of these 10 eyes with resolution of EZD post-SOR, mean VA was significantly better (Snellen equivalent 20/133) compared to eyes with persistent EZD (Snellen equivalent 20/513; P = .01). CST and choroidal thickness decreased post-SOR (P = .117, P = .07).Outer retinal abnormalities on SD-OCT in SiO-filled eyes may improve in some patients following SOR. Some changes may be related to duration of SiO tamponade. EZD in SiO-filled eyes may portend a worse clinical outcome post-SOR despite surgical success. [Ophthalmic Surg Lasers Imaging Retina. 2017;48:978-982.].

  View details for DOI 10.3928/23258160-20171130-04

  View details for PubMedID 29253300

• Bilateral Retinal Whitening in a Hospitalized Patient. JAMA ophthalmology Ali, F. S., Rahimy, E. 2017; 135 (7): 809-810

  View details for DOI 10.1001/jamaophthalmol.2016.5474

  View details for PubMedID 28426841

• Ophthalmic Complications Associated with Direct Oral Anticoagulant Medications. Seminars in ophthalmology Shieh, W. S., Sridhar, J., Hong, B. K., Maguire, J. I., Rahimy, E., Shahlaee, A., Ho, A. C., Hsu, J., Regillo, C. D., Chiang, A. 2017; 32 (5): 614-619

  Abstract

  To describe the clinical features and management of six patients with ocular complications associated with direct oral anticoagulants (DOACs).The medical records of all adult patients known to be taking a DOAC and with an unusual bleeding event at a large tertiary referral center over a one-year period were reviewed. Patients with less than one-month follow-up were excluded. Data collection included relevant clinic notes, operative reports, surgical videos, and clinical images (fundus photography, optical coherence tomography, B-scan ultrasonography, and fluorescein angiography).Six eyes in six patients were identified with an unusual bleeding event associated with DOAC use. One patient was taking apixaban, two patients were taking dabigatran, and three patients were taking rivaroxaban. Two patients had large submacular hemorrhage (including one with vitreous hemorrhage breakthrough), three patients had vitreous hemorrhage, and one patient had recurrent hyphema. Presenting visual acuity ranged from 20/40 to light perception. Three individuals required therapeutic and/or diagnostic pars plana vitrectomy for vitreous hemorrhage. Final visual acuity ranged from 20/25 to count finger vision. The associated DOAC was permanently discontinued in two of the six cases. Follow-up was one to four months from onset of identified DOAC-related complication.DOAC use may be associated with ocular bleeding. Ophthalmologists should be aware of potential hemorrhagic complications and obtain consultation with primary providers regarding DOAC cessation guidelines.

  View details for DOI 10.3109/08820538.2016.1139738

  View details for PubMedID 27367495

• Endogenous methicillin-resistant Staphylococcus aureus endophthalmitis secondary to axillary phlegmon: a case report. Canadian journal of ophthalmology. Journal canadien d'ophtalmologie Kansal, V., Rahimy, E., Garg, S., Dollin, M. 2017; 52 (3): e97-e99

  View details for DOI 10.1016/j.jcjo.2016.11.016

  View details for PubMedID 28576230

• Anterior segment migration of dexamethasone implant: risk factors, complications, and management. Current opinion in ophthalmology Rahimy, E., Khurana, R. N. 2017; 28 (3): 246-251

  Abstract

  To describe the risk factors, clinical course, and complications related to anterior segment migration of a dexamethasone (DEX) intravitreal implant, and review over potential management strategies.Recent reports have demonstrated that migration of a DEX implant into the anterior chamber may occur in patients with higher risk ocular characteristics. Although a relatively rare occurrence, DEX implant migration carries the possibility of inducing potentially vision-threatening corneal endothelial decompensation and edema.Any combination of previous pars plana vitrectomy, an open/defective lens capsule, and/or iris defects may increase the risk of DEX implant migration into the anterior chamber. In the setting of a DEX implant that has moved into the anterior segment with corneal edema already present, urgent removal of the implant is warranted to reduce the risk of permanent visual compromise.

  View details for DOI 10.1097/ICU.0000000000000365

  View details for PubMedID 28376511

• Reply. American journal of ophthalmology Rayess, N., Ying, G. S., Pefkianaki, M., Franklin, J., Regillo, C. D., Ho, A. C., Hsu, J., Rahimy, E. 2017; 176: 258-259

  View details for DOI 10.1016/j.ajo.2017.01.022

  View details for PubMedID 28190510

• Preoperative and postoperative features of macular holes on en face imaging and optical coherence tomography angiography. American journal of ophthalmology case reports Shahlaee, A., Rahimy, E., Hsu, J., Gupta, O. P., Ho, A. C. 2017; 5: 20-25

  Abstract

  To characterize and quantify the pre- and postoperative foveal structural and functional patterns in full-thickness macular holes.Subjects presenting with a full-thickness macular hole that had pre- and postoperative imaging were included. En face optical coherence tomography (OCT) and OCT angiography (OCTA) was performed. Foveal avascular zone (FAZ) area, macular hole size, number and size of perifoveal cysts were measured.Five eyes from 5 patients were included in the study. The hole was closed in all eyes after the initial surgery. OCTA showed enlargement of the FAZ and delineation of the holes within the FAZ. Mean preoperative FAZ area was 0.41 ± 0.104 mm2. Visual acuity was improved and mean FAZ area was reduced to 0.27 ± 0.098 mm2 postoperatively (P < 0.05) with resolution of the macular hole and adjacent cystic areas. En face images of the middle retina showed a range of preoperative cystic patterns surrounding the hole. Smaller holes showed fewer but larger cystic areas and larger holes had more numerous but smaller cystic areas.Quantitative evaluation of vascular and cystic changes following macular hole repair demonstrates the potential for recovery due to neuronal and vascular plasticity. Perifoveal microstructural patterns and their quantitative characteristics may serve as useful anatomic biomarkers for assessment of macular holes.

  View details for DOI 10.1016/j.ajoc.2016.10.008

  View details for PubMedID 29503940

  View details for PubMedCentralID PMC5758006

• Usefulness of Structured Video Indirect Ophthalmoscope-Guided Education in Improving Resident Ophthalmologist Confidence and Ability. Ophthalmology. Retina Sridhar, J., Shahlaee, A., Mehta, S., Rahimy, E., Garg, S. J., Finklea, B. D., Dunn, J. P., Chiang, A. 2017; 1 (4): 282-287

  Abstract

  To evaluate the usefulness of the video indirect ophthalmoscope (VIO) to improve resident ophthalmologist skill with indirect ophthalmoscopy (IO) and scleral depression (SD).Prospective, randomized, double-arm interventional study.Ten ophthalmology residents were enrolled in an educational program using the Heine Video Omega 2C VIO (Heine USA Ltd, Dover, NH) and served as the study group. Ten other experience-matched ophthalmology residents functioned as the control group.At baseline, all study and control residents completed surveys assessing their subjective comfort and skill with IO. Each resident also completed a standardized full IO examination with SD that was recorded using the VIO. Each resident in the study group received 3 monthly 1-hour teaching sessions using the VIO. Surveys and recorded standardized examinations were repeated for all residents after the 3-month period. Both baseline and final examination videos were graded using a standardized grading scale by 3 independent retina faculty members masked to the identities of the residents and timing of the examination.Improved visualization of the peripheral retina (ora serrata) as evaluated by masked graders was the primary outcome measure. Improved examination efficiency grade was the secondary outcome measure.Both the study group and the control group had significant improvement in ability to examine the peripheral retina and ora serrata compared with baseline (P = 0.02 and P = 0.03, respectively). The study group also showed significantly improved examination efficiency compared with baseline, which was not noted in the control group (P = 0.01 and P = 0.53, respectively). The study group self-reported significantly improved confidence in the ability to identify retinal tears, whereas the control group did not (P = 0.003 and P = 0.08, respectively). Study group participants also reported significantly improved ability to recognize retinal holes (P = 0.003), subretinal fluid (P = 0.02), and vitreoretinal tufts (P = 0.02), whereas the control group did not.This novel educational study suggests that VIO as part of a structured teaching program may improve resident ophthalmologist confidence and ability with identifying retinal pathologic features using IO with SD.

  View details for DOI 10.1016/j.oret.2016.12.010

  View details for PubMedID 31047513

• Effect of oral niacin on central retinal vein occlusion. Graefe's archive for clinical and experimental ophthalmology = Albrecht von Graefes Archiv fur klinische und experimentelle Ophthalmologie Gaynon, M. W., Paulus, Y. M., Rahimy, E., Alexander, J. L., Mansour, S. E. 2017

  Abstract

  Niacin, a treatment for dyslipidemia, is known to induce vasodilation as a secondary effect. Previous instances of patients with chronic central retinal vein occlusion (CRVO) and cystoid macular edema (CME) have been observed to spontaneously improve when placed on systemic niacin for hypercholesterolemia. The purpose of this study was to evaluate the effects of niacin on CRVO and associated ocular complications.A prospective, single-center, non-randomized, interventional case series of niacin for CRVO was conducted. Best-correct visual acuity (BCVA), central macular thickness (CMT), and ocular complications were analyzed in 50 patients over 1 year. Eight patients were controls.The mean initial logMAR BCVA was 0.915, and improved with niacin to 0.745 (P = 0.12), 0.665 (P = 0.02) and 0.658 (P = 0.03) after 3, 6, and 12 months of follow-up, respectively. At baseline, mean CMT was 678.9 μm, and improved to 478.1 μm (P = 0.001), 388.6 μm (P < 0.001), and 317.4 μm (P < 0.001) for the same time points. The control group had a mean initial logMAR BCVA of 1.023, which gradually deteriorated to 1.162 (P = 0.36) after 12 months, and baseline CMT of 700.0 μm at baseline, which gradually improved to 490.9 μm (P = 0.06) after 12 months. Panretinal photocoagulation for neovascularization was required in 5 patients (13.2%) receiving niacin and 3 (37.5%) controls.These data suggest that niacin may be associated with functional and anatomic improvements in eyes with CRVO. Future investigations will help ascertain whether there is a role for niacin as an adjunct therapy to intravitreal injections in the management of CRVO.

  View details for DOI 10.1007/s00417-017-3606-0

  View details for PubMedID 28161829

• PARACENTRAL ACUTE MIDDLE MACULOPATHY ASSOCIATED WITH POSTVIRAL PURTSCHER-LIKE RETINOPATHY. Retinal cases & brief reports Shahlaee, A., Sridhar, J., Rahimy, E., Shieh, W. S., Ho, A. C. 2017; 13 (1): 50-53

  Abstract

  To report the imaging findings of a single case of paracentral acute middle maculopathy associated with bilateral Purtscher-like retinopathy in the setting of recent viral illness.Case report, multimodal imaging.A 21-year-old woman who awoke with sudden-onset bilateral finger count vision in the setting of a recent viral illness. Initial examination and imaging was consistent with a bilateral Purtscher-like retinopathy with evidence of paracentral acute middle maculopathy and ellipsoid zone thickening and hyperreflectivity on spectral domain optical coherence tomography (OCT). Baseline fluorescein angiography and OCT angiography revealed normal perfusion and flow, respectively. All laboratory investigation was negative for possible causative etiology. The patient was followed for 6 months with steady visual improvement to 20/20 in both eyes. En face OCT demonstrated near-complete restoration of the ellipsoid layer. The patient still noted bilateral scotomas which were mapped out on microperimetry and found to correlate to en face OCT findings.Purtscher-like retinopathy in the setting of recent viral illness is a rare cause of vision loss that may be associated with the finding of paracentral acute middle maculopathy on spectral domain OCT. Despite poor presenting vision, in the presence of normal perfusion near total visual recovery is possible.

  View details for DOI 10.1097/ICB.0000000000000529

  View details for PubMedID 28085762

• Significant Bilateral Response in Diabetic Macular Edema After Single Unilateral Intravitreal Aflibercept Injection. Ophthalmic surgery, lasers & imaging retina Rahimy, E., Nyong'o, O., Leng, T. 2017; 48 (2): 167-169

  Abstract

  A 61-year-old patient with bilateral, treatment-naïve, diffuse diabetic macular edema (DME) that had been progressing during the previous 12 months received a single intravitreal injection of aflibercept (Eylea; Regeneron, Tarrytown, NY) to the left eye. At 2-week follow-up, noticeable bilateral improvement of the DME was observed by spectral-domain optical coherence tomography imaging with commensurate improvement of visual acuity to 20/30 bilaterally. [Ophthalmic Surg Lasers Imaging Retina. 2017;48:167-169.].

