Eubee Baughn Koo

All Publications

• Risk of Retinal Redetachment After Cataract Surgery Following Retinal Detachment Repair in Myopic and Highly Myopic Eyes. Journal of vitreoretinal diseases Mesfin, Y., Arnal, L., Salvi, A., Wai, K. M., Brodie, F., Koo, E., Kossler, A. L., Koo, E., Rahimy, E., Mruthyunjaya, P., Ludwig, C. A. 2026: 24741264261418517

  Abstract

  Purpose: To describe how risk factors such as repair of rhegmatogenous retinal detachment (RRD), cataract extraction, and myopia interrelate to influence the risk of retinal redetachment. Methods: This retrospective cohort study included patients with phakic RRD who had subsequent cataract extraction. The incidence and risk of redetachment were compared using Cox regression and χ2 analyses. Stratified analyses were performed based on time after cataract extraction, age, myopia status, and retinal repair type. Results: Of 1222 patients identified, no significant association was found between myopia and the incidence of redetachment, although the proportion of redetachments increased with the degree of myopia (nonmyopes, 8.5%, myopes, 9.5%, high myopes, 15.6%; P = .36). Myopia and high myopia were not associated with an increased risk of redetachment over time (hazard ratio, 1.01, P = .96; hazard ratio, 1.54, P = .35, respectively). Additionally, the incidence of redetachment was not significantly correlated with the time after cataract extraction (P = .33). A significant difference was observed between the incidence of redetachment and age (P = .003). Patients between 18 and 35 years experienced the highest incidence of redetachment within 1, 3, and 12 months after cataract extraction (5.26%, 7.02%, 7.02%, respectively). Such patients were overrepresented among those who underwent complex surgeries for initial phakic RRD repair (30-39 years, residual: 2.71; 40-49 years, residual: 3.32). Conclusions: Among patients with a phakic RRD, myopia did not significantly increase the risk of redetachment after cataract extraction. However, an upward trend was noted between the proportion of redetachments and the degree of myopia. Younger patients exhibited the highest incidence of redetachment and should be closely monitored after cataract extraction.

  View details for DOI 10.1177/24741264261418517

  View details for PubMedID 41756349

  View details for PubMedCentralID PMC12932135

• The Association Between the Retinal Sequelae of Myopia and Glaucoma in a Global Cohort. Clinical ophthalmology (Auckland, N.Z.) Arnal, L. I., Mesfin, Y., Ferreira, G., Salvi, A., Wai, K. M., Koo, E., Kossler, A. L., Koo, E., Rahimy, E., Mruthyunjaya, P., Ludwig, C. A. 2025; 19: 3749-3760

  Abstract

  Discerning glaucoma in myopic eyes with tilted optic nerve discs is challenging given the atypical appearance and segmentation on optical coherence tomography. This study aims to determine the association between retinal sequelae of myopia and primary open-angle glaucoma (POAG). We hypothesize that retinal sequelae of myopia may aid in identifying high-risk glaucoma patients.An aggregated electronic health records research network was used to retrospectively identify 929,142 myopic patients. We evaluated the association of POAG with retinal sequelae of myopia, including choroidal neovascularization (CNV), myopic macular degeneration (MMD), foveoschisis, macular hole (MH), rhegmatogenous retinal detachment (RRD), and foveal retinal detachment (FRD). Logistic regressions estimated odds ratios (adjusted for age, sex, race, and ethnicity). Cox models estimated hazard ratios (additionally adjusted for pseudophakia).FRD exhibited the strongest association with POAG (AOR: 5.82; 95% CI: 3.44-9.85), followed by foveoschisis (AOR: 3.10; 95% CI: 1.84-5.21) and MMD (AOR: 2.87; 95% CI: 2.19-3.75). Severe subtypes of POAG were also more highly associated with each retinal sequela than moderate and milder severity subtypes. Additionally, patients with each retinal sequela experienced a significantly faster progression from glaucoma suspect to POAG than those without these sequelae. Kaplan-Meier curves and adjusted Cox regression models suggested a faster progression from glaucoma suspect to POAG in those with foveoschisis (HR: 5.33; 95% CI: 2.21-12.85; p<0.005), CNV (HR: 1.73; 95% CI: 1.12-2.67; p=0.01), MMD (HR: 2.74; 95% CI: 1.47-5.10; p<0.005), MH (HR: 1.73; 95% CI: 1.29-2.31; p<0.005), and RRD (HR: 1.54; 95% CI: 1.28-1.86; p<0.005), whereas FRD was not significantly associated with glaucoma progression (HR: 1.28; 95% CI: 0.18-9.10; p=0.8).The retinal sequelae of myopia are associated with the presence and progression of primary open-angle glaucoma. The presence of the retinal sequelae of myopia should cue ophthalmologists to refer such patients for glaucoma evaluation to encourage earlier detection and more targeted management.

