Karen Wai, MD

All Publications

• Uveitis as a Correlate of Systemic Manifestations in Patients Diagnosed with Behçet's Disease. Ocular immunology and inflammation Shah, S. V., Wai, K. M., Mruthyunjaya, P., Nowatzky, J., Rahimy, E. 2026: 1-8

  Abstract

  Uveitis is common in Behçet's disease (BD), but risk stratification of potentially severe systemic disease by ocular involvement is still impossible. Here, we aimed to determine whether the risk for systemic manifestations of BD in Patients Diagnosed with Behçet's Disease (PDBD) depended on the presence of intra-ocular inflammation in one of the largest global health research networks.Screening > 150 million Electronic Medical Records (EMR), we compared subjects whose ICD-10 codes selected them as PDBD with or without a BD uveitis-reconcilable coding pattern. Outcomes included relative risk for systemic BD manifestations after diagnosis, likelihood of inpatient consultations, and probability of systemic manifestations over time.3474 subjects met inclusion criteria, with 458 in the ocular cohort. Ocular PDBD had more than a two-fold risk of skin and vascular manifestations than non-ocular PDBD, increased risk for musculoskeletal and central nervous system manifestations, was twice as likely to receive inpatient consultations when hospitalized and showed a much shorter median time to extraocular systemic disease onset (413 days) than non-ocular PDBD (1729 days). The risk for genital lesions and the time to initial diagnosis were similar between the groups.Within the constraints of an EMR-based study, our results indicate a significantly higher risk for extraocular manifestations and an overall more severe disease course for PDBD with uveitis than for those without. Our findings provide rationale for confirmation in cohorts outside of big data and justify an intensified multidisciplinary clinical approach to ocular PDBD to prevent, detect, and treat the associated systemic disease.

  View details for DOI 10.1080/09273948.2026.2735409

  View details for PubMedID 42848921

• Association between varicose veins and central serous chorioretinopathy. The British journal of ophthalmology Cakir, B., Yavari, N., Guo, L. Y., Ludwig, C. A., Rahimy, E., Rossin, E. J., Mruthyunjaya, P., Wai, K. M. 2026

  Abstract

  AimTo investigate the association between varicose veins and central serous chorioretinopathy (CSCR), based on emerging genetic evidence of a shared vascular mechanism.Propensity score-matched retrospective cohort study using the TriNetX Global Collaborative Network. Patients with varicose veins (n=621 513) were matched 1:1 to controls without varicose veins on age, sex, race and ethnicity, with prior CSCR or serous pigment epithelial detachment (PED) excluded. A secondary analysis excluded glucocorticoid users and additionally matched on hypertension, sleep apnoea and healthcare utilisation. A tertiary analysis compared thromboembolic risk (pulmonary embolism (PE) and deep vein thrombosis (DVT)) in varicose vein patients with and without CSCR.Varicose veins were significantly associated with CSCR (risk ratio (RR) 2.16; 95% CI 1.86 to 2.52; p<0.0001) and serous PED (RR 1.97; 95% CI 1.69 to 2.93; p<0.0001). Associations persisted after excluding glucocorticoid users and adjusting for comorbidities (CSCR RR 1.83; 95% CI 1.22 to 2.75; p=0.003; PED RR 1.95; 95% CI 1.38 to 3.34; p=0.013). Among varicose vein patients, rates of DVT (RR 1.36; p=0.078) and PE (RR 1.41; p=0.14) did not differ significantly between those with and without CSCR.Varicose veins were significantly associated with CSCR and serous PED, independent of glucocorticoid exposure and known comorbidities, supporting a possible systemic vascular mechanism in CSCR pathophysiology.

  View details for DOI 10.1136/bjo-2026-330067

  View details for PubMedID 42843970

• Ocular Adverse Events Associated With Dupilumab: Analysis From a Real-World Database. Cornea Elaraby, O., Wai, K. M., Nguyen, Q. D., Ludwig, C. A., Koo, E., Mruthyunjaya, P., Rahimy, E. 2026

  Abstract

  Dupilumab is a human monoclonal antibody used to treat various inflammatory conditions. The purpose of this study was to characterize the cumulative proportion of documented ocular adverse events after dupilumab initiation and compare outcomes between patients with atopic dermatitis (AD) and those treated for non-AD indications.This retrospective cohort study used the TriNetX electronic health record network. Patients who initiated dupilumab and had at least 2 years of available follow-up after treatment initiation were included. Patients with documented ocular adverse events within the 3 months before initiating dupilumab were excluded. Overall cumulative proportions were calculated, and propensity score-matched AD and non-AD cohorts were compared using risk ratios.The overall cohort included 64,497 patients. Two-year cumulative proportions were 1.39% for conjunctivitis, 1.20% for dry eye syndrome, 0.39% for blepharitis/blepharoconjunctivitis, 0.32% for keratitis: inflammatory eye disease and cicatricial ectropion were rare. After propensity score matching, the AD cohort had higher 2-year cumulative proportions of documented blepharitis/blepharoconjunctivitis (0.46% vs. 0.22%; P < 0.01), conjunctivitis (1.97% vs. 1.52%; P = 0.01), and keratitis (0.43% vs. 0.23%; P < 0.01) than the non-AD cohort.Our study found a low frequency of documented ocular adverse events among patients treated with dupilumab. Although routine ophthalmic screening for all patients initiating dupilumab may not be necessary, prescribing physicians should remain vigilant for ocular surface inflammation, particularly in patients with atopic dermatitis, and promptly refer patients who develop ocular symptoms for ophthalmic evaluation.

  View details for DOI 10.1097/ICO.0000000000004295

  View details for PubMedID 42766442

• Vitreoretinal procedures in inherited retinal diseases: a large retrospective cohort study. Canadian journal of ophthalmology. Journal canadien d'ophtalmologie Guo, L. Y., Wai, K. M., Al-Moujahed, A., Mahajan, V. B., Leung, L. B., Mruthyunjaya, P., Rahimy, E. 2026

  Abstract

  Management of inherited retinal diseases (IRDs) traditionally has been viewed as nonsurgical, but there are known complications of IRDs that may warrant surgical intervention. Patterns of procedural interventions among patients with IRDs remain poorly characterized, given their relatively small representation among individual institutions. The objective of this study is to characterize patterns of surgical diagnoses and procedures in patients with IRD compared with a control cohort.This retrospective cohort study used deidentified aggregated electronic health records from January 1, 2003, through March 30, 2024, from TriNetX, a network with data from more than 119 million patients across 85 health care organizations in 4 countries.Patients with IRDs and a control group with other posterior segment pathologies were identified and propensity score matched for age, sex, and ethnicity and race. International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, diagnosis codes for inherited retinal diseases (hereditary retinal dystrophy, hereditary choroidal dystrophy, congenital night blindness, achromatopsia, or other colour blindness) or posterior segment pathologies (disorders of choroid and retina, disorders of vitreous body and globe, glaucoma, visual disturbances and blindness, disorders of optic nerve and visual pathways, other disorders of eye and adnexa) were searched. Rates of surgical diagnoses and subsequent procedures in the IRD group were compared with the control group.Each cohort resulted in 69 235 patients after propensity-score matching. Among patients with IRDs, there was an increased rate of age-related cataracts (risk ratio [RR] 1.39, P < 0.001), other cataracts (RR 1.52, P < 0.001), macular edema (RR 2.98, P < 0.001), epiretinal membrane (RR 1.68, P < 0.001), macular hole/cyst/pseudohole (RR 1.93, P < 0.001), and slightly lower rates of rhegmatogenous retinal detachment (RR 0.87, P = 0.003). There was a greater rate of in-office vitreoretinal procedures, such as intravitreal injections (RR 2.22, P < 0.001), laser (RR 1.32, P < 0.001), and cataract surgery (RR 1.28, P < 0.001). However, there were lower rates of membrane peel (RR 0.74, P = 0.017) and retinal detachment repair (RR 0.60, P < 0.001) and no difference in the rate of macular hole repair (RR 1.09, P = 0.331).The discordance observed between the prevalence of potential surgical pathologies and the rates of subsequent intervention highlights the complexities in surgical decision-making for patients with IRDs.