  View details for DOI 10.3928/23258160-20170130-11

  View details for PubMedID 28195620

• Treat-and-Extend Regimen for Macular Edema Secondary to Central Retinal Vein Occlusion: 12-Month Results. Ophthalmology. Retina Rahimy, E., Rayess, N., Brady, C. J., Regillo, C. D. 2016; 1 (2): 118-123

  Abstract

  To determine treatment outcomes after 12 months of bevacizumab and ranibizumab therapy using a treat-and-extend regimen in patients with macular edema resulting from central retinal vein occlusion (CRVO).Retrospective, interventional, consecutive case series.Sixty eyes of 58 patients diagnosed with CRVO and associated macular edema between May 2010 and June 2014 were included. Eyes were treated with bevacizumab and/or ranibizumab for a minimum of 1 year, using a treat-and-extend regimen.Outcome measures were change from baseline visual acuity (VA), proportion of eyes gaining/losing ≥3 VA lines, change from baseline central retinal thickness (CRT), mean number of injections administered, and the longest treatment-free interval attained between injections.At baseline, mean logMAR VA was 1.18±0.71 (Snellen equivalent: 20/302), which improved to 0.85±0.71 (Snellen equivalent: 20/142) after 12 months of therapy (P = 0.018). During this period, 44.9% of eyes had gained ≥15 letters, while 10.2% had lost ≥15 letters. The mean CRT improved from 564.7±219.3 μm at baseline to 302.8±115.8 μm at 12-month follow-up (P < 0.001). Patients received, on average, 8.1 injections during the first year of treatment, and the mean longest duration of successful extension between injections during year 1 was 9.3±4.4 weeks. Multivariable analyses revealed that change in CRT over the first 3 months of therapy was significantly associated with the ability to extend injection intervals to at least 8 weeks' duration (P < 0.05).The treat-and-extend regimen is effective in achieving visual and anatomic improvements in patients with macular edema secondary to CRVO through the first year of therapy. Change in CRT during the first 3 months of treatment may help predict which patients will respond more favorably to an extension phase at or beyond 8 weeks.

  View details for DOI 10.1016/j.oret.2016.10.014

  View details for PubMedID 31047268

• Baseline Choroidal Thickness as a Predictor for Treatment Outcomes in Central Retinal Vein Occlusion. American journal of ophthalmology Rayess, N., Rahimy, E., Ying, G. S., Pefkianaki, M., Franklin, J., Regillo, C. D., Ho, A. C., Hsu, J. 2016; 171: 47-52

  Abstract

  To evaluate the association between initial subfoveal choroidal thickness and response to anti-vascular endothelial growth factor (anti-VEGF) therapy in central retinal vein occlusion (CRVO) eyes.Retrospective cohort study.Forty-three eyes from 42 patients with treatment-naïve CRVO were included. All patients included were treated with a standard algorithm of 3 monthly anti-VEGF injections. Serial enhanced depth imaging optical coherence tomography scans were used to measure subfoveal choroidal thickness and central macular thickness (CMT). Baseline predictors (particularly choroidal thickness) for functional response (best-corrected visual acuity gain ≥2 lines) were assessed at 3 months follow-up using univariate and multivariate analyses.Forty-three eyes from 42 patients were included. Initial choroidal thickness in CRVO eyes (246 ± 102 μm) was greater than in their fellow eye (197 ± 86 μm; P = .023). In addition, mean choroidal thickness at baseline for functional responders (272.2 ± 107.3 μm) was greater than that of nonresponders (209.6 ± 85.8 μm; P = .039). A higher baseline choroidal thickness (for every 100-μm increase in choroidal thickness) was found to be a positive predictor for functional response (regression coefficient: 0.7; P = .04) on univariate analysis, whereas age (<70 years old) was the only positive predictor for functional response with an odds ratio of 6.49 (95% confidence interval: 1.11-38.1; P = .03) on multivariate regression analysis.Baseline choroidal thickness and age may help predict which patients with CRVO have favorable visual outcomes following short-term anti-VEGF therapy.

  View details for DOI 10.1016/j.ajo.2016.08.026

  View details for PubMedID 27567889

• PARACENTRAL ACUTE MIDDLE MACULOPATHY ASSOCIATED WITH RETINAL ARTERY OCCLUSION AFTER COSMETIC FILLER INJECTION. Retinal cases & brief reports Sridhar, J., Shahlaee, A., Shieh, W. S., Rahimy, E. 2016; 11 Suppl 1: S216-S218

  Abstract

  To report a single case of paracentral acute middle maculopathy in association with retinal artery occlusion in the setting of ipsilateral facial cosmetic filler injection.Case report.A 35-year-old woman presenting with sudden vision loss to finger count vision immediately after left nasal fat pad cosmetic filler injection.Dilated funduscopic examination revealed a swollen optic disc with multiple branch arterial occlusions with visible embolic material. Fluorescein angiography confirmed multiple branch arterial occlusions in addition to a focal choroidal infarction in the macula. Spectral-domain optical coherence tomography revealed middle retinal hyperreflectivity in the superotemporal macula consistent with paracentral acute middle maculopathy. En face optical coherence tomography demonstrated a superotemporal area of whitening at the level of the deep capillary plexus corresponding to the paracentral acute middle maculopathy lesion seen on spectral-domain optical coherence tomography. On twelve-month follow-up, final visual acuity was 20/100 due to optic neuropathy.Emboli from cosmetic facial filler injections may rarely result in ipsilateral arterial occlusions and now have a novel association with paracentral acute middle maculopathy likely due to deep capillary plexus feeder vessel occlusion.

  View details for DOI 10.1097/ICB.0000000000000466

  View details for PubMedID 27763945

• Acute macular neuroretinopathy: A comprehensive review of the literature SURVEY OF OPHTHALMOLOGY Bhavsar, K. V., Lin, S., Rahimy, E., Joseph, A., Freund, K. B., Sarraf, D., Cunningham, E. T. 2016; 61 (5): 538-565

  Abstract

  Acute macular neuroretinopathy is a relatively rare condition originally defined by the presence of intraretinal, reddish-brown, wedge-shaped lesions, the apices of which tend to point toward the fovea. Acute onset of paracentral scotomas corresponding to the clinically evident lesions is both common and characteristic. Although the pathogenesis of acute macular neuroretinopathy is complex, recent research suggests a microvascular etiology. Advances in multimodal imaging have enabled better characterization of this retinal disorder and have led to newly proposed diagnostic criteria. We review 101 reported cases in the English and non-English language literature identified from 1975, when acute macular neuroretinopathy was first described, to December, 2014. We discuss common risk factors, demographic and clinical characteristics, and multimodal imaging findings, which together provide insights into pathogenesis and guide areas of future investigation.

  View details for DOI 10.1016/j.survophthal.2016.03.003

  View details for Web of Science ID 000383217000002

  View details for PubMedID 26973287

• Early Optical Coherence Tomography Findings after Vitreomacular Traction Release. Ophthalmology Rahimy, E., Shahlaee, A., Ehmann, D., Rayess, N., Fineman, M. S., Garg, S. J., Ho, A. C., Hsu, J. 2016; 123 (9): 2046-7

  View details for DOI 10.1016/j.ophtha.2016.04.045

  View details for PubMedID 27338012

• Combined 27-Gauge Pars Plana Vitrectomy and Scleral Fixation of an Akreos AO60 Intraocular Lens Using Gore-Tex Suture. Retina (Philadelphia, Pa.) Khan, M. A., Rahimy, E., Gupta, O. P., Hsu, J. 2016; 36 (8): 1602-4

  View details for DOI 10.1097/IAE.0000000000001147

  View details for PubMedID 27388733

• Incidence and clinical features of post-injection endophthalmitis according to diagnosis. The British journal of ophthalmology Rayess, N., Rahimy, E., Shah, C. P., Wolfe, J. D., Chen, E., DeCroos, F. C., Storey, P., Garg, S. J., Hsu, J. 2016; 100 (8): 1058-61

  Abstract

  To compare the incidence and clinical features of endophthalmitis after intravitreal antivascular endothelial growth factor (VEGF) therapy for diabetic eye disease, neovascular age-related macular degeneration (AMD) and retinal vein occlusion (RVO).Multicentre, retrospective, consecutive case-control study. All patients treated with intravitreal bevacizumab, ranibizumab or aflibercept for diabetic eye disease, neovascular AMD or RVO between 1 January 2009 and 30 September 2013 at three retina practices were included in this study. The total number of anti-VEGF injections administered for the three indications was calculated using billing records. Endophthalmitis cases were identified using both endophthalmitis log sheets and billing records. Patient charts were reviewed to confirm that endophthalmitis was directly related to anti-VEGF injection and to record clinical features and culture results.During the study period, a total of 353 978 intravitreal anti-VEGF injections were performed. Presumed infectious endophthalmitis occurred in 119 of 296 017 injections performed for neovascular AMD (1/2487, 0.040%), 12 of 24 541 for diabetic eye disease (1/2045, 0.049%) and 4 of 32 418 for RVO (1/8104, 0.012%). χ(2) analysis found endophthalmitis rates to be higher in diabetic eye disease compared with RVO (p=0.010) and higher in neovascular AMD compared with RVO (p=0.014), while diabetic eye disease and neovascular AMD (p=0.517) had similar rates. The average age of the overall neovascular AMD patient population (81.9 years) was significantly older than the diabetic eye disease (64.7 years, p<0.001) and RVO (73.4 years, p<0.001) populations.Endophthalmitis rates appear to be lower in eyes with RVO compared with diabetic eye disease and neovascular AMD, possibly due to impaired immunity in diabetics and waning immunity in the generally older AMD population.

  View details for DOI 10.1136/bjophthalmol-2015-307707

  View details for PubMedID 26584579

• Reply. American journal of ophthalmology Rahimy, E., Shahlaee, A., Khan, M. A., Ying, G. S., Maguire, J. I., Ho, A. C., Regillo, C. D., Hsu, J. 2016; 168: 291-292

  View details for DOI 10.1016/j.ajo.2016.05.014

  View details for PubMedID 27270363

• Potentially Reversible Effect of Niacin Therapy on Edema From Retinal Vein Occlusion JAMA OPHTHALMOLOGY Rahimy, E., Gaynon, M. W., Paulus, Y. M., Alexander, J. L., Mansour, S. E. 2016; 134 (7): 839-840

  View details for DOI 10.1001/jamaophthalmol.2016.1028

  View details for PubMedID 27227881

• Optical Coherence Tomography Angiography of Combined Hamartoma of the Retina and Retinal Pigment Epithelium. Retina (Philadelphia, Pa.) Sridhar, J., Shahlaee, A., Rahimy, E., Hong, B., Shields, C. L. 2016; 36 (7): e60-2

  View details for DOI 10.1097/IAE.0000000000000976

  View details for PubMedID 26825528

• Bilateral Optic Nerve Coloboma and Macular Schisis in Papillorenal Syndrome OPHTHALMOLOGY Rahimy, E., Rahimy, E. 2016; 123 (5): 990

  View details for DOI 10.1016/j.ophtha.2016.02.039

  View details for Web of Science ID 000375942300017

  View details for PubMedID 27107352

• TREATMENT OUTCOMES FOR NEOVASCULAR AGE-RELATED MACULAR DEGENERATION PATIENTS WITH INITIAL VISION BETTER THAN 20/40 USING A TREAT-AND-EXTEND REGIMEN. Retina (Philadelphia, Pa.) Rahimy, E., Rayess, N., Ho, A. C., Regillo, C. D. 2016; 36 (5): 875-80

  Abstract

  To determine treatment outcomes in eyes with neovascular age-related macular degeneration having visual acuity better than 20/40 after 1 years to 2 years of ranibizumab or bevacizumab therapy using a treat-and-extend regimen.Retrospective observational case series. Clinical records were reviewed from patients with treatment-naive neovascular age-related macular degeneration and baseline best-corrected Snellen visual acuity >20/40 treated with intravitreal ranibizumab or bevacizumab for a minimum of 1 year using a treat-and-extend regimen. The primary outcome measures were change from initial visual acuity, proportion of eyes losing <3 best-corrected visual acuity lines, proportion of eyes maintaining visual acuity ≥20/40, change from baseline central retinal thickness, and mean number of injections after 1 years and 2 years of follow-up.A total of 42 eyes from 40 patients were included. The mean follow-up period was 1.44 years. The mean initial logMAR visual acuity was 0.226, and remained stable at 0.257 and 0.267 after 1 years and 2 years of follow-up, respectively. At baseline, mean central retinal thickness was 305.8 μm, improved to 272.6 μm after 1 year of treatment (P < 0.001), and remained stable at 266.2 μm (P = 0.015) after 2 years. At 1-year follow-up period, 94.4% of eyes had lost less than 3 Snellen lines, and 94.1% of eyes lost less than 3 Snellen lines after 2 years. The percentage of eyes maintaining visual acuity ≥20/40 was 81% and 75% after each year. Eyes received on average 7.8 injections during the first year of treatment and 6.1 injections over the second year.Eyes with neovascular age-related macular degeneration presenting with initial visual acuity better than 20/40 on average maintained vision, lost less than 3 lines of acuity, and achieved anatomical improvements using a treat-and-extend regimen over a 2-year period.