  View details for DOI 10.2147/OPTH.S542692

  View details for PubMedID 41103309

  View details for PubMedCentralID PMC12523566

• Exogenous Testosterone Use Increases the Risk of Central Serous Chorioretinopathy. American journal of ophthalmology Roig, E. M., Arnal, L., Salvi, A., Mesfin, Y., Wai, K. M., Koo, E., Kossler, A., Koo, E., Rahimy, E., Mruthyunjaya, P., Ludwig, C. A., Hua, H. U. 2025

  Abstract

  To evaluate the association between exogenous testosterone (ExoT) use and central serous chorioretinopathy (CSCR).Retrospective observational cohort study using large-scale electronic health record (EHR) data.Patients receiving exogenous testosterone therapy, identified from the MarketScan and STARR databases.Data were accessed from two sources: Merative™ MarketScan® Commercial Database, and Stanford's Clinical Data Warehouse (STARR), which aggregates de-identified patient records from Stanford Health Care. Patients on testosterone therapy were included and categorized by CSCR status. Demographic factors such as sex (administrative field), race, and ethnicity were assessed. Laboratory values (testosterone, hematocrit, RBC count, cortisol) were compared in STARR, with limited availability in MarketScan. Logistic regression analyses were performed in MarketScan adjusting for age and sex. A sensitivity analysis restricted to patients exposed to ExoT prior to CSCR diagnosis was also performed.The primary outcomes were CSCR prevalence and adjusted odds ratios (AOR) for CSCR risk in patients on exogenous testosterone. Secondary outcomes included differences in laboratory values and treatment requirements (photodynamic therapy [PDT] and intravitreal injections).In STARR, individuals with CSCR on exogenous testosterone had significantly higher mean testosterone levels (p=0.001), hematocrit (p=0.022), and RBC counts (p=0.005) compared to those without CSCR. In MarketScan, laboratory values trended in the same direction but were not statistically significant, likely reflecting limited sample sizes. Logistic regression in MarketScan showed that exogenous testosterone was significantly associated with increased CSCR risk (AOR: 8.05; 99% CI: 6.04-10.73). In both datasets, there were no significant differences in treatment rates (PDT or intravitreal injections) between ExoT and non-ExoT users. In a sensitivity analysis restricted to patients who received ExoT prior to CSCR diagnosis, no significant laboratory differences were observed.This study demonstrates a significant association between exogenous testosterone use and increased CSCR risk, highlighting the importance of monitoring patients on testosterone therapy for potential ocular symptoms, especially among high-risk demographic groups.

  View details for DOI 10.1016/j.ajo.2025.09.044

  View details for PubMedID 41047110

• Reduced rates of diabetic retinopathy complications with use of continuous glucose monitoring. Scientific reports Alsoudi, A. F., Wai, K. M., Koo, E., Koo, E., Mruthyunjaya, P., Rahimy, E. 2025; 15 (1): 25215

  Abstract

  Elucidating the outcomes of patients using continuous glucose monitoring (continuous glucose monitoring) in day-to-day clinical practice could help expand optimal practice guidelines in prevention and mitigation of diabetic retinopathy (DR). Retrospective cohort study. Subjects, Participants, and/or Controls: 13,302 patients with NPDR initiated on continuous glucose monitoring, compared with 179,079 patients with NPDR not initiated on continuous glucose monitoring before propensity score matching (propensity score matching) at one year. TriNetX (Cambridge, MA, USA), was used to identify patients diagnosed with NPDR stratified by initiation of continuous glucose monitoring or not with at least six months of follow-up. propensity score matching controlled for baseline demographics and medical comorbidities. After propensity score matching, 12,730 patients were subsequently analyzed in each cohort. Use of continuous glucose monitoring was associated with lower risk of vision threatening complications (DME: hazards ratio [HR], 0.87, 95% CI, 0.82-0.93; P < .001; PDR: HR, 0.74, 95% CI, 0.66-0.82; P < .001; VH: HR, 0.55, 95% CI, 0.47-0.66; P < .001; TRD: HR, 0.42, 95% CI, 0.27-0.68; P = .027), and need for ocular intervention (anti-VEGF injection: HR, 0.72, 95% CI, 0.65-0.80; P < .001; PRP: HR, 0.53, 95% CI, 0.44-0.64; P < .001; PPV: HR, 0.37, 95% CI, 0.26-0.51; P < .001) among patients with NPDR when compared with matched patients not using continuous glucose monitoring at 1 year. Similar associations at two years were found. continuous glucose monitoring use in patients with NPDR without prior ocular therapy was associated with lower risk of progression to vision threatening complications as well as need for ocular intervention at one year and two years, highlighting that glycemic variability and time in range are important factors influencing the risk of complications from diabetic eye disease.