  View details for DOI 10.1016/j.jcjo.2026.06.010

  View details for PubMedID 42468902

• Longitudinal Trends of Intraocular Lens Dislocation in a Federated Electronic Health Record Network. Ophthalmic surgery, lasers & imaging retina Lin, J. B., Wai, K. M., Alsoudi, A. F., Adam, M. K., Mruthyunjaya, P., Rahimy, E. 2026; 57 (6): 376-381

  Abstract

  The aim of this study was to characterize longitudinal trends in intraocular lens (IOL) dislocation in patients after cataract surgery.Using the TriNetX network, a retrospective cohort study was conducted of 866,010 patients who underwent cataract surgery from the years 2000 to 2024. Those patients who had experienced IOL dislocation based on International Classification of Diseases, Ninth and Tenth Revision (ICD-9 and -10) codes were identified. Patients with risk factors for IOL dislocation, such as ocular trauma, prior intravitreal injections, prior pars plana vitrectomy, pseudoexfoliation glaucoma, and Marfan syndrome, based on ICD-9/-10 and Current Procedural Terminology (CPT) codes, were also identified.From 2020 to 2024, 9,929 (1.1%) of the 866,010 patients experienced IOL dislocation. Over the past 2 decades, there was a significant monotonic increase in the incidence rate of IOL dislocation (P < .01), as well as ocular trauma (P < .01), intravitreal injections (P < .01), and pars plana vitrectomy (P < .01).IOL dislocation is becoming increasingly common. Practitioners must be prepared to manage these conditions.

  View details for DOI 10.3928/23258160-20260511-01

  View details for PubMedID 42274713

• Incidence of Actionable Ocular Pathology in Patients after Screening Positive or Indeterminate in Artificial Intelligence-Based Diabetic Retinopathy Screening Program Chung, M., Esmaeilkhanian, H., Xiang, J., Or, C., Wai, K. M., Leng, T., Wang, S., Myung, D. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2026

  View details for Web of Science ID 001886819200025

• Prevalence and incidence of mental health disorders in patients with inherited retinal diseases: a population-based study. Journal of AAPOS : the official publication of the American Association for Pediatric Ophthalmology and Strabismus Yuan, M., Alsoudi, A., Nangia, P., Guo, L., Al-Moujahed, A., Ludwig, C. A., Wai, K. M., Mruthyunjaya, P., Rahimy, E. 2026: 104860

  Abstract

  To characterize the prevalence and incidence of mental health disorders in pediatric patients with inherited retinal diseases (IRDs).This retrospective cohort study utilized the TriNetX research network to identify, using ICD-10 codes for retinal dystrophies, 74,317 unique IRD patients (16% pediatric) between January 2016 and December 2024 with at least 6 months' follow-up after diagnosis.Anxiety disorders were most prevalent (24.6%). In pediatric patients, anxiety disorders affected 15.3%, and major depression affected 7.7%. Mental health burden increased progressively during adolescence, with anxiety rising from 8.2% in early childhood to 21.4% in late adolescence. Among pediatric patients, Black children demonstrated 2.5-fold higher rates of mental health disorders compared with White children (38.4% vs 15.2%).This large-scale analysis of mental health in IRDs provides the first population-based characterization of the mental health burden across the IRD spectrum, including in pediatric patients. These findings underscore the need for integrating standardized mental health screening protocols into routine IRD management.

  View details for DOI 10.1016/j.jaapos.2026.104860

  View details for PubMedID 42167533

• Effect of Oral Opioid Prescription on Rates of Postoperative Pain among Ophthalmology Subspecialties: A Large Database Analysis OPHTHALMOLOGY SCIENCE Toth, A. B., Binczyk, N. M., Tran, E. M., Wai, K. M., Koo, E. B., Kossler, A. L., Rahimy, E., Mruthyunjaya, P., Koo, E. B. 2026; 6 (5): 101120

  Abstract

  To assess whether postoperative opioid prescriptions are associated with reduced pain diagnoses or emergency room (ER) visits after ophthalmic surgery.Retrospective cohort study using aggregated electronic health record data (June 2005-June 2025) from the TriNetX collaborative research network.Patients who underwent ophthalmic procedures across 11 subspecialty categories in the past 20 years, with or without a postoperative opioid prescription.Data were analyzed using the TriNetX integrated analytics platform. Patients with chronic pain syndrome or opioid dependence were excluded. Ophthalmic procedures were identified using Current Procedural Terminology codes, and characterized as cataract; major or minor cornea, glaucoma, oculoplastics, trauma; retina; or strabismus. Associations were assessed by calculating absolute risk differences with 95% confidence intervals (CIs) and risk ratios.Diagnosis of postprocedural pain or ER visits within 2 weeks after surgery.The study included 2 510 984 patients. Absolute rates of postoperative pain diagnoses were low across all subspecialties. Opioid prescriptions were associated with small absolute reductions in postprocedural pain diagnoses in glaucoma major (-1.3%, 95% CI: -1.4% to -1.2%, P < 0.001), oculoplastics major (-0.9%, 95% CI: -1.2% to 0.6%, P < 0.001), cornea major (-0.8%, 95% CI: -0.9% to -0.7%, P < 0.001), cornea minor (-0.8%, 95% CI: -0.8% to -0.7%, P < 0.001), trauma major (-0.8%, 95% CI: -0.9% to -0.6%, P < 0.001), trauma minor (-0.7%, 95% CI: -0.9% to -0.5%, P < 0.001), and oculoplastics minor (-0.1%, 95% CI: -0.2% to < -0.1%, P = 0.008) procedures. Emergency room visit reduction was observed only for glaucoma major procedures (-0.1%, 95% CI: -0.1% to < -0.1%, P < 0.001). In other subspecialties, opioid prescriptions were not associated with reduced ER utilization and were associated with higher ER visit rates in oculoplastics, retina, and trauma major procedures.Postoperative opioid prescriptions were associated with small absolute reductions in pain diagnoses in selected subspecialties, including cornea, glaucoma, oculoplastics, and trauma, but not cataract, retina, or strabismus. Opioid prescriptions offered no consistent benefit in reducing ER visits and were linked to higher ER visit rates in some subspecialties. These findings highlight the limited clinical benefit of routine opioid prescribing after many ophthalmic procedures and underscore the need for subspecialty-specific, evidence-based postoperative pain management strategies in ophthalmology.Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

  View details for DOI 10.1016/j.xops.2026.101120

  View details for Web of Science ID 001733468400001

  View details for PubMedID 41958712

  View details for PubMedCentralID PMC13059299

• The Role of Systemic Methotrexate on Preventing Proliferative Vitreoretinopathy Following Retinal Detachment Repair. Ophthalmic surgery, lasers & imaging retina Yavari, N., Alsoudi, A. F., Wai, K. M., Koo, E., Ludwig, C. A., Kossler, A. L., Mruthyunjaya, P., Rahimy, E. 2026; 57 (5): 320-326

  Abstract

  This study aimed to evaluate the association between systemic methotrexate (MTX) use and the incidence of proliferative vitreoretinopathy (PVR) following retinal detachment (RD) repair.A retrospective cohort study was conducted using the TriNetX Health Research Network. Patients undergoing RD repair were identified by CPT codes and stratified into MTX users (systemic exposure within one year prior to or on the day of RD repair) versus nonusers. Cases of proliferative diabetic retinopathy were excluded. The primary endpoint was development of PVR-related complications within 3, 6, and 12 months postoperatively. Propensity score matching (PSM) was performed to balance baseline demographics and clinical covariates.After 1:1 PSM, 496 patients were identified in both cohorts (mean age: 56.5 (19.0) years). MTX use was associated with significantly higher odds of tractional RD at 3 months (22.38% vs 8.06%; odds ratio [OR] 3.28, 95% CI: 2.23-4.83, P < .0001), 6 months (24.95% vs 8.11%; OR 3.76, 95% CI: 2.57-5.52, P < .0001), and 12 months (20.29% vs 10.63%; OR 2.14, 95% CI: 1.44-3.17, P < .0001). Postoperative ERM development was more frequent in MTX cohort at 3 months (11.49% vs 6.65%, OR 1.82, 95% CI: 1.16-2.85, P = .0080). No significant differences were observed in complex RD repair, repeat PPV, and PPV with ERM removal.Systemic MTX use within one year of RD repair was not associated with a reduced risk of PVR. MTX exposure correlated with increased odds of tractional RD and higher rates of ERM development rate. These findings suggest systemic MTX may not offer protective benefit against PVR.