  View details for DOI 10.1097/IAE.0000000000000814

  View details for PubMedID 26630316

• Postinjection Endophthalmitis Rates and Characteristics Following Intravitreal Bevacizumab, Ranibizumab, and Aflibercept. American journal of ophthalmology Rayess, N., Rahimy, E., Storey, P., Shah, C. P., Wolfe, J. D., Chen, E., DeCroos, F. C., Garg, S. J., Hsu, J. 2016; 165: 88-93

  Abstract

  To compare the incidence and clinical outcomes of endophthalmitis following intravitreal injections of bevacizumab, ranibizumab, and aflibercept.Multicenter, retrospective cohort study.All included patients had received intravitreal injections of bevacizumab, ranibizumab, or aflibercept between January 1, 2009 and September 30, 2013 at 5 retina practices. Billing records were used to identify the total number of anti-vascular endothelial growth factor (VEGF) injections administered. Patients who developed endophthalmitis were ascertained from endophthalmitis logs and billing records. Chart review of these patients was performed to confirm that the endophthalmitis was related to the antecedent anti-VEGF injection. Visual outcomes, causative organisms, and clinical course were also recorded.A total of 503 890 anti-VEGF injections were included, from which 183 cases of presumed endophthalmitis were identified. The rate of endophthalmitis for bevacizumab was 0.039% (60/153 812), which was similar to ranibizumab 0.035% (109/309 722; P = .522) and aflibercept 0.035% (14/40 356; P = .693). Similarly, there was no difference in the rates between ranibizumab and aflibercept (P = .960). The culture-positive rate of the vitreous/aqueous tap was 38% for both bevacizumab and ranibizumab and was 43% for aflibercept. Furthermore, visual acuity remained decreased at 3 months follow-up for bevacizumab (P = .005), ranibizumab (P < .001), and aflibercept (P = .07) compared to vision at causative injection.Endophthalmitis following intravitreal bevacizumab, ranibizumab, and aflibercept injection appears to occur at similar rates and have comparable visual outcomes. This study suggests that the choice of anti-VEGF agent should be primarily based on efficacy and patient response rather than concern for risk of infection.

  View details for DOI 10.1016/j.ajo.2016.02.028

  View details for PubMedID 26944277

• Conversion to Aflibercept After Prior Anti-VEGF Therapy for Persistent Diabetic Macular Edema. American journal of ophthalmology Rahimy, E., Shahlaee, A., Khan, M. A., Ying, G. S., Maguire, J. I., Ho, A. C., Regillo, C. D., Hsu, J. 2016; 164: 118-27.e2

  Abstract

  To evaluate the short-term functional and anatomic outcomes of patients with persistent diabetic macular edema (DME) who were converted from bevacizumab and/or ranibizumab to aflibercept.Retrospective, interventional, noncomparative, consecutive case series.Only eyes treated with at least 4 consecutive injections of ranibizumab/bevacizumab spaced 4-6 weeks apart prior to conversion and with at least 2 aflibercept injections afterward were considered for inclusion. Pertinent patient demographic, examination, and treatment data were extracted from clinical charts and tabulated for analysis.Fifty eyes of 37 patients were included. Eyes received a mean of 13.7 bevacizumab/ranibizumab injections prior to conversion, followed by 4.1 aflibercept injections over 4.6 months of subsequent follow-up. The mean logMAR visual acuity at the pre-switch visit was 0.60 ± 0.43 (Snellen equivalent, 20/80). This improved to 0.55 ± 0.48 (Snellen equivalent, 20/70) by the second visit after conversion, corresponding to a mean logMAR change of -0.05 ± 0.22 (P = .12). The average central macular thickness from the pre-switch spectral-domain optical coherence tomography scan was 459.2 ± 139.2 μm. This significantly improved to 348.7 ± 107.8 μm by the second visit following conversion, reflecting a mean decrease of 112 ± 141 μm (P < .0001). The mean intraocular pressure (IOP) recorded at the pre-switch visit was 15.1 ± 3.3 mm Hg. At the second follow-up after converting to aflibercept, the IOP averaged 14.9 ± 3.2 mm Hg, with a mean decrease of 0.2 ± 3.0 mm Hg (P = .63).Conversion to aflibercept for persistent DME resulted in significant anatomic improvements. While trends towards improved visual acuity and reduction in IOP were observed, these were not statistically significant.

  View details for DOI 10.1016/j.ajo.2015.12.030

  View details for PubMedID 26748058

• Radial versus raster spectral-domain optical coherence tomography scan patterns for detection of macular fluid in neovascular age-related macular degeneration. The British journal of ophthalmology Adam, M. K., Rayess, N., Rahimy, E., Maguire, J. I., Hsu, J. 2016; 100 (4): 491-4

  Abstract

  To compare the 12-line radial to the 25-line raster spectral-domain optical coherence tomography (SD-OCT) acquisition patterns at detecting intraretinal or subretinal fluid in eyes with neovascular age-related macular degeneration (AMD).Retrospective cross-sectional analysis of 200 eyes with neovascular AMD. Sequential 12-line radial and 25-line raster scans were evaluated for the presence of intraretinal/subretinal fluid.A total of 394 SD-OCT scans were interpreted (1.97 scans per eye). The 12-line radial detected intraretinal/subretinal fluid in all but 7 of 394 scans (1.7%; 95% CI 0.7% to 3.6%), resulting in a sensitivity of 98.3%. The 25-line raster detected intraretinal/subretinal fluid in all but 10 of 394 scans (2.5%; 95% CI 1.2% to 4.6%), resulting in a sensitivity of 97.5%. This small difference in fluid detection between the two acquisition patterns for neovascular AMD was not found to be statistically significant (p=0.6276).The 12-line radial scan is statistically comparable with the 25-line raster scan in detecting the presence of intraretinal/subretinal fluid in neovascular AMD. The 12-line radial SD-OCT pattern alone may be adequate to guide day-to-day clinical decisions in a more time-efficient manner.

  View details for DOI 10.1136/bjophthalmol-2014-306561

  View details for PubMedID 26261232

• IMPACT OF INTERNAL LIMITING MEMBRANE PEELING ON MACULAR HOLE REOPENING: A Systematic Review and Meta-Analysis. Retina (Philadelphia, Pa.) Rahimy, E., McCannel, C. A. 2016; 36 (4): 679-87

  Abstract

  To assess the literature regarding macular hole reopening rates stratified by whether the internal limiting membrane (ILM) was peeled during vitrectomy surgery.Systematic review and meta-analysis of studies reporting on macular hole reopenings among previously surgically closed idiopathic macular holes. A comprehensive literature search using the National Library of Medicine PubMed interface was used to identify potentially eligible publications in English. The minimum mean follow-up period for reports to be included in this study was 12 months. Analysis was divided into eyes that underwent vitrectomy with and without ILM peeling. The primary outcome parameter was the proportion of macular hole reopenings among previously closed holes between the two groups. Secondary outcome parameters included duration from initial surgery to hole reopening and preoperative and postoperative best-corrected correct visual acuities among the non-ILM peeling and ILM peeling groups.A total of 50 publications reporting on 5,480 eyes met inclusion criteria and were assessed in this meta-analysis. The reopening rate without ILM peeling was 7.12% (125 of 1,756 eyes), compared with 1.18% (44 of 3,724 eyes) with ILM peeling (odds ratio: 0.16; 95% confidence interval: 0.11-0.22; Fisher's exact test: P < 0.0001). There were no other identifiable associations or risk factors for reopening.The results of this meta-analysis support the concept that ILM peeling during macular hole surgery reduces the likelihood of macular hole reopening.

  View details for DOI 10.1097/IAE.0000000000000782

  View details for PubMedID 26441264

• Giraffe Pattern of Bilateral Diffuse Uveal Melanocytic Proliferation. Ophthalmology Rahimy, E., Soheilian, M. 2016; 123 (3): 483

  View details for DOI 10.1016/j.ophtha.2015.12.015

  View details for PubMedID 26902560

• Corticosteroid implants for chronic non-infectious uveitis. The Cochrane database of systematic reviews Brady, C. J., Villanti, A. C., Law, H. A., Rahimy, E., Reddy, R., Sieving, P. C., Garg, S. J., Tang, J. 2016; 2: CD010469

  Abstract

  Uveitis is a term used to describe a heterogeneous group of intraocular inflammatory diseases of the anterior, intermediate, and posterior uveal tract (iris, ciliary body, choroid). Uveitis is the fifth most common cause of vision loss in high-income countries, accounting for 5% to 20% of legal blindness, with the highest incidence of disease in the working-age population.Corticosteroids are the mainstay of acute treatment for all anatomical subtypes of non-infectious uveitis and can be administered orally, topically with drops or ointments, by periocular (around the eye) or intravitreal (inside the eye) injection, or by surgical implantation.To determine the efficacy and safety of steroid implants in people with chronic non-infectious posterior uveitis, intermediate uveitis, and panuveitis.We searched CENTRAL (which contains the Cochrane Eyes and Vision Trials Register) (Issue 10, 2015), Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid MEDLINE Daily, Ovid OLDMEDLINE (January 1946 to November 2015), EMBASE (January 1980 to November 2015), PubMed (1948 to November 2015), Latin American and Caribbean Health Sciences Literature Database (LILACS) (1982 to November 2015), the metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com) (last searched 15 April 2013), ClinicalTrials.gov (www.clinicaltrials.gov), and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). We did not use any date or language restrictions in the electronic search for studies. We last searched the electronic databases on 6 November 2015.We also searched reference lists of included study reports, citation databases, and abstracts and clinical study presentations from professional meetings.We included randomized controlled trials comparing either fluocinolone acetonide (FA) or dexamethasone intravitreal implants with standard-of-care therapy with at least six months of follow-up after treatment. We included studies that enrolled participants of all ages who had chronic non-infectious posterior uveitis, intermediate uveitis, or panuveitis with vision that was better than hand-motion.Two review authors independently reviewed studies for inclusion. Two review authors independently extracted data and assessed the risk of bias for each study.We included data from two studies (619 eyes of 401 participants) that compared FA implants with standard-of-care therapy. Both studies used similar standard-of-care therapy that included administration of prednisolone and, if needed, immunosuppressive agents. The studies included participants from Australia, France, Germany, Israel, Italy, Portugal, Saudi Arabia, Spain, Switzerland, Turkey, the United Kingdom, and the United States. We assessed both studies at high risk of performance and detection bias.Only one study reported our primary outcome, recurrence of uveitis at any point during the study through 24 months. The evidence, judged as moderate-quality, showed that a FA implant probably prevents recurrence of uveitis compared with standard-of-care therapy (risk ratio (RR) 0.29, 95% confidence interval (CI) 0.14 to 0.59; 132 eyes). Both studies reported safety outcomes, and moderate-quality evidence showed increased risks of needing cataract surgery (RR 2.98, 95% CI 2.33 to 3.79; 371 eyes) and surgery to lower intraocular pressure (RR 7.48, 95% CI 3.94 to 14.19; 599 eyes) in the implant group compared with standard-of-care therapy through two years of follow-up. No studies compared dexamethasone implants with standard-of-care therapy.After considering both benefits and harms reported from two studies in which corticosteroids implants were compared with standard-of-care therapy, we are unable to conclude that the implants are superior to traditional systemic therapy for the treatment of non-infectious uveitis. These studies exhibited heterogeneity in design and outcomes that measured efficacy. Pooled findings regarding safety outcomes suggest increased risks of post-implant surgery for cataract and high intraocular pressure compared with standard-of-care therapy.