  View details for DOI 10.1038/s41598-025-08971-7

  View details for PubMedID 40652066

  View details for PubMedCentralID 4543190

• The Impact of Myopia on the Risk of Retinal Re-Detachment After Cataract Surgery Mesfin, Y., Arnal, L., Salvi, A., Wai, K., Brodie, F., Koo, E., Kossler, A., Koo, E., Rahimy, E., Mruthyunjaya, P., Ludwig, C. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2025

  View details for Web of Science ID 001559865900029

• High Myopia and Capsular Tension Rings-To Be or Not To Be? JAMA OPHTHALMOLOGY Koo, E. B. 2025

  View details for DOI 10.1001/jamaophthalmol.2025.0442

  View details for Web of Science ID 001449664900001

  View details for PubMedID 40111350

• Risk of Cataract Surgery Complications in Patients with Prior Intravitreal Injection Therapy. American journal of ophthalmology Zhao, C. S., Chwialkowski, K., Wai, K. M., Mruthyunjaya, P., Rahimy, E., Koo, E. B. 2025

  Abstract

  To compare the rate of cataract surgery complications in patients with and without prior intravitreal injection (IVI) pharmacotherapy.A retrospective cohort study was performed using the TriNetX (Cambridge, MA) aggregated electronic health records research network.Patients with a history of IVI therapy within twenty years of cataract surgery were compared to a control group using propensity score matching (PSM) to balance for baseline demographics, systemic, and ocular co-morbidities. Patients with a history of lensectomy or pars plana vitrectomy (PPV) prior to cataract surgery were excluded.IVI therapy within twenty years of cataract surgery.Rate of retinal detachment (RD), RD repair, anterior vitrectomy, retained lens, dislocated intraocular lens (IOL), need for a secondary lens procedure, and endophthalmitis within 14, 30, and 90 days of cataract surgery.Prior to PSM, 16,356 and 512,152 patients did and did not, respectively, have IVI pharmacotherapy prior to cataract surgery. After PSM, both groups had 14,240 patients. A higher rate (RR 1.34; 95% CI, 1.16-1.54; p<0.0005) of aggregate complications within 90 days of cataract surgery was found in the group with prior IVI (447/13,719 = 3.3%) relative to controls (340/13,945=2.4%). The exposure group saw an increased risk of RD repair at 30 days (RR 1.84; 95% CI, 1.27-2.66; p=0.001) and 90 days (RR 2.05; 95% CI, 1.65-2.54; p<0.0005). No other complications were associated with IVI. In particular, IVI was not associated with higher rates of anterior vitrectomy except in patients with diabetic retinopathy (DR) at 90 days (RR 1.24; 95% CI, 0.85-1.79; p=0.001). Patients with DR and prior IVI had a higher risk of lensectomy, RD repair, and secondary procedures (p < 0.0005 for all) compared to DR patients without prior IVI.Patients with prior IVI saw more complications following cataract surgery, primarily for RD. IVI treatment history should be considered in pre-operative planning.

  View details for DOI 10.1016/j.ajo.2025.01.004

  View details for PubMedID 39826858

• Reply to Comment on Ophthalmic Immune-Related Adverse Events and Association with Survival: Results from a Real-World Database. American journal of ophthalmology Quiruz, L., Yavari, N., Kikani, B., Gupta, A. S., Wai, K. M., Kossler, A. L., Ludwig, C., Koo, E. B., Rahimy, E., Mruthyunjaya, P. 2024

  View details for DOI 10.1016/j.ajo.2024.11.001

  View details for PubMedID 39528009

• 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