  View details for DOI 10.3928/23258160-20260413-01

  View details for PubMedID 42139590

• Association Between Mental Health Disorders in Age-Related Macular Degeneration: A Cohort Study Using a Global Health Records Network. Ophthalmic surgery, lasers & imaging retina Xiao, J., Yavari, N., Nimmagadda, H., Mruthyunjaya, P., Rahimy, E., Smith, S. J., Ludwig, C. A., Koo, E., Wai, K. M. 2026; 57 (5): 301-308

  Abstract

  This study assessed risk of mental health disorders in patients with age-related macular degeneration (AMD).Data were obtained from an aggregated electronic health records database. Patients who were diagnosed with AMD with cataract were propensity score-matched with cataract controls. Diagnoses were identified using International Classification of Diseases, 10th Revision (ICD-10) codes. Subgroup analyses evaluated relative risk (RR) of new diagnoses of mental health disorders among patients with dry AMD, neovascular AMD (nAMD), vision impairment, and receipt of intravitreal therapy.After matching, 126,799 cases comprising 53.1% female patients with a mean age of 74.6 ± 8.9 years were included. Patients with AMD and cataract had elevated risk of receiving diagnoses of depression (RR = 1.27; 95% CI 1.24-1.29) and anxiety (RR = 1.19; 1.17-1.22). These patients were also at increased risk for self-harm (RR = 1.16), substance use (RR = 1.10), dysthymia (RR = 1.41), and psychosis (RR = 1.22) (all P < .05). The presence of visual impairment amplified these risks, particularly for depression (RR = 1.97) and anxiety (RR = 1.62). Patients with dry AMD had an increased risk of depression and anxiety compared to those with nAMD. Treatment with intravitreal injections in nAMD patients was associated with decreased risk of depression (RR = 0.88) and anxiety (RR = 0.82).AMD is associated with increased risk of mental health disorders, including anxiety, depression, and self-harm, particularly in the first year following diagnosis. Risk varies by disease subtype, visual function, and treatment status.

  View details for DOI 10.3928/23258160-20260311-02

  View details for PubMedID 42139589

• Xanthelasma and its association with developing major cardio-cerebrovascular events. Atherosclerosis Yavari, N., Wai, K. M., Alsoudi, A. F., Koo, E., Ludwig, C. A., Kossler, A. L., Mruthyunjaya, P., Rahimy, E. 2026; 416: 120647

  Abstract

  To evaluate short- and long-term incidence of major adverse cardio-cerebrovascular events (MACCEs) in patients with xanthelasma.Using TriNetX, an aggregated electronic health-records network, we identified adults with xanthelasma and matched controls with presbyopia without xanthelasma. Patients with a history of myocardial infarction (MI), ST-elevation/non-ST-elevation MI, stroke, and transient ischemic attack (TIA) any time prior to diagnosis were excluded in both cohorts. Cohorts were matched 1:1 by propensity scores, and MACCEs were compared at 1-, 5-, and 10-years. A Kaplan-Meier was evaluated with the log-rank test based on the incidence of MACCEs.After PSM, there were a total of 17,925 patients with at least 12 months of follow-up in each cohort. At 1 year, xanthelasma was associated with higher incidence of MI (1.00% vs 0.35%; hazard ratio (HR) 2.92, 95% confidence interval (CI): 2.20, 3.90), stroke (0.95% vs 0.30%; HR 3.35, 95% CI: 2.44-4.52), and TIA (0.60% vs 0.19%; HR 3.29, 95% CI: 2.24, 4.84). At 5 years, MI (2.26% vs 1.13%; HR 2.24, 95% CI: 1.89, 2.65), stroke (2.25% vs 1.03%; HR 2.46, 95% CI: 2.06, 2.93), and TIA (1.60% vs 0.74%; HR 2.41, 95% CI: 1.96, 2.97) remained high. At 10 years, MI (3.13% vs 1.73%; HR 2.14, 95% CI: 1.85, 2.45), stroke (3.00% vs 1.53%; HR 2.32, 95% CI: 2.00, 2.70), and TIA (2.00% vs 1.13%; HR 2.10, 95% CI: 1.75, 2.50) remained elevated. All comparisons were statistically significant (p < 0.0001).Xanthelasma is associated with higher short- and long-term incidence of MACCEs up to 10 years, highlighting its value as a clinical marker for cardiocerebrovascular risk stratification and preventive management.

  View details for DOI 10.1016/j.atherosclerosis.2026.120647

  View details for PubMedID 42019468

• Survival Rates After Pars Plana Vitrectomy for Proliferative Diabetic Retinopathy. Journal of vitreoretinal diseases Chung, M. E., Pan, C. K., Smith, S. J., Greven, M. A., Koo, E., Ludwig, C. A., Rahimy, E., Mruthyunjaya, P., Wai, K. M. 2026: 24741264261432178

  Abstract

  Purpose: To provide updated survival data for patients with proliferative diabetic retinopathy (PDR) undergoing pars plana vitrectomy (PPV) and identify associated prognostic factors. Methods: An aggregated electronic health records research network was used to identify patients with a diagnosis of PDR who underwent PPV between 2009 and 2019 and a control group of patients with PDR without a history of PPV. Groups were propensity score matched for age, sex, race, ethnicity, and HbA1c. Main outcomes included survival rates at 3, 5, and 10 years using the Kaplan-Meier life table method. Additional analyses were performed to assess if survival rates differed in patients with PDR by PPV indication (vitreous hemorrhage [VH] or tractional retinal detachment [TRD]). Results: A total of 8637 patients were included. The 3-, 5-, and 10-year survival rates in patients with PDR after PPV were 89.2%, 80.9%, and 52.8%, respectively. Survival rates in patients with PDR with a history of PPV vs without a history of PPV were lower at 3 (88.7% vs 89.9%; P = .03), 5 (80.2% vs 82.6%; P < .01), and 10 years (51.4% vs 55.8%; P < .01). Survival rates were similar between patients who underwent PPV for VH or TRD at 3 (90.4% vs 88.7%; P = .05), 5 (82.7% vs 81.0%; P = .10), and 10 years (53.0% vs 53.4%; P = .75). Conclusions: Despite major advances in diabetes care, the long-term survival rates in patients with PDR after PPV have remained stable the last 2 decades, emphasizing the need for multidisciplinary evaluation and prompt cardiovascular and renal optimization.

  View details for DOI 10.1177/24741264261432178

  View details for PubMedID 41993973

  View details for PubMedCentralID PMC13079556

• Prevalence of Systemic Comorbidities and Ocular Complications in Patients With Bilateral Retinal Telangiectasia. Journal of vitreoretinal diseases Zhao, C. S., Do, D. V., Sanislo, S. R., Ludwig, C., Rahimy, E., Mruthyunjaya, P., Wai, K. M. 2026: 24741264261423313

  Abstract

  Purpose: To compare systemic comorbidities in bilateral retinal telangiectasia, a proxy for macular telangiectasia (MacTel) type 2, vs matched controls. Methods: We conducted a retrospective cohort study of a large electronic health research network of patients who were older than 45 years at bilateral retinal telangiectasia diagnosis vs controls receiving eye care. Patients with macular edema or exudative age-related macular degeneration were excluded. Propensity score matching was performed on demographics. The prevalence of hypertension, diabetes mellitus, obesity, hyperlipidemia, and death within 5 years of retinal telangiectasia diagnosis or eye care visit were compared. Results: 2320 patients with bilateral retinal telangiectasia and 1 671 600 patients with an eye care visit were included. After matching, no demographic differences persisted. Bilateral retinal telangiectasia (vs control) patients had higher rates of type 2 diabetes mellitus (32.8% vs 20.7%; odds ratio [OR], 1.87; 95% CI, 1.64-2.14; P < .005) and obesity (19.9% vs 16.9%; OR 1.22; 95% CI:1.05-1.42; P = .01) and a lower rate of hyperlipidemia (32.0% vs 39.5%; OR 0.71; 95% CI, 0.63-0.80; P < .005). No differences occurred in hypertension or death. Conclusions: Retinal telangiectasia and MacTel type 2 are uncommon and poorly understood, with high coexisting rates of diabetes and obesity. Systemic disease associations should be investigated to identify disease interactions, the impact of systemic interventions, and leads for potential new treatments.