  View details for DOI 10.1002/14651858.CD010469.pub2

  View details for PubMedID 26866343

  View details for PubMedCentralID PMC5038923

• RUPTURED RETINAL ARTERIAL MACROANEURYSM ON THE OPTIC DISK. Retinal cases & brief reports Rahimy, E., Doyle, B. C., Brown, G. C. 2016; 11 (1): 12-14

  Abstract

  To describe multimodal imaging findings in a patient presenting with an occult optic disk macroaneurysm.A 54-year-old woman presented with decreased vision in the right eye secondary to preretinal, intraretinal, and optic disk hemorrhage.Ancillary fluorescein angiography revealed evidence of an occult optic disk macroaneurysm that was not realized on fundoscopic examination. Subsequent optical coherence tomography obtained once the hemorrhage resolved demonstrated a thrombosed macroaneurysm with an adjacent ring of exudate.Detection of optic disk macroaneurysms at the time of initial presentation can be difficult because of concurrent overlying hemorrhage, but should nevertheless be kept in the differential when macular hemorrhage in multiple retinal layers is observed.

  View details for DOI 10.1097/ICB.0000000000000275

  View details for PubMedID 26829446

• En Face Optical Coherence Tomography and Optical Coherence Tomography Angiography Imaging of Taxane-Associated Cystoid Macular Edema. Ophthalmic surgery, lasers & imaging retina Sridhar, J., Shahlaee, A., Ehmann, D., Samara, W. A., Rahimy, E., Ho, A. C., Chiang, A. 2016; 47 (2): 176-9

  Abstract

  The taxanes are chemotherapeutic agents that may, in rare cases, cause cystoid macular edema without leakage on fluorescein angiography. Two patients with evidence of taxane-related macular edema presented and were evaluated using novel en face optical coherence tomography (OCT) and OCT angiography (OCTA) imaging modalities. Although OCTA revealed no flow abnormalities in either patient, en face OCT revealed a striking bilateral symmetric cystic tessellation pattern.

  View details for DOI 10.3928/23258160-20160126-12

  View details for PubMedID 26878452

• Assessing Deep Retinal Capillary Ischemia in Paracentral Acute Middle Maculopathy by Optical Coherence Tomography Angiography. American journal of ophthalmology Nemiroff, J., Kuehlewein, L., Rahimy, E., Tsui, I., Doshi, R., Gaudric, A., Gorin, M. B., Sadda, S., Sarraf, D. 2016; 162: 121-132.e1

  Abstract

  To assess microvascular blood flow of the deep retinal capillary plexus in eyes with paracentral acute middle maculopathy using optical coherence tomography (OCT) angiography.Retrospective, multicenter observational case series.Clinical and multimodal imaging findings from 8 patients with paracentral acute middle maculopathy were reviewed and analyzed. OCT angiography scans were analyzed and processed, and vessel density was calculated.Eight patients (7 male, 1 female, aged 9-82 years) were included. OCT angiography was obtained at either the acute (4 cases) or old stage (4 cases). Scans of the deep capillary plexus showed preservation of perfusion in acute lesions and capillary attenuation in old cases. Cases of central retinal artery occlusion showed marked loss of the deep capillary plexus. The mean vessel density of the superficial capillary plexus in normal fellow eyes was 12.8 ± 1.8 mm(-1) vs 12.1 ± 1.9 mm(-1) in eyes with paracentral acute middle maculopathy (reduction -6.0%, P = .08). The mean vessel density of the deep capillary plexus in normal fellow eyes was 17.5 ± 1.4 mm(-1) vs 14.7 ± 3.5 mm(-1) in eyes with paracentral acute middle maculopathy (reduction -19.4%, P = .04). This significant difference was representative of the eyes with old lesions.Paracentral acute middle maculopathy lesions correspond to preservation of perfusion in focal acute lesions and to pruning of the plexus in old cases. Cases of central retinal artery occlusion demonstrate marked hypoperfusion of the deep capillary plexus. Our study further supports an ischemic pathogenesis of this retinal vasculopathy.

  View details for DOI 10.1016/j.ajo.2015.10.026

  View details for PubMedID 26562176

• Optical Coherence Tomography Angiography and En Face Optical Coherence Tomography Features of Paracentral Acute Middle Maculopathy. American journal of ophthalmology Sridhar, J., Shahlaee, A., Rahimy, E., Hong, B. K., Khan, M. A., Maguire, J. I., Dunn, J. P., Mehta, S., Ho, A. C. 2015; 160 (6): 1259-1268.e2

  Abstract

  To characterize the optical coherence tomography (OCT) angiography, en face OCT, and microperimetry features of paracentral acute middle maculopathy in both the acute phase and after resolution, and to propose a classification of distinct subtypes of this entity.Retrospective observational case series.Clinical histories, high-resolution digital color imaging, spectral-domain OCT images, fluorescein angiography, OCT angiography images, and en face OCT images of 16 patients with paracentral acute middle maculopathy were evaluated. Microperimetry was available in 6 patients.The most common referring diagnoses were isolated branch retinal arterial occlusion (5/16), combined central retinal vein and cilioretinal artery occlusion (4/16), and isolated central retinal vein occlusion (4/16). All patients demonstrated hyperreflective plaque-like lesions at the level of the inner nuclear layer on spectral-domain OCT, with no fluorescein angiographic correlate. OCT angiography demonstrated variable areas of capillary dropout within the superficial and deep retinal capillary plexi in these areas. En face OCT highlighted confluent areas of middle retina hyperreflectivity corresponding to these lesions. Three distinct en face OCT patterns were observed: arteriolar, fern-like, and globular. Microperimetry demonstrated relative scotomas mapping to the area of middle retinal hyperreflectivity seen on en face OCT.Paracentral acute middle maculopathy may be best evaluated with the use of en face OCT imaging, which corresponds to subjective and objective visual field defects. En face OCT appearance may be used to classify paracentral acute maculopathy into distinct subtypes.

  View details for DOI 10.1016/j.ajo.2015.09.016

  View details for PubMedID 26386158

• Enhanced Depth Imaging Optical Coherence Tomography of Endogenous Fungal Chorioretinitis. JAMA ophthalmology Adam, M. K., Rahimy, E. 2015; 133 (11): e151931

  View details for DOI 10.1001/jamaophthalmol.2015.1931

  View details for PubMedID 26562514

• No-Touch Removal of Anterior Segment-Migrated Dexamethasone Implant. Retina (Philadelphia, Pa.) Rahimy, E., Pitcher, J. D., Abbey, A. M., Garretson, B. R., Haller, J. A. 2015; 35 (11): 2414-6

  View details for DOI 10.1097/IAE.0000000000000753

  View details for PubMedID 26405769

• En Face Optical Coherence Tomography Imaging of Deep Capillary Plexus Abnormalities in Paracentral Acute Middle Maculopathy. Ophthalmic surgery, lasers & imaging retina Khan, M. A., Rahimy, E., Shahlaee, A., Hsu, J., Ho, A. C. 2015; 46 (9): 972-5

  Abstract

  The authors describe a case of para-central acute middle maculopathy (PAMM) in a 75-year-old man who had recently undergone cardiac catheterization. Imaging with simultaneous en face optical coherence tomography (OCT) and OCT angiography (OCTA) revealed signal abnormalities localized to the deep capillary plexus. This case highlights the ability of OCTA to image and localize retinal disease by vascular distribution, previously difficult with conventional fluorescein angiography, and lends evidence to the belief that PAMM is caused by vascular injury to the intermediate and deep capillary plexus.

  View details for DOI 10.3928/23258160-20151008-12

  View details for PubMedID 26469239

• Paracentral Acute Middle Maculopathy: What We Knew Then and What We Know Now. Retina (Philadelphia, Pa.) Rahimy, E., Kuehlewein, L., Sadda, S. R., Sarraf, D. 2015; 35 (10): 1921-30

  View details for DOI 10.1097/IAE.0000000000000785

  View details for PubMedID 26360227

• Video Recording of Vitreous Tap and Intravitreal Antibiotic Injection From the Surgeon's Perspective. Retina (Philadelphia, Pa.) Calvo, C. M., Sridhar, J., Hong, B. K., Rahimy, E., Hsu, J., Garg, S. J. 2015; 35 (10): 2147-9

  View details for DOI 10.1097/IAE.0000000000000719

  View details for PubMedID 26398554

• Acute Macular Neuroretinopathy Following Non-Ocular Trauma: A Hypothesis Regarding Pathophysiologic Mechanism. Ophthalmic surgery, lasers & imaging retina Chinskey, N. D., Rahimy, E., Johnson, M. W. 2015; 46 (10): 1013-20

  Abstract

  To describe the imaging characteristics and clinical course of acute macular neuroretinopathy (AMN) following non-ocular trauma, and to hypothesize a pathophysiologic mechanism for this syndrome.The records of five patients who developed symptoms and findings suggestive of AMN following trauma to the face or chest were retrospectively reviewed. Optical coherence tomography (OCT), infrared reflectance, fundus autofluorescence, fluorescein and indocyanine green angiography, and multifocal electroretinography were evaluated.Visual symptoms started immediately or very soon after non-ocular trauma, and scotomas persisted at last follow-up (2 weeks to 10 years after trauma). OCT imaging performed within days of the trauma demonstrated focal areas of hyper-reflectivity in the outer plexiform and outer nuclear layers with eventual thinning of the outer nuclear layer, as well as variable loss of the ellipsoid and interdigitation zones.Acute ischemic injury caused by trauma-induced hypotension and/or catecholamine release and involving the deep retinal capillary plexus is the pathogenic mechanism that most plausibly explains trauma-associated AMN.

  View details for DOI 10.3928/23258160-20151027-05

  View details for PubMedID 26599243

• Management of Symptomatic Floaters: Current Attitudes, Beliefs, and Practices Among Vitreoretinal Surgeons. Ophthalmic surgery, lasers & imaging retina Cohen, M. N., Rahimy, E., Ho, A. C., Garg, S. J. 2015; 46 (8): 859-65

  Abstract

  To assess the current attitudes, beliefs, and practice patterns among vitreoretinal surgeons when dealing with symptomatic floaters in patients with otherwise healthy eyes.A cross-sectional, Internet-based anonymous survey of 10 questions was distributed via email to vitreoretinal specialists practicing in the United States.The survey response rate was 6.1% (159 of 2,600). Forty of 159 respondents (25%) reported they would perform pars plana vitrectomy (PPV) to reduce symptomatic floaters, and 110 of 159 (69%) had previously performed PPV for this indication. When compared to those unlikely to intervene for symptomatic floaters, 33 of 40 (83%) of those likely to intervene performed more than 100 vitrectomy surgical cases annually (P<.05). Between those that had and had not performed PPV for symptomatic floaters in the past, statistically significant differences were observed regarding the likelihood to perform PPV for symptomatic floaters in the future (35% vs. 4%; P<.0001) and tendency to elect a procedure if the surgeon's own vision were impacted by symptomatic floaters (55% vs. 8%; P<.001). When compared to those likely to perform surgery for symptomatic floaters, those unlikely to intervene identified three statistically significant barriers: the surgical risks involved with PPV (28% vs. 86%; P<.001), unrealistic patient expectations (25% vs 58%; P<.001), and the possibility of ridicule from the local retina community (10% vs. 32%; P<.01).Vitreoretinal specialists are more likely to intervene for symptomatic floaters if they have previously done so and if they perform more than 100 surgical cases per year. The major barriers preventing physicians from performing an intervention for floaters are standard risks associated with PPV, the fear of unreasonable patient expectations, and the possibility of ridicule within the local retina community.

  View details for DOI 10.3928/23258160-20150909-11

  View details for PubMedID 26431302

• Spectral-Domain Optical Coherence Tomography in Acute Posterior Vitreous Detachment. Ophthalmology Rayess, N., Rahimy, E., Vander, J. F., Spirn, M. J., Chiang, A., Garg, S. J., Hsu, J. 2015; 122 (9): 1946-7

  View details for DOI 10.1016/j.ophtha.2015.03.030

  View details for PubMedID 25935788

• Bilateral Acute-Onset Vision Loss in a Previously Healthy Man. JAMA ophthalmology Durrani, A., Rahimy, E., Dunn, J. P. 2015; 133 (8): 957-8

  View details for DOI 10.1001/jamaophthalmol.2015.1139

  View details for PubMedID 26270403

• PROSPECTIVE EVALUATION OF VISUAL ACUITY AGREEMENT BETWEEN STANDARD EARLY TREATMENT DIABETIC RETINOPATHY STUDY CHART AND A HANDHELD EQUIVALENT IN EYES WITH RETINAL PATHOLOGY. Retina (Philadelphia, Pa.) Rahimy, E., Reddy, S., DeCroos, F. C., Khan, M. A., Boyer, D. S., Gupta, O. P., Regillo, C. D., Haller, J. A. 2015; 35 (8): 1680-7

  Abstract

  To evaluate the visual acuity agreement between a standard back-illuminated Early Treatment Diabetic Retinopathy Study (ETDRS) chart and a handheld internally illuminated ETDRS chart.Two-center prospective study. Seventy patients (134 eyes) with retinal pathology were enrolled between October 2012 and August 2013. Visual acuity was measured using both the ETDRS chart and the handheld device by masked independent examiners after best protocol refraction. Examination was performed in the same room under identical illumination and testing conditions.The mean number of letters seen was 63.0 (standard deviation: 19.8 letters) and 61.2 letters (standard deviation: 19.1 letters) for the ETDRS chart and handheld device, respectively. Mean difference per eye between the ETDRS and handheld device was 1.8 letters. A correlation coefficient (r) of 0.95 demonstrated a positive linear correlation between ETDRS chart and handheld device measured acuities. Intraclass correlation coefficient was performed to assess the reproducibility of the measurements made by different observers measuring the same quantity and was calculated to be 0.95 (95% confidence interval: 0.93-0.96). Agreement was independent of retinal disease.The strong correlation between measured visual acuity using the ETDRS and handheld equivalent suggests that they may be used interchangeably, with accurate measurements. Potential benefits of this device include convenience and portability, as well as the ability to assess ETDRS visual acuity without a dedicated testing lane.

  View details for DOI 10.1097/IAE.0000000000000518

  View details for PubMedID 25719987

• Speculum versus Bimanual Lid Retraction during Intravitreal Injection. Ophthalmology Rahimy, E., Fineman, M. S., Regillo, C. D., Spirn, M. J., Hsu, J., Kaiser, R. S., Maguire, J. I., Brown, G. C., Chiang, A. 2015; 122 (8): 1729-30

  View details for DOI 10.1016/j.ophtha.2015.02.001

  View details for PubMedID 25726752

• Spectrum of Retinal Vascular Diseases Associated With Paracentral Acute Middle Maculopathy. American journal of ophthalmology Chen, X., Rahimy, E., Sergott, R. C., Nunes, R. P., Souza, E. C., Choudhry, N., Cutler, N. E., Houston, S. K., Munk, M. R., Fawzi, A. A., Mehta, S., Hubschman, J. P., Ho, A. C., Sarraf, D. 2015; 160 (1): 26-34.e1

  Abstract

  To evaluate the spectrum of retinal diseases that can demonstrate paracentral acute middle maculopathy and isolated ischemia of the intermediate and deep capillary plexus.Retrospective, multicenter, observational case series.This is a retrospective case series review of 9 patients (10 eyes) from 5 centers with paracentral acute middle maculopathy lesions and previously unreported retinal vascular etiologies. Case presentations and multimodal imaging, including color photographs, near-infrared reflectance, fluorescein angiography, spectral-domain optical coherence tomography (SD OCT), and orbital color Doppler imaging, are described. Baseline and follow-up findings are correlated with clinical presentation, demographics, and systemic associations.Five men and 4 women, aged 27-66 years, were included. Isolated band-like hyperreflective lesions in the middle retinal layers, otherwise known as paracentral acute middle maculopathy, were observed in all patients at baseline presentation. Follow-up SD OCT analysis of these paracentral acute middle maculopathy lesions demonstrated subsequent thinning of the inner nuclear layer. Novel retinal vascular associations leading to retinal vasculopathy and paracentral acute middle maculopathy include eye compression injury causing global ocular ischemia, sickle cell crisis, Purtscher's retinopathy, inflammatory occlusive retinal vasculitis, post-H1N1 vaccine, hypertensive retinopathy, migraine disorder, and post-upper respiratory infection.Paracentral acute middle maculopathy lesions may develop in a wide spectrum of retinal vascular diseases. They are best identified with SD OCT analysis and may represent ischemia of the intermediate and deep capillary plexus. These lesions typically result in permanent thinning of the inner nuclear layer and are critical to identify in order to determine the cause of unexplained vision loss.

  View details for DOI 10.1016/j.ajo.2015.04.004

  View details for PubMedID 25849522

• Google Glass for Recording Scleral Buckling Surgery. JAMA ophthalmology Rahimy, E., Garg, S. J. 2015; 133 (6): 710-1

  View details for DOI 10.1001/jamaophthalmol.2015.0465

  View details for PubMedID 25811488

• Bilateral diffuse uveal melanocytic proliferation as a precursor to multiple systemic malignancies. Seminars in ophthalmology Rahimy, E., Coffee, R. E., McCannel, T. A. 2015; 30 (3): 206-9

  Abstract

  Bilateral diffuse uveal melanocytic proliferation (BDUMP) is a rare, intraocular paraneoplastic syndrome characterized by multiple, elevated, pigmented uveal lesions, diffuse thickening of the uveal tract, and rapidly progressive cataracts. We report a 70-year-old Caucasian male with an inferotemporal conjunctival-scleral pigmented lesion of the right eye. Funduscopy and ultrasonography revealed multiple elevated pigmented choroidal lesions in both eyes. Genome-wide single nucleotide polymorphism (SNP) analysis of intraoperative transscleral fine-needle aspiration biopsies from both eyes revealed a whole gain on chromosome 5. BDUMP was diagnosed, and the patient underwent a thorough systemic investigation, which was negative for an underlying malignancy; however, by maintaining a high index of suspicion, multiple malignancies were uncovered and appropriately treated over the ensuing years. This report presents the clinical, cytologic, and cytogenetic features of BDUMP, and is the first to demonstrate a novel finding of a whole gain in chromosome 5 by SNP analysis of the choroidal lesions. Additionally, this is the first case to potentially associate BDUMP and both transitional cell carcinoma of the bladder as well as renal clear cell carcinoma.

  View details for DOI 10.3109/08820538.2013.835835

  View details for PubMedID 24124896

• Tattoo-associated uveitis. JAMA ophthalmology Adam, M. K., Rahimy, E., Dunn, J. P. 2015; 133 (4): e144543

  View details for DOI 10.1001/jamaophthalmol.2014.4543

  View details for PubMedID 25856648

• Prepapillary vascular loop-reply. JAMA ophthalmology Rahimy, E., Rayess, N., Kaiser, R. S. 2015; 133 (3): 362-3

  View details for DOI 10.1001/jamaophthalmol.2014.5049

  View details for PubMedID 25473876

• Spectral-domain optical coherence tomography features of bilateral chorioretinitis sclopetaria. Ophthalmic surgery, lasers & imaging retina Rayess, N., Rahimy, E., Ho, A. C. 2015; 46 (2): 253-5

  Abstract

  The authors report a case of bilateral chorioretinitis sclopetaria in a 31-year-old man who sustained a perforating gunshot trauma. On presentation, best corrected visual acuity was light perception in the right eye and counting fingers at 5 feet in the left eye. Funduscopic examination demonstrated bilateral peripapillary fibrogliotic lesions with associated pigmentation in the posterior pole. Spectral-domain optical coherence tomography scans revealed bilateral full-thickness hyperreflectivity consistent with chorioretinal disruption. The patient was closely monitored, and his vision remained stable at 6-week follow-up.

  View details for DOI 10.3928/23258160-20150213-10

  View details for PubMedID 25707053

• Diabetic tractional retinal detachment repair by vitreoretinal fellows in a county health system. Retina (Philadelphia, Pa.) Rahimy, E., Pitcher, J. D., Gee, C. J., Kreiger, A. E., Schwartz, S. D., Hubschman, J. P. 2015; 35 (2): 303-9

  Abstract

  To investigate anatomical and functional outcomes of vitreoretinal fellow-performed vitrectomy for tractional retinal detachment secondary to proliferative diabetic retinopathy in a county hospital system.Consecutive retrospective review of patients surgically treated for diabetic tractional retinal detachment at Olive View-UCLA County Medical Center (Sylmar, CA) during a 2-year training period.Sixty-two eyes of 58 patients met inclusion criteria with a mean age of 48 ± 9 years and preoperative hemoglobin A1c of 8.4 ± 1.9%. Previous panretinal photocoagulation had been performed in 34 eyes (54.8%). Mean surgery duration was 153 ± 54 minutes. There was no significant time difference observed between first-year fellow surgeries (159.5 ± 52.3 minutes) and those performed by second-year fellows (146.8 ± 56.4 minutes, P = 0.35), although there was a trend toward longer first-year surgical times. After a mean follow-up of 11.2 months, successful retinal reattachment was achieved in 56 eyes (90.3%). Overall, mean logMAR visual acuity improved from 2.0 ± 0.5 to 1.4 ± 0.8 (P = 0.0007). Final visual acuity had improved in 33 eyes (53.2%), was unchanged in 11 eyes (17.7%), and decreased in 18 eyes (29%). Postoperative complications encountered included early vitreous hemorrhage in 10 eyes (16.1%), delayed vitreous hemorrhage in 3 eyes (4.8%), secondary rhegmatogenous retinal detachment in 11 eyes (17.7%), and neovascular glaucoma in 5 eyes (8%). Second-year fellows had a lower incidence of rhegmatogenous retinal detachment than first-year fellows (P = 0.016).Patients with diabetic tractional retinal detachment present to county hospitals with more complex retinal pathology, yet surgical outcomes as performed by vitreoretinal fellows compare favorably to previously reported series.

  View details for DOI 10.1097/IAE.0000000000000310

  View details for PubMedID 25105314

• Baseline choroidal thickness as a predictor for response to anti-vascular endothelial growth factor therapy in diabetic macular edema. American journal of ophthalmology Rayess, N., Rahimy, E., Ying, G. S., Bagheri, N., Ho, A. C., Regillo, C. D., Vander, J. F., Hsu, J. 2015; 159 (1): 85-91.e1-3

  Abstract

  To determine the association between baseline subfoveal choroidal thickness and short-term response to intravitreal anti-vascular endothelial growth factor (anti-VEGF) therapy in diabetic macular edema (DME).Retrospective, consecutive case series.Fifty-three eyes from 42 patients diagnosed with treatment-naïve DME were treated with 3 monthly intravitreal injections of ranibizumab or bevacizumab. Serial enhanced depth imaging optical coherence tomography scans were used to measure subfoveal choroidal thickness and central macular thickness (CMT). Anatomic response (CMT decrease ≥ 50 μm) and functional response (best-corrected visual acuity gain ≥ 1 line) were assessed at 3 months follow-up using univariate and multivariate analyses.After 3 monthly anti-VEGF treatments, subfoveal choroidal thickness decreased significantly (225 μm at baseline, 201 μm at 3 months, P < .0001). The anatomic responder group (32 eyes) had a greater baseline choroidal thickness (243 ± 15 μm) than the nonresponder group (21 eyes, 198 ± 13 μm, P = .03). Similarly, the functional responder group (28 eyes) tended to have a greater baseline subfoveal choroidal thickness (239 ± 12 μm) than the nonresponder group (25 eyes, 211 ± 16 μm, P = .08). Multivariate analyses revealed that a greater baseline subfoveal choroidal thickness was associated with a better anatomic (odds ratio = 1.12 for every 10 μm increase, P = .03) and functional response (odds ratio = 8.45 for >200 μm vs ≤ 200 μm, P = .008).Baseline subfoveal choroidal thickness may help predict which patients with DME will respond more favorably in the short term to intravitreal anti-VEGF pharmacotherapy. In this study, eyes with a thicker baseline subfoveal choroidal thickness had better short-term anatomic and functional responses.