  View details for DOI 10.1177/24741264261423313

  View details for PubMedID 41783117

  View details for PubMedCentralID PMC12953167

• Risk of diabetic retinopathy progression after YAG laser capsulotomy. Journal of cataract and refractive surgery Alshaikhsalama, A. M., Mansoor, B. S., Zaidi, Z., Alsoudi, A., Loya, A., Wai, K., Koo, E., Ludwig, C., Mruthyunjaya, P., Rahimy, E. 2026; 52 (3): 282-288

  Abstract

  To evaluate the risk of diabetic retinopathy (DR) progression and associated ophthalmic complications after YAG laser capsulotomy in patients with nonproliferative DR (NPDR) after cataract surgery.Multicenter study using deidentified electronic health records from 69 U.S. healthcare organizations across outpatient and academic ophthalmology settings.Retrospective cohort study using propensity score matching to balance baseline characteristics.Patients aged 18 years or older with type 1 or 2 diabetes and NPDR who underwent cataract surgery with or without subsequent YAG laser capsulotomy were identified. Patients were followed for 1-year postcataract surgery. Exclusion criteria included less than 6 months of follow-up. Primary outcomes included development of proliferative DR (PDR), vitreous hemorrhage (VH), tractional retinal detachment (TRD), neovascular glaucoma, and need for panretinal photocoagulation (PRP) or pars plana vitrectomy.10 750 patients (10 750 eyes) were included after matching: 5375 YAG-treated and 5375 control eyes. At 1 year, YAG-treated patients had higher risk of PDR (hazard ratio [HR], 1.91; 95% CI, 1.67-2.18), VH (HR, 1.40; 95% CI, 1.15-1.72), TRD (HR, 2.04; 95% CI, 1.32-3.13), and PRP (HR, 1.48; 95% CI, 1.14-1.91). A secondary analysis of patients with ≥5 years of NPDR showed similar elevated risks.YAG laser capsulotomy in patients with NPDR is associated with increased risk of DR progression and vision-threatening complications. Ophthalmic screening and close follow-up are recommended in this population after YAG treatment.

  View details for DOI 10.1097/j.jcrs.0000000000001813

  View details for PubMedID 41719525

• 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

• Risk of mental health disorders following traumatic ocular and orbital injury. Graefe's archive for clinical and experimental ophthalmology = Albrecht von Graefes Archiv fur klinische und experimentelle Ophthalmologie Elaraby, O., Yuan, M., Rahimy, E., Koo, E., Ludwig, C. A., Mruthyunjaya, P., Wai, K. M. 2026

  View details for DOI 10.1007/s00417-026-07136-0

  View details for PubMedID 41721854

  View details for PubMedCentralID 5072032

• The Risk of Retinal Breaks or Detachment in Fellow Eye with Lattice Degeneration after Primary Rhegmatogenous Retinal Detachment. Retina (Philadelphia, Pa.) Arnal, L., Mesfin, Y., Salvi, A., Wai, K. M., Rahimy, E., Mruthyunjaya, P., Ludwig, C. A. 2026

  Abstract

  Lattice poses risks to patients with prior detachments. This study evaluates such patients' likelihood of rhegmatogenous retinal detachments (RRD) and retinal breaks (RB) and assesses the efficacy of prophylactic laser retinopexy and cryopexy.Retrospective cohort study utilizing the TriNetX registry. Patients either with or without prior contralateral RRD/RB and also with fellow eye lattice were included. Logistic regression calculated the likelihood of RRD/RB in the fellow eye. The number needed to treat (NNT) was calculated for prophylactic laser retinopexy and cryopexy.Patients with prior unilateral RRD/RB had a higher likelihood of fellow eye RRD/RB than those without prior unilateral RRD/RB (OR: 4.47, 99% CI: 3.47-5.76). Myopia increased this likelihood (OR: 5.67, 99% CI: 3.80-8.48). The NNT to prevent one RRD was lower for patients with prior unilateral RRD (NNT: 5.63; 95% CI: 4.07-5.37) than those without (NNT: 43.29; 95% CI: 38.72-49.08). The NNT to prevent one RB was lower for patients with prior unilateral RB (NNT: 3.83; 95% CI: 3.37-4.44) than those without (NNT: 45.70; 95% CI: 39.99-53.30).Prior contralateral RRD/RB increases the likelihood of RRD/RB in fellow eyes with lattice. Prophylactic laser retinopexy and cryopexy reduces the number of fellow eye RRD/RB.

  View details for DOI 10.1097/IAE.0000000000004806

  View details for PubMedID 41707078

• Recurrent Macular Edema Associated With Belzutifan Therapy for Metastatic Renal Cell Carcinoma. Journal of vitreoretinal diseases Chung, M. E., Wai, K. M. 2026: 24741264261418516

  Abstract

  Purpose: To report a case of rapidly reversible cystoid macular edema (ME) associated with belzutifan therapy. Methods: A single case was reviewed. Results: A 70-year-old man with sporadic metastatic renal cell carcinoma developed acute symptomatic cystoid macular edema (CME) within 2 weeks of initiating belzutifan therapy. The CME began to improve within 1 week after treatment cessation and resolved completely thereafter. Belzutifan was subsequently restarted at a lower dose, following which CME recurred within 2 weeks. Conclusions: This is the first reported instance of rapidly reversible CME associated with the use of belzutifan in a real-world clinical setting, highlighting the need for ophthalmic monitoring in patients receiving hypoxia-inducible factor-2α inhibitors.

  View details for DOI 10.1177/24741264261418516

  View details for PubMedID 41640429

  View details for PubMedCentralID PMC12864017

• Ocular and Orbital Trauma Correlated With an Increased Risk of Mortality in Female Patients With a History of Intimate Partner Violence AMERICAN JOURNAL OF OPHTHALMOLOGY Amarikwa, L., Renner, L. M., Wai, K. M., Homer, N. A., Ludwig, C. A., Koo, E., Rahimy, E., Mruthyunjaya, P., Shriver, E. M., Kossler, A. L. 2026; 282: 502-503

  Abstract

  XXX.

  View details for DOI 10.1016/j.ajo.2025.10.040

  View details for Web of Science ID 001666612300001

  View details for PubMedID 41253212

• Risk of Glaucoma after Pars Plana Vitrectomy in a Large Federated Health Record Network. Ophthalmology science Lin, J. B., Wai, K. M., Mruthyunjaya, P., Rahimy, E. 2026; 6 (1): 100807

  Abstract

  To examine the risk of glaucoma after pars plana vitrectomy (PPV).We conducted a retrospective cohort study using aggregate electronic health record data from the large, federated TriNetX network.We identified a retrospective cohort of 42 242 patients from 67 health care organizations in the United States who underwent PPV based on Current Procedural Terminology (CPT) codes from the period between January 1, 2013 and December 31, 2018 and identified subcohorts based on preoperative diagnoses of epiretinal membrane, macular hole, tractional retinal detachment, and rhegmatogenous retinal detachment.Among these patients, we identified patients who were newly diagnosed with glaucoma after PPV based on International Classification of Diseases, Tenth Revision codes, those who required topical intraocular pressure (IOP)-lowering medications after PPV, and those who required incisional glaucoma surgery based on CPT codes, in the postoperative period between 3 months and 5 years after surgery.Five-year cumulative risk of new diagnosis of glaucoma, of initiation of topical IOP-lowering medications, or of need for incisional glaucoma surgery (i.e., glaucoma drainage implant or trabeculectomy); Kaplan-Meier probability of being diagnosed with glaucoma or of requiring topical IOP-lowering medications.In our retrospective cohort, >5% of patients who underwent PPV were newly diagnosed with glaucoma and >9% newly required topical IOP-lowering medications in the 5-year period after surgery. Patients with a preoperative diagnosis of rhegmatogenous or tractional retinal detachment had a significantly higher risk of glaucoma compared with those with a preoperative diagnosis of epiretinal membrane or macular hole (P < 0.001).We estimate that the risk of glaucoma in patients after PPV is >5%. It is important to monitor for the development of ocular hypertension or glaucoma in patients after PPV, so they can receive treatment if necessary to prevent further vision loss.Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

  View details for DOI 10.1016/j.xops.2025.100807

  View details for PubMedID 41140897

  View details for PubMedCentralID PMC12553039

• Ocular adverse effects of bisphosphonates and association with osteonecrosis from a real-world database. Eye (London, England) Kim, S. H., Rahimy, E., Koo, E. B., Ludwig, C. A., Kossler, A. L., Mruthyunjaya, P., Wai, K. M. 2025

  Abstract

  While bisphosphonates are widely used to treat osteoporosis, ocular adverse effects (OAEs) and their associations with serious systemic side effects, such as osteonecrosis, remain unexplored in large, diverse cohorts.Retrospective cohort study from a deidentified aggregated multinational electronic health records database. Patients were included based on no prior recorded history of OAEs, recorded prescription of bisphosphonates and a subsequent visit. The risk of osteonecrosis for patients with and without OAEs after bisphosphonate initiation was assessed. Propensity score matching was used to control for demographic factors and prior autoimmune conditions. Rates of OAEs were compared between patients on intravenous or oral bisphosphonates.A cohort of 944,559 patients was identified. The cohort mean age was 75 years. The most common OAEs were dry eyes (1.73%), cornea and ocular surface inflammation (0.97%), and uveitis (0.17%). Patients with any OAEs with bisphosphonate use compared to those without OAEs had an increased risk of osteonecrosis (RR: 1.48, (1.30, 1.93)), with the highest increased risk for zoledronate (RR: 2.22, (1.63-3.03)). Furthermore, intravenous bisphosphonates compared to oral bisphosphonates had an increased risk of dry eyes (RR: 1.27 (1.20, 1.36)) at all timepoints.Although rarer than reported in literature, our large cohort size revealed that patients on bisphosphonates with OAEs had an increased risk of osteonecrosis compared to those without OAEs. Patients on intravenous compared to oral bisphosphonates were at increased risk for OAEs. These findings guide ophthalmologists to identify OAEs from bisphosphonate use and to be vigilant for increased risks of systemic side effects.

  View details for DOI 10.1038/s41433-025-04185-3

  View details for PubMedID 41454062

  View details for PubMedCentralID 4652608

• Corticosteroids Versus Teprotumumab for the Treatment of Thyroid Eye Disease. Does Either Mitigate the Need for Additional Treatments? Thyroid : official journal of the American Thyroid Association Choi, S., Shah, S. V., Chandraparnik, P., Wai, K. M., Rahimy, E., Koo, E., Ludwig, C. A., Pakdel, F., Dosiou, C., Mruthyunjaya, P., Kossler, A. L. 2025

  Abstract

  Background: The treatment paradigm for thyroid eye disease (TED) in the United States has shifted from corticosteroids toward targeted therapies such as teprotumumab. However, it remains unknown whether teprotumumab decreases the need for subsequent treatments for TED compared with intravenous methylprednisolone (IVMP). This study compares the long-term need for additional medical or surgical interventions in TED patients treated with teprotumumab versus IVMP. Methods: A retrospective cohort study identified TED patients treated with IVMP or teprotumumab utilizing the TriNetX Analytics platform. Patients with comorbidities requiring high-dose steroids, prior TED therapy within 6 months, or concurrent TED treatments were excluded. Propensity score matching (PSM) adjusted for baseline demographic and TED-related risk factor differences. Patients were followed for 6, 12, and 18 months after a 6-month washout period. The primary outcome was the incidence of additional TED-related interventions. Secondary outcomes included post-treatment care trajectories, treatment burden, and complexity, assessed through longitudinal pathway analysis. Results: The IVMP cohort included 308 patients, and the teprotumumab cohort included 417; after PSM, each contained 263 patients. No significant differences were found in the incidence of additional TED-related interventions between cohorts. A similar percentage required additional medical therapies (41% vs. 37%, p = 0.423), while fewer in the IVMP cohort underwent additional surgical interventions (3.8% vs. 8.8%, p = 0.019, 4.8% vs. 10.0%, p = 0.040) at 12 and 18 months. Among those needing additional TED interventions, the IVMP cohort exhibited a higher treatment burden and more complex treatment trajectories, requiring a greater average number of treatments (2.34 vs. 1.34 per patient; 32.8% vs. 5.5% requiring ≥3 additional treatments). Conclusions: TED patients treated with IVMP or teprotumumab had similar overall rates of additional interventions. However, IVMP was associated with greater treatment complexity, requiring more varied medical therapies. Teprotumumab-treated patients typically required fewer additional medical therapies and underwent more surgical interventions as a second-line step, suggesting that teprotumumab may simplify the treatment pathway. These data have important implications for patient education and future assessment of the cost-effectiveness of TED therapies.

  View details for DOI 10.1177/10507256251408731

  View details for PubMedID 41467905

• Risk of intestinal complications, extraintestinal morbidity, and mortality in patients with ulcerative colitis and ocular involvement. Eye (London, England) Do, B. K., Alsoudi, A. F., Wai, K. M., Koo, E., McConnell, R. A., Pham, N. H., Kossler, A. L., Mruthyunjaya, P., Rahimy, E. 2025

  Abstract

  To explore health outcomes of patients with ulcerative colitis (UC) and associated ocular inflammatory disease, compared to those of matched patients with UC without associated ocular inflammatory disease.Retrospective case-control study.An aggregated electronic health records research network, TriNetX (Cambridge, MA, USA), was used to identify patients diagnosed with UC stratified by the presence or absence of ocular inflammatory disease with at least one year of follow-up. Propensity score matching (PSM) was performed to control for baseline demographics and medical comorbidities.Rates and relative risk (RR) of developing various forms of intestinal complications, extraintestinal morbidities, rheumatologic disease, cardiovascular disease, and death.Patients with UC with associated ocular inflammatory disease showed greater risk of undergoing total colectomy, as well as acquiring Clostridioides difficile and CMV colitis. They also demonstrated a greater risk of developing MASLD, vitamin D deficiency, iron deficiency anaemia, UC-related dermatological disease, osteoporosis, and sepsis. These individuals were more likely to carry rheumatologic diagnoses, including ankylosing spondylitis, psoriatic, rheumatoid, enteropathic, reactive, and inflammatory arthritis. There was an elevated risk of stroke, myocardial infarction, and VTE in this cohort as well. There was no significant difference in risks of colorectal cancer, primary sclerosing cholangitis, toxic megacolon, non-radiographic axial spondyloarthritis, or mortality between the cohorts.Patients with UC with ocular inflammatory disease have an increased risk of intestinal complications, extraintestinal morbidity, rheumatologic disease, and cardiovascular complications when compared to those without.

  View details for DOI 10.1038/s41433-025-04151-z

  View details for PubMedID 41345346

  View details for PubMedCentralID 3959315

• Reply to Comment on Ocular and Orbital Trauma Correlated With an Increased Risk of Mortality in Female Patients With a History of Intimate Partner Violence. American journal of ophthalmology Amarikwa, L., Renner, L. M., Homer, N. A., Wai, K. M., Ludwig, C. A., Koo, E., Rahimy, E., Mruthyunjaya, P., Shriver, E. M., Kossler, A. L. 2025

  Abstract

  XXX.