  View details for DOI 10.1016/j.ajo.2014.09.033

  View details for PubMedID 25261844

• The spectrum of superficial and deep capillary ischemia in retinal artery occlusion. American journal of ophthalmology Yu, S., Pang, C. E., Gong, Y., Freund, K. B., Yannuzzi, L. A., Rahimy, E., Lujan, B. J., Tabandeh, H., Cooney, M. J., Sarraf, D. 2015; 159 (1): 53-63.e1-2

  Abstract

  To describe the spectrum of retinal capillary ischemia, including superficial and deep capillary ischemia, as identified with spectral-domain optical coherence tomography (SD OCT), that occurs in retinal arterial occlusive disease.Retrospective observational case series.Clinical charts, color fundus photography, red-free fundus photography, fluorescein angiography, near-infrared reflectance, and SD OCT imaging in 40 eyes of 35 patients with retinal arterial occlusive disease were studied in both the acute and chronic phases in multicenter clinical practices. SD OCT imaging analysis was employed to characterize the presence of superficial and deep capillary ischemia in each eye.Of the 40 eyes, 15 eyes had central retinal artery occlusion (CRAO), 22 eyes had branch retinal artery occlusion (BRAO), and 3 eyes had cilioretinal artery occlusion. During the acute phase, SD OCT showed the following 3 distinct patterns, related to retinal ischemia occurring at varying levels within the retina: (1) thickening and hyperreflectivity of the inner retinal layers, including the nerve fiber and ganglion cell layers owing to ischemia of the superficial capillary plexus; (2) a hyperreflective band at the level of the inner nuclear layer, termed "paracentral acute middle maculopathy," representing ischemia of the intermediate and deep retinal capillary plexuses (deep capillary ischemia); and (3) diffuse thickening and hyperreflectivity of both the inner and middle retinal layers, which represented both superficial and deep capillary ischemia. Of all eyes, 31 (78%) had both superficial and deep lesions. The remaining 9 eyes (22%) had isolated deep capillary ischemia producing paracentral acute middle maculopathy with sparing of the superficial capillary plexus and a normal fluorescein angiographic appearance. As the lesions evolved into the chronic phase over the ensuing 3 months, the resultant thinning and atrophy reflected the retinal layers affected during the acute phase.SD OCT imaging reveals the spectrum of capillary ischemia in retinal artery occlusive disease showing variable involvement of the superficial and intermediate/deep capillary plexuses. Isolated deep capillary ischemia manifested as paracentral acute middle maculopathy on SD OCT and may be seen in some eyes with retinal arterial circulation compromise despite complete absence of perfusion abnormalities on fluorescein angiography.

  View details for DOI 10.1016/j.ajo.2014.09.027

  View details for PubMedID 25244976

• Endophthalmitis after penetrating ocular injury in the dentist's chair. Canadian journal of ophthalmology. Journal canadien d'ophtalmologie Adam, M. K., Rahimy, E., Brady, C. J., Aronsky, M., Hsu, J., Spirn, M. 2014; 49 (6): e154-6

  View details for DOI 10.1016/j.jcjo.2014.09.008

  View details for PubMedID 25433754

• I see a seashell in my right eye. JAMA ophthalmology Rahimy, E., Vander, J. 2014; 132 (12): 1413

  View details for DOI 10.1001/jamaophthalmol.2014.581

  View details for PubMedID 25321604

• Traumatic prepapillary loop torsion and associated branch retinal artery occlusion. JAMA ophthalmology Rahimy, E., Rayess, N., Talamini, C. L., Kaiser, R. S. 2014; 132 (11): 1376-7

  View details for DOI 10.1001/jamaophthalmol.2014.2415

  View details for PubMedID 25058406

• Bilateral neuroretinitis and retinal hemorrhages in an immunocompetent patient. JAMA ophthalmology Rayess, N., Rahimy, E., Dunn, J. P. 2014; 132 (10): 1243-4

  View details for DOI 10.1001/jamaophthalmol.2014.3341

  View details for PubMedID 25320946

• Peripheral retinal ischemia after intravenous tissue plasminogen activator for central retinal artery occlusion. Canadian journal of ophthalmology. Journal canadien d'ophtalmologie Joseph, A., Rahimy, E., Sarraf, D. 2014; 49 (5): e127-9

  View details for DOI 10.1016/j.jcjo.2014.07.010

  View details for PubMedID 25284117

• Radial versus raster spectral-domain optical coherence tomography scan patterns for detection of macular pathology. American journal of ophthalmology Rahimy, E., Rayess, N., Maguire, J. I., Hsu, J. 2014; 158 (2): 345-353.e2

  Abstract

  To compare the 6-line radial vs the 25-line raster spectral-domain optical coherence tomography (SD OCT) acquisition patterns at detecting intraretinal fluid, subretinal fluid, vitreomacular traction, and full-thickness macular hole (MH).Retrospective cross-sectional analysis.Series of 365 eyes with neovascular age-related macular degeneration (AMD), diabetic macular edema (DME), central and branch retinal vein occlusion (CRVO/BRVO), central serous chorioretinopathy, vitreomacular traction, and full-thickness MH. Sequential 6-line radial and 25-line raster scans were evaluated for intraretinal/subretinal fluid and, when applicable, vitreomacular traction and MH.For neovascular AMD (133 scans), 7 25-line raster scans confirmed subretinal/intraretinal fluid not identified by the 6-line radial (P=.02). For DME (140 scans) and central serous chorioretinopathy (91 scans), 25-line raster confirmed fluid in 4 scans (P=.13) and 1 scan (P=.32), respectively, that was not observed with the 6-line radial. For CRVO (123 scans) and BRVO (126 scans), 25-line raster confirmed fluid on 2 (P=.25) and 4 scans (P=.13), respectively, that was not detected by the 6-line radial. Conversely, for focal vitreomacular traction (70 scans) and full-thickness MH (82 scans), 25-line raster missed focal traction (<1500 μm) and MH in 5 scans (P=.07) and 7 scans (P=.02), respectively, that were identified using the 6-line radial.The 6-line radial scan is statistically comparable to the 25-line raster at detecting fluid in DME, BRVO/CRVO, and central serous chorioretinopathy, but not neovascular AMD. Furthermore, it is superior to the 25-line raster pattern at detecting early MH formation, while demonstrating a positive trend in identifying focal vitreomacular traction.

  View details for DOI 10.1016/j.ajo.2014.05.013

  View details for PubMedID 24857688

• Paracentral acute middle maculopathy in nonischemic central retinal vein occlusion. American journal of ophthalmology Rahimy, E., Sarraf, D., Dollin, M. L., Pitcher, J. D., Ho, A. C. 2014; 158 (2): 372-380.e1

  Abstract

  To better characterize a novel spectral-domain optical coherence tomography (OCT) presentation, termed paracentral acute middle maculopathy, to describe this finding in patients with nonischemic central retinal vein occlusion (CRVO), and to support a proposed pathogenesis of intermediate and deep retinal capillary ischemia.Retrospective observational case series.Clinical histories, high-resolution digital color imaging, red-free photography, fluorescein angiography, near-infrared reflectance, and spectral-domain OCT images of 484 patients with acute CRVO from 2 centers were evaluated for the presence of coexisting paracentral acute middle maculopathy.Of 484 patients diagnosed with CRVO, 25 (5.2%) demonstrated evidence of concurrent paracentral acute middle maculopathy. Patients averaged 51 years of age and presented with complaints of paracentral scotomas. All patients demonstrated hyper-reflective plaquelike lesions at the level of the inner nuclear layer by spectral-domain OCT and showed corresponding dark-gray lesions on near-infrared reflectance and perivenular deep retinal whitening on color fundus photography. There was no fluorescein angiographic correlate to these lesions. On follow-up spectral-domain OCT imaging, the lesions had resolved into areas of inner nuclear layer atrophy with persistence of scotomas.Paracentral acute middle maculopathy refers to characteristic hyper-reflective spectral-domain OCT lesions involving the middle layers of the retina at the level of the inner nuclear layer that may develop in response to ischemia of the intermediate and deep capillary plexuses. This series is the largest to describe this spectral-domain OCT finding to date, and it is the first to associate it with nonischemic CRVO.

  View details for DOI 10.1016/j.ajo.2014.04.024

  View details for PubMedID 24794089

• Multilayered pigment epithelial detachment in neovascular age-related macular degeneration. Retina (Philadelphia, Pa.) Rahimy, E., Freund, K. B., Larsen, M., Spaide, R. F., Costa, R. A., Hoang, Q., Christakopoulos, C., Munch, I. C., Sarraf, D. 2014; 34 (7): 1289-95

  Abstract

  To describe the spectral domain optical coherence tomography findings in eyes with chronic fibrovascular pigment epithelial detachment (PED) receiving intravitreal anti-vascular endothelial growth factor (anti-VEGF) therapy.Retrospective observational case series of patients with chronic fibrovascular PEDs receiving serial intravitreal anti-VEGF therapy. Corresponding spectral domain optical coherence tomography scans of chronic PEDs were studied in detail over multiple visits. The internal structure within the sub-PED compartment was analyzed, characteristic features were identified, and then correlated with visual outcome.Thirty-eight eyes of 34 patients with fibrovascular PEDs were included. Mean and median Snellen visual acuity was 20/50 (range, 20/20-20/400). Eyes received a mean of 28.2 intravitreal anti-VEGF injections (median, 23.0; range, 3-70) administered over a mean of 36.9 months (median, 37.5; range, 6-84). A fusiform, or spindle-shaped, complex of highly organized layered hyperreflective bands was noted within each PED. Nineteen eyes demonstrated heterogenous, dilated, irregular neovascular tissue adherent to the undersurface of the retinal pigment epithelium. Additionally, 25 eyes demonstrated a hyporeflective cavity separating the choroidal neovascularization complex from the underlying choroid.Chronic fibrovascular PEDs receiving serial anti-VEGF therapy demonstrate a characteristic fusiform complex of highly organized, layered, hyperreflective bands, termed a "multilayered PED," which is often seen in conjunction with neovascular tissue adherent to the undersurface of the retinal pigment epithelium monolayer. On the basis of previous histopathologic correlations, these bands may represent a fibrous tissue complex with contractile properties. An associated hyporeflective space, termed a "pre-choroidal cleft," separates the fusiform complex from the underlying choroid and may be due to contraction, the exudation of fluid, or both. Many of these eyes maintain good visual acuity, presumably because the neovascular and cicatricial process is suppressed within the sub-retinal pigment epithelium space by chronic anti-VEGF therapy, thus permitting the viability of the photoreceptor population through preservation of the retinal pigment epithelium.

  View details for DOI 10.1097/IAE.0000000000000130

  View details for PubMedID 24675391

• Retinal pigment epithelial tears in the era of intravitreal pharmacotherapy: risk factors, pathogenesis, prognosis and treatment (an American Ophthalmological Society thesis). Transactions of the American Ophthalmological Society Sarraf, D., Joseph, A., Rahimy, E. 2014; 112: 142-59

  Abstract

  To describe the risk factors, pathogenesis, and prognosis of retinal pigment epithelial (RPE) tears and to demonstrate our hypothesis that continued anti-vascular endothelial growth factor (VEGF) therapy after an RPE tear has occurred correlates with improved long-term visual and anatomical outcomes.We searched a database of 10,089 patients and retrospectively identified a large case series of 56 eyes with neovascular age-related macular degeneration (AMD) complicated by an RPE tear over an 8-year period. Baseline visual acuity (VA) was tabulated and analysis of the RPE tear was performed with multimodal imaging. Follow-up VA, progression of the tear, and severity of fibrosis were evaluated, and each was correlated with number of anti-VEGF injections.Average follow-up for the 56 eyes was 42 months, and mean logMAR VA at baseline was 0.88 (Snellen VA 20/150) with minimal decline over 3 years. LogMAR VA plotted against number of anti-VEGF injections demonstrated that more frequent and cumulative injections correlated with better VA (P<.0001). A greater number of anti-VEGF injections was associated with minimal progression of the RPE tear, reduced fibrosis, and lower risk of a large, end-stage exudative disciform scar.Fifteen to 20% of vascularized pigment epithelial detachments (PEDs) may develop RPE tears after anti-VEGF therapy due to progressive contraction of the type 1 choroidal neovascular membrane in a PED at risk. Continued monitoring of RPE tears for exudative changes warranting anti-VEGF therapy may stabilize VA, improve anatomical outcomes, reduce fibrosis, and decrease the risk of developing a large blinding end-stage exudative disciform scar.

  View details for PubMedID 25646033

  View details for PubMedCentralID PMC4310706

• Bilateral diffuse uveal melanocytic proliferation with multiple iris cysts. JAMA ophthalmology Joseph, A., Rahimy, E., Sarraf, D. 2014; 132 (6): 756-60

  Abstract

  Bilateral diffuse uveal melanocytic proliferation (BDUMP) is a rare paraneoplastic syndrome with characteristic findings, including exudative retinal detachment, rapid cataract formation, and uveal melanocytic tumors. We report a case notable for bilateral iris and ciliary body cysts--a rare presentation of the disease.A woman in her 50s presented with bilateral decreased vision. Her medical history was significant for clear cell adenocarcinoma of the endometrium. Slitlamp examination revealed a contiguous ring of pigmented translucent iris cysts at the pupillary margin of each eye, confirmed with ultrasound biomicroscopy. Ophthalmoscopic examination of the left eye showed a geographic patch of subretinal fluid temporal to the macula that was associated with orange polygonal pigment. The patient underwent periocular injection of triamcinolone acetonide, with resolution of the subretinal fluid. Recurrent fluid was treated successfully with a second injection of triamcinolone.Our case of BDUMP appears to be the first to demonstrate multiple iris and ciliary body cysts with high-quality color photography and ultrasound biomicroscopy. Involvement of the anterior uveal tract may be more common than reported in the literature because of its occult nature. Ultrasound biomicroscopy and anterior segment optical coherence tomography may be useful in patients with suspected BDUMP to identify anterior uveal tract involvement.