  View details for DOI 10.1016/j.ajo.2025.11.013

  View details for PubMedID 41253212

• 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

• Ocular and Orbital Trauma Correlated with an Increased Risk of Mortality in Female Patients with a History of Intimate Partner Violence. American journal of ophthalmology Amarikwa, L., Renner, L. M., Homer, N. A., Wai, K. M., Ludwig, C. A., Koo, E., Rahimy, E., Mruthyunjaya, P., Shriver, E. M., Kossler, A. L. 2025

  Abstract

  To characterize the risk factors for mortality and rates of mortality in female patients with a history of ocular or orbital trauma and intimate partner violence (IPV).This is a retrospective cohort study that included all data from 2005 to 2024.Included females aged 18-55 years old with variable history of IPV and orbital trauma.Patients were identified using the TriNetX Network and were grouped by presence of IPV and orbital trauma. Rates of mortality, hospitalization, and emergency department (ED) visits following trauma were analyzed. Propensity score matching (PSM) was done to control for differences in baseline demographics and medical comorbidities. Cox regression analysis was completed to determine the association between mortality and known risk factors for IPV.Hazard ratio (HR) for mortality and rate of 5-year mortality following ocular or orbital trauma.After matching and assessing for the presence of ocular or orbital trauma, 2,812 patients were included in both the IPV-related ocular or orbital trauma and IPV with no ocular or orbital trauma groups. The analysis found that a history of ocular or orbital trauma increased the risk of mortality in patients with a history of IPV (hazard ratio (HR) = 1.7, 95% CI: 1.3-2.4, p < 0.001).A history of ocular or orbital trauma is a significant risk factor for mortality among female patients with a history of IPV. High risk patients should be identified at the time of presentation and protective measures initiated.

  View details for DOI 10.1016/j.ajo.2025.09.013

  View details for PubMedID 40945888

• Ocular Adverse Events of Antibody Drug Conjugates and Association With Survival From a Real-World Database. Cornea Kim, S. H., Marshall, R. F., Wai, K. M., Rahimy, E., Vingopoulos, F., Mishra, K., Berkenstock, M., Mruthyunjaya, P. 2025

  Abstract

  Ocular adverse events can be black box warning complications for antibody drug conjugates (ADCs), requiring ophthalmologic evaluation. Although extensive management and deescalation protocols are in place, association with overall survival for patients with ocular adverse events are unknown.Retrospective cohort study with data from deidentified aggregated electronic health records database. Inclusion criteria were prescription of ADCs, no prior recorded ocular symptoms, and the presence of a clinical visit after ADC initiation. Propensity score matching was used to control for demographic factors and cancer diagnoses.A cohort of 14,138 patients with a mean age of 59 years (SD: 20y) was identified. Most common ocular adverse events were dry eyes (2.9%), keratitis or conjunctivitis (2.21%), uveitis (0.23%), and corneal ulcers (0.085%). Belantamab mafodotin had the highest rates of keratitis or conjunctivitis (17.8%). Patients without any ocular adverse events after ADC initiation had an increased risk of death [RR: 1.20, P = 0.0013] within 5 years compared with patients with ocular adverse events. Specifically, patients without keratitis or conjunctivitis after ADC initiation had an increased risk of death [RR: 1.43, P = 0.019] within 1 year.Uveitis and corneal ulcers were exceedingly rare for all ADCs. Patients on ADCs with ocular adverse events, compared with those without, had a decreased risk of death. As ophthalmologic management of patients on ADCs are becoming more prevalent, aggressive management of ocular adverse events may be warranted, when ADCs are effective, as ocular adverse events may portend better survival outcomes.

  View details for DOI 10.1097/ICO.0000000000003997

  View details for PubMedID 40957001

• Time to incident ocular and extraintestinal manifestation in HLA-B27-Associated diseases: a comparative study of immunotherapies. Clinical rheumatology Yavari, N., Wai, K. M., Alsoudi, A. F., Koo, E., Ludwig, C. A., Kossler, A. L., Nguyen, Q. D., Mruthyunjaya, P., Rahimy, E. 2025

  Abstract

  This study compared the incidence and time-to-event outcomes of ocular extraintestinal manifestations (O-EIMs) and EIMs among patients with human leukocyte antigen (HLA)-B27-associated diseases receiving different classes of immunotherapy.A retrospective cohort study was conducted using aggregated electronic health records from the TriNetX network between January 1, 2014, and December 31, 2024. Patients with HLA-B27-associated diseases were included if they were newly prescribed tumor necrosis factor (TNF), janus kinase (JAK), or interleukin (IL) inhibitors on or after their initial diagnosis. The cumulative incidence of O-EIMs and EIMs was calculated per 100 person-years. Kaplan-Meier estimates were used to graph time-to-event outcomes using R Studio (version 4.4.1).We identified 22,287 patients [mean age 47.2 (16.8) years; 13,132 (58.9) % women]. The cumulative incidence of anterior uveitis from the index date was 0.11 cases per 100 person-years. According to first medication prescribed, the incidence of anterior uveitis was lowest in patients prescribed IL inhibitors, followed by JAK and TNF inhibitors (0.07%, 0.10%, and 0.20%, cases per 100 person-years respectively). Time-to-event analysis showed a higher likelihood of anterior uveitis with initial TNF inhibitor use, although the difference was not statistically significant. Regarding EIMs, incident sacroiliitis was highest with TNF (0.91%), followed by JAK (0.72%) and IL (0.37%). Psoriatic dermatitis incidence was highest with JAK inhibitors (2.85%), compared to TNF (2.19%) and IL (2.17%).In this cohort study of patients with HLA-B27-associated diseases, the lack of statistical significance indicates similar effectiveness across immunotherapy classes in preventing O-EIMs and EIMs. Key Points • Large-scale comparative study assessing time-to-incident O-EIMs and EIMs in patients with HLA-B27-associated diseases treated with TNF, JAK, or IL inhibitor therapies using real-world data from the TriNetX network. • Low overall incidence of O-EIMs and EIMs was observed across all immunotherapy classes, with no statistically significant difference in time-to-event outcomes, indicating similar effectiveness in preventing these manifestations.

  View details for DOI 10.1007/s10067-025-07670-y

  View details for PubMedID 40906344

  View details for PubMedCentralID 6597169

• Machine Learning Predictive Models for Survival in Gastric Cancer Patients with Diabetes: A Population-Based Cohort Study ONCOLOGY Huang, J., Zhong, C., Li, Z., Jiang, Y., Yang, Z., Yuan, J., Poon, J., Dou, Q., Wong, M. C. S. 2025: 1-20

  Abstract

  Our study aimed to identify risk factors associated with the survival of gastric cancer patients with type 2 diabetes mellitus (T2DM) and create a risk-scoring system for predicting their survival probabilities.We gathered data from 1,912 individuals with both gastric cancer and T2DM from the Hong Kong Hospital Authority Data Collaboration Laboratory (HADCL), spanning from 2000 to 2020. We used conventional Cox proportional hazards regression and tree-based machine learning algorithms to construct models for prognosis risk prediction. In the best-performing model, risk factors were identified using SHAP (Shapley Additive Explanations) analysis, and the AutoScore-Survival package was used to develop a risk-scoring system.Our findings indicate that older age at cancer diagnosis, longer duration of T2DM, higher body mass index (BMI), central obesity, lower levels of high-density lipoprotein cholesterol, and reduced serum potassium are associated with poorer prognosis for gastric cancer in patients with T2DM. The Random Survival Forests (RSF) model exhibited the best performance, achieving an AUC of 0.870 and a concordance index of 0.78. Additionally, we developed two risk-scoring systems using predefined and tuned models, which yielded C-indices of 0.672 and 0.654, respectively, in the test set.This study enhances our understanding of gastric cancer prognosis in patients with T2DM by identifying significant risk factors and developing risk-scoring systems. Further research is needed to elucidate the underlying mechanisms of these risk factors and to validate the risk-scoring systems in clinical settings.

  View details for DOI 10.1159/000548220

  View details for Web of Science ID 001604147600001

  View details for PubMedID 40906601

• Mammalian Target Rapamycin Inhibition as a Therapeutic Target for Prevention of Proliferative Vitreoretinopathy. JAMA ophthalmology Alsoudi, A. F., Loya, A., Wai, K., Koo, E., Weng, C. Y., Mruthyunjaya, P., Rahimy, E. 2025

  Abstract

  The use of systemic mammalian target of rapamycin (mTOR) inhibitor (MTI) therapy may confer benefits against the development of proliferative vitreoretinopathy (PVR).To examine the use of systemic MTI therapy for the prevention of PVR among patients who underwent initial retinal detachment (RD) repair.This was a retrospective cohort study aggregating deidentified electronic health record data from January 2003 to January 2025, from 15 countries. The study included 681 patients who underwent primary RD repair while receiving systemic MTI therapy at least 3 months before and 1 year after initial RD repair. This cohort was compared with a control group of 47 626 patients never exposed to systemic mTOR inhibition. After propensity score matching, outcomes from 681 patients in each cohort were analyzed after 1 year following their initial RD surgery.Patients were stratified by use of systemic mTOR therapy or not using RxNorm code.Relative risk (RR) of developing a PVR-related RD and requiring a subsequent ocular intervention including pars plana vitrectomy (PPV), and complex RD repair within 6 months and 1 year of follow-up. Patients who underwent initial RD repair while receiving systemic MTI therapy were separately compared with a matched cohort of patients with concomitant use of systemic methotrexate (MTX) for the same measures at 6 months and 1 year.A total of 681 and 47 626 patients who underwent initial RD repair with concomitant use of an MTI or not, respectively, were identified prior to PSM. The mean (SD) age in the MTI cohort was 66.5 (15.4) years; 319 (46.8%) were female and 319 (46.8%) were male. In the control cohort, the mean (SD) age was 64.5 (17.6) years; 16 140 (33.9%) were female and 27 858 (58.5%) were male. At 1 year, concomitant use of systemic MTI therapy was associated with a decreased risk of developing a subsequent RD (RR, 0.58; 95% CI, 0.36-0.94; P = .03) compared with matched patients who underwent initial RD repair without exposure to systemic MTI therapy. Moreover, concomitant use of systemic MTI therapy was associated with a decreased risk of requiring subsequent PPV (RR, 0.57; 95% CI, 0.40-0.82; P < .001) and complex RD repair (RR, 0.60; 95% CI, 0.40-0.91; P = .01) when compared with matched patients who underwent initial RD repair without exposure to systemic MTI therapy at 1 year. There was no difference in the development of subsequent RD and need for PPV or complex RD repair when comparing patients who underwent initial RD repair with concomitant systemic MTI therapy to a matched cohort of patients with concomitant use of systemic MTX therapy at 6 months and 1 year.Patients who underwent initial RD repair and were concomitantly being treated with systemic MTI therapy were less likely to develop a subsequent PVR-related RD compared with matched patients not exposed to systemic MTI therapy. Future studies are needed to investigate MTI therapy safety and efficacy profile in this setting of potential PVR prevention.

  View details for DOI 10.1001/jamaophthalmol.2025.2497

  View details for PubMedID 40773191

• Risk of developing thyroid eye disease in patients with thyroid dysfunction that received a COVID-19 vaccination. Canadian journal of ophthalmology. Journal canadien d'ophtalmologie Amarikwa, L., Chandraparnik, P., Wai, K. M., Rahimy, E., Kinde, B., Koo, E., Ludwig, C. A., Dosiou, C., Mruthyunjaya, P., Kossler, A. L. 2025

  Abstract

  To assess the risk of developing thyroid eye disease (TED) after receiving mRNA COVID-19 vaccination in patients with thyroid dysfunction.A retrospective cohort study.All patients with hyperthyroidism who have no history of TED prior to March 2021 and no history of another orbital inflammatory disease.The rates of TED in patients that received or did not receive any type of COVID-19 vaccination were compared. TED incidence was also compared in those receiving influenza and Tdap vaccines. All patient records were identified using the TriNetX network (Cambridge, MA). Propensity score matching (PSM) was done to control for differences in baseline demographics and medical comorbidities. The primary outcome was the relative risk of developing TED after COVID-19 vaccination.A total of 373,909 patients with hyperthyroidism and no signs of TED were identified. After matching and assessing for vaccination status, 69,378 patients were in the COVID-19 vaccine and no COVID-19 vaccine cohorts. We found that COVID-19 vaccination resulted in an increased risk of developing TED when compared with the no COVID-19 vaccine (RR = 1.49, 95% CI: 1.39-1.58), Tdap (RR = 1.80, 95% CI: 1.56-2.06), and influenza cohorts (RR = 1.68, 95% CI: 1.49-1.88).Patients with underlying hyperthyroidism demonstrated an increased risk of developing TED following COVID-19 vaccination. Although further studies are required to confirm these findings, patients with underlying autoimmune thyroid dysfunction should receive education on the signs and symptoms of TED and be monitored for the development of TED after COVID-19 vaccination.

  View details for DOI 10.1016/j.jcjo.2025.06.017

  View details for PubMedID 40684801

• 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

• Long-Term Cannabis Use and Risk of Postoperative Proliferative Vitreoretinopathy. JAMA ophthalmology Alshaikhsalama, A. M., Alsoudi, A. F., Mukhtar, A., Wai, K., Koo, E., Kossler, A., Ludwig, C., Mruthyunjaya, P., Rahimy, E. 2025

  Abstract

  Proliferative vitreoretinopathy (PVR) is a major cause of retinal detachment (RD) repair failure, resulting in poor visual outcomes. Cannabis use continues to increase globally and may affect PVR development through its anti-inflammatory and neuroprotective properties, although this association remains unclear.To assess the risk of developing PVR among patients with concomitant cannabis use who underwent primary RD repair.This retrospective cohort study examined data from electronic health records for a multicenter research network extracted for the period February 1, 2005, to February 1, 2025. Participants were patients who underwent initial RD repair with pars plana vitrectomy (PPV) with or without scleral buckle (SB), primary SB, or pneumatic retinopexy. The records were used to identify patients diagnosed with concomitant cannabis-related disorder together with confirmatory testing of cannabis in urine or blood compared with a control group without documented use. Exclusion criteria were a history proliferative diabetic retinopathy or less than 6 months of follow-up.Primary RD repair and cannabis-related disorder.Relative risk (RR) of developing PVR and requiring a subsequent complex RD repair at 6 months and 1 year of follow-up.After propensity score matching, each cohort had 1193 patients. The mean (SD) age was 53.2 (16.1) years; 1662 were male (69.7%), 641 were female (26.9%), and for 83 patients (3.5%), the sex was unknown. At 6 months, patients with concomitant cannabis use with RD repaired by any method had a reduced risk of developing subsequent PVR (25 events [2.10%] vs 52 events [4.36%]; RR, 0.48; 95% CI, 0.30-0.77; P = .002) and requiring complex RD repair (37 [3.10%] vs 60 [5.03%]; RR, 0.62; 95% CI, 0.41-0.92; P = .02) when compared with controls. Similar results were observed at 1 year for both outcomes.Patients who underwent initial repair for RD with concomitant cannabis use were less likely to develop PVR and require subsequent complex RD repair compared with matched patients without documented cannabis exposure; however, the absolute difference in rates was small. While this protective association noted with cannabis use could be due to the population using it rather than an effect of the cannabis itself, the findings suggest that cannabis use might have a role in reducing PVR development. Intervention trials would be needed to try to control for confounding factors.

  View details for DOI 10.1001/jamaophthalmol.2025.1851

  View details for PubMedID 40608320

• Gout and Risk of Age-related Macular Degeneration. Retina (Philadelphia, Pa.) Alshaikhsalama, A. M., Alsoudi, A. F., Wai, K. M., Koo, E., Mruthyunjaya, P., Rahimy, E. 2025

  Abstract

  To examine the association between gout and subsequent development and progression of age-related macular degeneration (AMD).In this retrospective cohort study, a multicenter healthcare research network was used to identify patients with an International Classification of Diseases, Tenth Revision (ICD-10 code) for idiopathic gout and a prescription for uric acid-lowering agent (Gout cohort) compared to a matched cohort of patients without a diagnosis of gout (Control cohort) for ophthalmic outcomes. Propensity score matching was applied to balance baseline demographics and health status between cohorts.Patients with gout had an increased risk of developing dry AMD (RR, 2.73, 95% CI, 2.30 - 3.25; P<.001), advanced dry AMD (RR, 2.64, 95% CI, 1.32 - 5.28; P<.001), wet AMD (RR, 2.48, 95% CI, 1.82 - 3.38; P<.001), and needing subsequent anti-VEGF therapy (RR, 2.80, 95% CI, 2.14 - 3.67; P<.001) compared to those without gout at five years. Similar trends were observed among patients with early AMD and gout compared to those with early AMD without gout.In a national multicenter database, an increased risk of AMD development and progression to advanced disease stages was found among patient with gout compared to controls. Additional investigation into the mechanisms and effects of hyperuricemia are necessary to clarify these associations.