  View details for DOI 10.1001/jamaophthalmol.2014.311

  View details for PubMedID 24763691

• Paracentral acute middle maculopathy spectral-domain optical coherence tomography feature of deep capillary ischemia. Current opinion in ophthalmology Rahimy, E., Sarraf, D. 2014; 25 (3): 207-12

  Abstract

  To describe the novel spectral-domain optical coherence tomography (SD-OCT) finding of paracentral acute middle maculopathy (PAMM) that can be associated with acute macular neuroretinopathy (AMN) or retinal vasculopathy, and that may indicate an underlying pathogenesis related to ischemia of the retinal deep capillary plexus (DCP).With the advent of high-definition SD-OCT imaging, we are now able to detect deep capillary ischemia. Although cotton wool spots are caused by ischemia of the superficial capillary plexus, PAMM is caused by ischemia of the DCP, and appears as hyper-reflective, band-like lesions in the middle retina, extending from the inner nuclear layer (INL)/outer plexiform layer junction to involve the full-thickness INL. Over time, these lesions resolve with atrophy of the INL, resulting in persistent paracentral scotomas for the patient. Originally, PAMM was identified in isolation and thus classified into a subcategory of AMN. Subsequent reports have demonstrated PAMM lesions in the setting of coexisting retinal vascular disease, notably nonproliferative diabetic retinopathy and central retinal vein occlusion.PAMM refers to a recently described class of characteristic SD-OCT lesions involving the middle layers of the retina at the level of the INL. If a patient presenting with PAMM is young and healthy without any other vascular disease, this may represent a novel variant of AMN. However, if the patient has an underlying retinal vascular disease, such as diabetic retinopathy or retinal vascular occlusion, one would refer to the lesion as PAMM complicating the underlying retinal vascular disease.

  View details for DOI 10.1097/ICU.0000000000000045

  View details for PubMedID 24614148

• Grading of posterior staphyloma with spectral-domain optical coherence tomography and correlation with macular disease. Canadian journal of ophthalmology. Journal canadien d'ophtalmologie Rahimy, E., Beardsley, R. M., Gomez, J., Hung, C., Sarraf, D. 2013; 48 (6): 539-45

  Abstract

  To develop a novel grading system for posterior staphyloma imaged by spectral-domain optical coherence tomography (SD-OCT) and to correlate the incidence of macular disease (vitreomacular traction, epiretinal membrane, macular schisis, lamellar macular hole, and full-thickness macular hole) with each grade.Retrospective chart review.A total of 150 eyes from 89 patients with posterior staphylomas were examined at Jules Stein Eye Institute, University of California Los Angeles.Retrospective analysis of the Cirrus SD-OCT (Carl Zeiss Meditec, Dublin, Calif.) database at a large institution (Jules Stein Eye Institute) was performed and eyes with a posterior staphyloma involving the macula were evaluated for the presence of macular pathology. The radius of each circle was measured and graded, and the incidence of macular pathology was correlated with each staphyloma grade. Statistical analysis was done using Fisher exact and Kruskal-Wallis tests.The overall incidence rate of macular disease was 50.6% (76/150 eyes). The incidence rate of macular schisis was 17.3% (26/150) and was significantly greater with steeper (grade 3 [25.0%] and grade 4 [30.3%] staphyloma) versus shallower grade (grade 1 [5.6%]) staphyloma (p = 0.016).Imaging of staphyloma via SD-OCT is a valuable tool for determining the severity of posterior staphyloma and for determining risk stratification for various macular diseases.

  View details for DOI 10.1016/j.jcjo.2013.07.006

  View details for PubMedID 24314419

• Optical coherence tomography findings in ocular argyrosis. Ophthalmic surgery, lasers & imaging retina Rahimy, E., Beardsley, R., Ferrucci, S., Ilsen, P., Sarraf, D. 2013; 44 Online: E20-2

  Abstract

  A 68-year-old Caucasian man with a remote history of daily colloidal silver ingestion presented for ophthalmic examination in which he was noted to have a distinct slate gray skin discoloration. Funduscopy revealed confluent perimacular drusenoid deposits bilaterally, most of which localized at the level of or anterior to the inner segment ellipsoid band by optical coherence tomography (OCT) imaging. Enhanced depth imaging OCT demonstrated marked choroidal thinning. Fluorescein angiogram displayed a dark or silent choroid. Confirmatory serum silver levels were found to be markedly elevated. This report describes a unique geographic maculopathy with large drusenoid deposits anterior to the ellipsoid layer and severe choroidal thinning in association with ocular argyrosis.

  View details for DOI 10.3928/23258160-20131111-02

  View details for PubMedID 24548762

• Fundus autofluorescence and photoreceptor bleaching in multiple evanescent white dot syndrome. Ophthalmic surgery, lasers & imaging retina Joseph, A., Rahimy, E., Freund, K. B., Sorenson, J. A., Sarraf, D. 2013; 44 (6): 588-92

  Abstract

  The authors present three cases of multiple evanescent white dot syndrome (MEWDS) with characteristic fundus autofluorescence (FAF) findings, including one patient without any visible white dots on funduscopic examination and another with many more hyperautofluorescent lesions than seen ophthalmoscopically. Additionally, the findings support an alternative mechanism for the hyperautofluorescent lesions in MEWDS, whereby photoreceptor loss causes unmasking of normal underlying retinal pigment epithelium autofluorescence. This hypothesis is demonstrated in two cases by optical coherence tomography showing clear ellipsoid zone attenuation with registration to hyperautofluorescent lesions. It is further supported in two cases by photoreceptor bleaching in successive FAF images captured in the same session leading to diminished autofluorescence intensity of the characteristic dots.

  View details for DOI 10.3928/23258160-20131105-08

  View details for PubMedID 24221465

• Paracentral acute middle maculopathy: a new variant of acute macular neuroretinopathy associated with retinal capillary ischemia. JAMA ophthalmology Sarraf, D., Rahimy, E., Fawzi, A. A., Sohn, E., Barbazetto, I., Zacks, D. N., Mittra, R. A., Klancnik, J. M., Mrejen, S., Goldberg, N. R., Beardsley, R., Sorenson, J. A., Freund, K. B. 2013; 131 (10): 1275-87

  Abstract

  With the advent of more sophisticated imaging systems, such as spectral domain optical coherence tomography (SD-OCT), disruption of the inner segment/outer segment (IS/OS) band, and thinning of the outer nuclear layer (ONL) have been identified in association with acute macular neuroretinopathy (AMN).To characterize a new SD-OCT presentation of AMN as a paracentral acute middle maculopathy and to describe multimodal imaging findings that implicate an underlying pathogenesis related to retinal capillary ischemia.Retrospective observational case series (January 1, 2012, to January 1, 2013) reviewing clinical and imaging data from 9 patients (11 eyes) with AMN at 6 tertiary referral centers. Lesions were classified as type 1 or 2 in relation to the SD-OCT location of the lesion above (type 1) or below (type 2) the outer plexiform layer (OPL) at 6 tertiary referral centers.Of the 9 patients, 5 were female and 4 were male (mean age, 47.6 years; range, 21-65 years). All patients presented with an acute paracentral scotoma and demonstrated a classic dark gray paracentral lesion with near-infrared imaging. Visual acuity ranged from 20/15 to 20/30. Six eyes (5 patients) had type 1 SD-OCT lesions, also referred to as paracentral acute middle maculopathy, and 5 eyes (4 patients) had type 2 SD-OCT lesions. Although type 1 lesions lead to inner nuclear layer (INL) thinning, type 2 lesions resulted in ONL thinning. Type 2 lesions were always associated with significant outer macular defects, including disruption of the inner segment/outer segment and outer segment/retinal pigment epithelium bands, whereas type 1 lesions spared the outer macula.Paracentral acute middle maculopathy may represent a novel variant of AMN that affects the middle layers of the macula above the OPL as diagnosed with SD-OCT imaging. Two types of AMN lesions may be seen with SD-OCT occurring above and below the OPL. Type 1 refers to hyperreflective bands in the OPL/INL region with subsequent INL thinning. Type 2 is hyperreflective bands in the OPL/ONL region with subsequent ONL thinning. Type 2 lesions may be associated with concomitant defects of the inner segment/outer segment layer. We propose that each of these lesions may be explained by occlusion of either the superficial capillary plexus (type 1) or deep capillary plexus (type 2) located in the innermost and outermost portion of the INL, respectively, immediately adjacent to each corresponding lesion type.

  View details for DOI 10.1001/jamaophthalmol.2013.4056

  View details for PubMedID 23929382

• Prospective evaluation of the incidence and risk factors for the development of RPE tears after high- and low-dose ranibizumab therapy. Retina (Philadelphia, Pa.) Sarraf, D., Chan, C., Rahimy, E., Abraham, P. 2013; 33 (8): 1551-7

  Abstract

  To prospectively determine the incidence and risk factors for retinal pigment epithelial (RPE) tears in eyes with vascularized pigment epithelial detachments (PED) and exudative age-related macular degeneration receiving antivascular endothelial growth factor therapy.Eyes were prospectively randomized into 1 of 4 arms: 1) 0.5 mg of ranibizumab monthly for 12 months; 2) 0.5 mg of ranibizumab monthly for 3 months and then pro re nata on the basis of clinical and optical coherence tomography-guided indications; 3) high-dose 2.0 mg of ranibizumab monthly for 12 months; or 4) 2.0 mg of ranibizumab monthly for 3 months and then pro re nata thereafter. All PEDs were measured for height, greatest linear diameter, and surface area at baseline. The incidence of RPE tears in the entire 4-arm cohort was determined at the end of 12 months. Eyes were divided into two groups (tear vs. nontear) and statistically compared to determine risk factors for the development of RPE tear.Of 37 eyes, a total of 5 developed postranibizumab RPE tears during the course of the study (incidence 14%). Four of the 5 tears occurred in the high-dose 2.0-mg groups. Baseline PED height, surface area, and greatest linear diameter were significantly greater in the group that developed RPE tears versus the nontear group (P = 0.018, 0.031, and 0.048, respectively). There were significantly more eyes with PED height >550 microns in the RPE tear group (4 of 5, 80%) compared with the nontear group (9 of 32, 18%) (P = 0.042). The presence of PED height >550 microns was associated with an increased tear rate from 14% to 31%. Furthermore, retrospective identification of a ring sign or Grade 1 tear at baseline, in addition to PED height >550 microns, was associated with a further increase in the tear rate to 67%.In this study, the prospective incidence of RPE tears was ∼14%. A baseline PED height >550 microns and presence of a Grade 1 tear, or positive ring sign, were identified as high-risk factors for the subsequent development of an RPE tear.

  View details for DOI 10.1097/IAE.0b013e31828992f5

  View details for PubMedID 23652578

• Robot-assisted intraocular surgery: development of the IRISS and feasibility studies in an animal model. Eye (London, England) Rahimy, E., Wilson, J., Tsao, T. C., Schwartz, S., Hubschman, J. P. 2013; 27 (8): 972-8

  Abstract

  The aim of this study is to develop a novel robotic surgical platform, the IRISS (Intraocular Robotic Interventional and Surgical System), capable of performing both anterior and posterior segment intraocular surgery, and assess its performance in terms of range of motion, speed of motion, accuracy, and overall capacities.To test the feasibility of performing 'bimanual' intraocular surgical tasks using the IRISS, we defined four steps out of typical anterior (phacoemulsification) and posterior (pars plana vitrectomy (PPV)) segment surgery. Selected phacoemulsification steps included construction of a continuous curvilinear capsulorhexis and cortex removal in infusion-aspiration (I/A) mode. Vitrectomy steps consisted of performing a core PPV, followed by aspiration of the posterior hyaloid with the vitreous cutter to induce a posterior vitreous detachment (PVD) assisted with triamcinolone, and simulation of the microcannulation of a temporal retinal vein. For each evaluation, the duration and the successful completion of the task with or without complications or involuntary events was assessed.Intraocular procedures were successfully performed on 16 porcine eyes. Four eyes underwent creation of a round, curvilinear anterior capsulorhexis without radialization. Four eyes had I/A of lens cortical material completed without posterior capsular tear. Four eyes completed 23-gauge PPV followed by successful PVD induction without any complications. Finally, simulation of microcannulation of a temporal retinal vein was successfully achieved in four eyes without any retinal tears/perforations noted.Robotic-assisted intraocular surgery with the IRISS may be technically feasible in humans. Further studies are pending to improve this particular surgical platform.

  View details for DOI 10.1038/eye.2013.105

  View details for PubMedID 23722720

  View details for PubMedCentralID PMC3740307

• Cystoid macular edema secondary to nanoparticle albumin-bound Paclitaxel therapy. Ophthalmic surgery, lasers & imaging retina Rahimy, E., Sarraf, D. 2013; 44 (2): 187-9

  Abstract

  The authors report a case of nanoparticle albumin-bound paclitaxel-induced cystoid macular edema (CME) without fluorescein angiographic leakage in a patient being treated for metastatic breast cancer. The CME briskly improved 3 weeks after the chemotherapeutic agent was discontinued and was completely resolved after 6 weeks. Patients receiving taxane therapy must be counseled to report any vision problems during their treatment period because early recognition of this rare but severe adverse event can facilitate appropriate intervention to reverse visual compromise and minimize any potential long-term ophthalmologic sequelae.

  View details for DOI 10.3928/23258160-20130212-02

  View details for PubMedID 23421925

• Orbital inflammation after zoledronate infusion: an emerging complication. Canadian journal of ophthalmology. Journal canadien d'ophtalmologie Rahimy, E., Law, S. K. 2013; 48 (1): e11-2

  View details for DOI 10.1016/j.jcjo.2012.09.011

  View details for PubMedID 23419305

• Paraneoplastic and non-paraneoplastic retinopathy and optic neuropathy: evaluation and management. Survey of ophthalmology Rahimy, E., Sarraf, D. 2012; 58 (5): 430-58

  Abstract

  Paraneoplastic syndromes involving the visual system are a heterogeneous group of disorders occurring in the setting of systemic malignancy. Timely recognition of one of these entities can facilitate early detection and treatment of an unsuspected, underlying malignancy, sometimes months before it would have otherwise presented, and gives the patient an increased chance at survival. We outline the clinical features, pathogenesis, and treatment strategies for the retinal- and optic nerve-based paraneoplastic syndromes: cancer-associated retinopathy; melanoma-associated retinopathy; paraneoplastic vitelliform maculopathy; bilateral diffuse uveal melanocytic proliferation; paraneoplastic optic neuropathy; and polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy, and skin changes syndrome. Distinguishing these disorders from their non-paraneoplastic counterparts (e.g., autoimmune-related retinopathy and optic neuropathy, and acute zonal occult outer retinopathy) and determining appropriate systemic evaluation for the responsible tumor can be challenging. In addition, we discuss the utility and interpretation of autoantibody testing.

  View details for DOI 10.1016/j.survophthal.2012.09.001

  View details for PubMedID 23969019

• Bevacizumab therapy for tamoxifen-induced crystalline retinopathy and severe cystoid macular edema. Archives of ophthalmology (Chicago, Ill. : 1960) Rahimy, E., Sarraf, D. 2012; 130 (7): 931-2

  View details for DOI 10.1001/archophthalmol.2011.2741

  View details for PubMedID 22776935

• Ocriplasmin for Vitreoretinal Diseases JOURNAL OF BIOMEDICINE AND BIOTECHNOLOGY Tsui, I., Pan, C. K., Rahimy, E., Schwartz, S. D. 2012: 354979

  Abstract

  Fibronectin and laminin are clinically relevant plasmin receptors in the eye. Located at the vitreoretinal interface, they are cleaved by ocriplasmin (Microplasmin, ThromboGenics, Iselin, NJ), a novel ophthalmic medication. A series of clinical trials to study ocriplasmin for the treatment of vitreoretinal diseases such as vitreomacular traction, macular hole, and exudative age-related macular degeneration are underway. The results are promising and may impact patient care.

  View details for DOI 10.1155/2012/354979

  View details for Web of Science ID 000310028500001

  View details for PubMedID 23193358

  View details for PubMedCentralID PMC3496214

• Pharmacological cholinergic blockade stimulates inflammatory cytokine production and lymphocytic infiltration in the mouse lacrimal gland. Investigative ophthalmology & visual science Pitcher, J. D., De Paiva, C. S., Pelegrino, F. S., McClellan, A. J., Raince, J. K., Pangelinan, S. B., Rahimy, E., Farley, W. J., Stern, M. E., Li, D. Q., Pflugfelder, S. C. 2011; 52 (6): 3221-7

  Abstract

  To investigate the effects of cholinergic blockade on inflammatory cell infiltration and cytokine production in the mouse lacrimal gland (LG).C57BL/6 mice were untreated (UT) or received subcutaneous injections of either scopolamine hydrobromide (SCOP; 0.5 mg/0.2 mL) or saline (SAL) four times daily for 2 or 5 days (2D, 5D). This was followed by a 7-day rest period in separate groups. Tear volume (cotton thread) and tear epidermal growth factor (EGF, by ELISA) concentrations were measured. Extraorbital LGs were surgically excised and sectioned or lysed for gene expression analysis. Immunohistochemistry evaluated immunophenotype of infiltrating cells. Expression of EGF and T helper (Th)-1, -2, and -17-associated cytokines in LGs was evaluated by real-time PCR. Goblet cell density was evaluated in periodic acid Schiff-stained conjunctival sections.Tear volume and EGF protein levels were significantly reduced in SCOP5D mice compared with controls, indicating that cholinergic blockade decreased LG secretory function. LGs of SCOP2D and SCOP5D mice showed an increased density of CD4(+), CD11c+, CD11b+, and myeloperoxidase+ cells compared with UT controls. At day 5, these cells were significantly elevated compared with SAL-treated counterparts. Elevated levels of IL-17A, IL-17R, IFN-γ, IL-12Rβ1, IL-2, IL-13, IL-6, IL-1β, and TNF-α transcripts were noted in SCOP2D mice and IFN-γ, TGF-β1, and IL-18R transcripts in SCOP5D mice.Pharmacological blockade of lacrimal secretion induced a significant CD4(+) infiltration in the LG, mimicking Sjögren's syndrome. The mRNA expression profile revealed elevations of a mix of inflammatory cytokines and Th-1-associated factors.

  View details for DOI 10.1167/iovs.09-4212

  View details for PubMedID 21273534

  View details for PubMedCentralID PMC3109024

• Spontaneous autoimmune dacryoadenitis in aged CD25KO mice. The American journal of pathology Rahimy, E., Pitcher, J. D., Pangelinan, S. B., Chen, W., Farley, W. J., Niederkorn, J. Y., Stern, M. E., Li, D. Q., Pflugfelder, S. C., De Paiva, C. S. 2010; 177 (2): 744-53

  Abstract

  To investigate time-related immunopathological changes in the lacrimal glands (LGs) of CD25KO mice, we examined LGs of C57BL/6 (wild-type) and CD25KO mice at 8, 12, and 16 weeks of age. T cell infiltration was quantified by flow cytometry, and gland function by tear peroxidase activity and epidermal growth factor mRNA expression. T helper (Th)-1, -2 and -17-associated cytokine expression was evaluated by real-time PCR. Epithelial apoptosis was assessed by terminal deoxynucleotidyl transferase dUTP nick-end labeling assay and activated caspase-3 staining. Eight-week-old CD25KO mice demonstrated significantly increased numbers of CD4 and CD8 T cells infiltrating the LGs. This peaked at 12 weeks of age. No peroxidase secretion was detected, and epidermal growth factor mRNA expression was barely detected in CD25KO mice. Ductal epithelial apoptosis was noted in CD25KO mice. Young CD25KO LGs had higher Th-17- (interleukin [IL]-23R, transforming growth factor-beta1, IL-17A, CC chemokine attractant ligand-20) and Th-1-associated cytokine transcripts (interferon-gamma, T-bet, IL-12, IL-2, IL-18) than young wild-type LGs. There was also a significant time-related decrease in IL-17A and CC chemokine attractant ligand-20 in CD25KO LGs. Taken together, autoimmune LG infiltration with loss of LG function was observed in CD25KO mice as early as 8 weeks of age. Time-related switch from Th-17 to Th-1 inflammation was noted in CD25KO mice.

  View details for DOI 10.2353/ajpath.2010.091116

  View details for PubMedID 20566743

  View details for PubMedCentralID PMC2913359

• Age-related T-cell cytokine profile parallels corneal disease severity in Sjogren's syndrome-like keratoconjunctivitis sicca in CD25KO mice. Rheumatology (Oxford, England) De Paiva, C. S., Hwang, C. S., Pitcher, J. D., Pangelinan, S. B., Rahimy, E., Chen, W., Yoon, K. C., Farley, W. J., Niederkorn, J. Y., Stern, M. E., Li, D. Q., Pflugfelder, S. C. 2010; 49 (2): 246-58

  Abstract

  IL-2ralpha (CD25)(-/-) mice develop autoimmunity and lymphoproliferative disorders, including SS-like disease. The objective of this study was to evaluate the severity of corneal epithelial disease and T-cell cytokine profile in the ocular surface tissues of CD25KO mice.CD25KO mice were evaluated at 8, 12 and 16 weeks of age. Corneal epithelial smoothness and corneal permeability were measured. Phenotype of infiltrating lymphocytes was evaluated by immunohistochemistry. Th-1, -2 and -17 associated factors were measured by real-time PCR in cornea and conjunctiva and by Luminex immunobead assay in tears.Compared with 8-week-old wild-type (WT) mice, CD25KO mice of the same age had significantly greater corneal irregularity and a significant increase in the number of CD4(+) and CD8(+) T cells infiltrating the conjunctiva. CD25KO mice had significantly higher levels of IL-6, TGF-beta1, IL-23R, IL-17A, IL-17F, IL-21, CCL20, IL-10, GATA-3 and IFN-gamma mRNA transcripts in their cornea and conjunctiva than WT mice at 8 weeks. IL-17A and IL-17F mRNA transcripts peaked at 12 weeks, whereas IFN-gamma spiked at 16 weeks in CD25KO mice. Increased expression of IL-17A and IL-17F at 12 weeks in CD25KO mice was accompanied by a worsening of corneal surface parameters and an increase of CD4(+) T cell infiltrating the cornea.Disruption of IL-2 signalling in CD25KO mice results in age-dependent SS-like autoimmune lacrimal-keratoconjunctivitis. A mix of Th-1 and Th-17 cytokines was detected. The peak severity of corneal epithelial disease corresponded to the peak of IL-17 expression.

  View details for DOI 10.1093/rheumatology/kep357

  View details for PubMedID 20007286

  View details for PubMedCentralID PMC2909796

• Overexpression of prolylcarboxypeptidase enhances plasma prekallikrein activation on Chinese hamster ovary cells. American journal of physiology. Heart and circulatory physiology Shariat-Madar, Z., Rahimy, E., Mahdi, F., Schmaier, A. H. 2005; 289 (6): H2697-703

  Abstract

  Plasma prekallikrein (PK) complexes with its receptor, high-molecular-weight kininogen (HK), on human umbilical vein endothelial cells (HUVEC). When assembled on endothelial cells, PK is activated to plasma kallikrein independent of factor XIIa by the serine protease prolylcarboxypeptidase (PRCP, Km= 9 nM). PRCP was shown to be a PK activator when isolated from HUVEC (J Biol Chem 277: 17962-17969, 2002) and produced as a recombinant protein (Blood 103: 4554-4561, 2004). To additionally confirm that human PRCP is a physiological PK activator, PRCP was overexpressed in Chinese hamster ovary (CHO) cells. CHO cells were transfected with full-length PRCP under the control of a cytomegalovirus promoter, and CHO recombinant PRCP was expressed as a fusion protein with COOH-terminal enhanced green fluorescence protein (EGFP). The presence of recombinant PRCP in transfected CHO cells was detected by real-time RT-PCR, immunoblot, and immunoprecipitation. PRCP mRNA and PK activation were two- to threefold higher in transfected than in control CHO cells. The increase in PRCP-induced PK activation in the transfected CHO cells paralleled the increase in PRCP antigen expression, as determined by anti-PRCP and anti-green fluorescence protein antibodies. PK activation of the transfected cells was blocked by small interfering RNA to PRCP. Anti-PRCP antibody and Z-Pro-Pro-aldehyde dimethyl acetate also blocked PK activation (IC50= 0.01 and 7.0 mM, respectively). Localization of PRCP in intact cells observed via confocal microscopy and flow cytometry also confirmed overexpression of PRCP on the external membrane. These investigations independently confirm that PRCP is expressed on cell membranes and that PRCP expression increases PK activation.

  View details for DOI 10.1152/ajpheart.00715.2005

  View details for PubMedID 16113074