  View details for DOI 10.1097/IAE.0000000000004604

  View details for PubMedID 40632946

• Low Occurrence of Ocular Adverse Events after CAR-T Cell Therapy. Ocular oncology and pathology Murty, T., Wai, K. M., Rahimy, E., Mruthyunjaya, P. 2025; 11 (2): 104-108

  Abstract

  Chimeric antigen receptor (CAR)-T cell therapies have demonstrated remarkable therapeutic efficacy in leukemias and lymphomas that were previously considered incurable. However, concerns persist over potential risks related to toxicities, including those secondary to activation of the patient's immune system.To investigate ocular adverse effects (o-AEs) associated with CAR-T cell therapy, a retrospective cohort study was designed in which data were obtained from the TriNetX aggregated electronic health records database through August 2024, with data analysis performed in August 2024. Billing codes were used to identify patients receiving autologous CAR-T therapy approved by the US Food and Drug Administration (FDA) for the treatment of a hematological malignancy: tisagenlecleucel, brexucabtagene autoleucel, lisocabtagene maraleucel, ciltacabtagene autoleucel, idecabtagene vicleucel, or axicabtagene ciloleucel.In a cohort of 684 patients on CAR-T therapy with at least 6 months of follow-up, the most prevalent o-AEs were related to vision changes (1.9%), which included vitreous opacities, visual disturbances, diplopia, and visual discomfort; inflammation (1.8%), which included optic neuritis, conjunctivitis, optic papillitis, chorioretinal inflammation, iridocyclitis, zoster ocular disease; and dry eyes (1.6%), which included dry eye syndrome, keratitis, and ocular manifestations of Vitamin A deficiency.In the period of 6 months following CAR-T therapy infusion, o-AEs were rare in patients receiving CAR-T cell therapy, indicating that patients without existing eye conditions do not need routine prescreening or directed follow-up after treatment, unless symptomatic. Ongoing monitoring and reporting of ocular adverse events will be important given the durable effects of CAR-T therapy in the treatment of hematologic cancers as well as increasing indications for CAR-T therapy in malignant and nonmalignant disease.

  View details for DOI 10.1159/000543055

  View details for PubMedID 40726603

  View details for PubMedCentralID PMC12296209

• Ophthalmic Outcomes and Management of Retinopathy in Patients With Sickle Cell Disease: A Comprehensive Health Registry Study and Review of Management Strategies OPHTHALMIC SURGERY LASERS & IMAGING RETINA Nangia, P., Wai, K. M., Scott, A. W., Rahimy, E., Mruthyunjaya, P. 2025: 1-6

  Abstract

  The purpose of this study was to report the rates of ophthalmic complications and interventions in patients diagnosed with sickle cell disease (SCD) and sickle cell retinopathy (SCR), while reviewing current management strategies within the literature.This retrospective cohort study included patients ≥ 18 years of age with the diagnosis of SCD and SCR. The electronic health record system TriNetX was utilized to identify patients diagnosed with SCD and SCR. The main outcome measures included rates of ophthalmic complications and interventions.We identified 1,249 patients with the diagnosis of both SCD and SCR. The mean age at diagnosis of SCR was 34.9 ± 14.8 years. The most common ocular complication was vitreous hemorrhage (VH) (19.5%) followed by cataracts (17.8%), rhegmatogenous retinal detachment (12.4%), and tractional retinal detachment (4.7%). The most common ocular intervention was retinal laser photocoagulation (13.6%).In a large, contemporary population-based study for SCD patients with SCR, the rates of preventable visually significant complications are high. Timely screening, diagnosis, and management strategies can help prevent these complications. [Ophthalmic Surg Lasers Imaging Retina 2025;56:XX-XX.].

  View details for DOI 10.3928/23258160-20250425-01

  View details for Web of Science ID 001512052100001

  View details for PubMedID 40525949

• Association of Mental Health Disorders with Age-related Macular Degeneration Xiao, J., Nimmagadda, H., Mruthyunjaya, P., Rahimy, E., Ludwig, C. A., Koo, E., Wai, K. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2025

  View details for Web of Science ID 001559849200011

• Longitudinal Trends of Intraocular Lens Implant Dislocation in a Large, Federated Electronic Health Record Network Lin, J. B., Wai, K., Alsoudi, A., Adam, M. K., Mruthyunjaya, P., Rahimy, E. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2025

  View details for Web of Science ID 001558957000001

• Ocular Adverse Events Associated with Dupilumab: Analysis from a Real-World Database Elaraby, O., Wai, K., Nguyen, Q., Ludwig, C. A., Koo, E., Mruthyunjaya, P., Rahimy, E. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2025

  View details for Web of Science ID 001580356000027

• Ocular Complications and Treatment Outcomes with Plaque Brachytherapy for Uveal Melanoma: A Real-World, Retrospective Study from Two Sources Nangia, P., Wai, K., Rahimy, E., Mruthyunjaya, P. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2025

  View details for Web of Science ID 001559760200029

• Risk of Ophthalmic Adverse Events in Breast Cancer Patients Receiving Taxane-Based Chemotherapy Versus Tamoxifen: an Aggregated Electronic Health Record Database Study Quiruz, L., Kikani, B., Wai, K., Rahimy, E., Mruthyunjaya, P., Quiruz, L., Kikani, B., Wai, K., Rahimy, E. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2025

  View details for Web of Science ID 001560034400015

• Ocular Outcomes Comparing the Left Atrial Appendage Occlusion Device to Systemic Anticoagulation Therapy Yeung, T., Alsoudi, A., Koo, E., Wai, K., Mruthyunjaya, P., Rahimy, E. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2025

  View details for Web of Science ID 001561888600049

• Association of Age-Related Macular Degeneration and Dementia: A Health Registry Database Study Nimmagadda, H., Wai, K., Koo, E., Rahimy, E., Mruthyunjaya, P. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2025

  View details for Web of Science ID 001561888600030

• Ocular Complicationsand treatments in Patients with Sickle Cell Retinopathy: Real World Data Compared in Two Databases Yahya, Y., Wai, K., Rahimy, E., Mruthyunjaya, P. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2025

  View details for Web of Science ID 001561888100018

• 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

• Prevalence and Risk of Systemic Comorbidities in Bilateral Retinal Telangiectasia Zhao, C., Do, D., Rahimy, E., Mruthyunjaya, P., Wai, K. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2025

  View details for Web of Science ID 001558634800031

• Morbidity and Mortality Associated With Systemic Lupus Erythematosus and Retinal Vasculitis: A Multicenter Cohort Study OPHTHALMIC SURGERY LASERS & IMAGING RETINA Huang, J. D., Mishra, K., Wai, K., Mruthyunjaya, P., Rahimy, E. 2025: 1-7

  Abstract

  To determine the long-term rates of death, myocardial infarction (MI), dialysis, and stroke in patients with systemic lupus erythematosus (SLE) and retinal vasculitis (RV).A total of 435 patients with SLE/RV were identified using TriNetX, a federated electronic health records network from January 1, 2004 to January 1, 2024. Patients were matched for age, sex, race, and propensity score, excluding those with MI, dialysis, or cerebrovascular complication in the year prior to diagnosis.The risk of death, MI, and dialysis was not statistically different between cohorts at 5 and 10 years. The risk of stroke was increased at 5 and 10 years in the SLE/RV cohort, but no statistically significant difference in risk was found at 1 year.Although patients with and without RV may have similar long-term rates of death, MI, and dialysis, patients with SLE/RV may have an elevated risk of stroke in the subsequent 5 and 10 years after diagnosis, highlighting the need for multidisciplinary care. [Ophthalmic Surg Lasers Imaging Retina 2025;56:XX-XX.].

  View details for DOI 10.3928/23258160-20250417-01

  View details for Web of Science ID 001497001200001

  View details for PubMedID 40407607

• Types of strabismus and strabismus surgery after retinal detachment repair: a health registry database analysis. Journal of AAPOS : the official publication of the American Association for Pediatric Ophthalmology and Strabismus Soetikno, B. T., Tran, E. M., Wai, K. M., Mruthyunjaya, P., Rahimy, E., Koo, E. B. 2025: 104216

  Abstract

  To examine the rate of diplopia, strabismus, and interventions for strabismus after pneumatic retinopexy, scleral buckle, and pars plana vitrectomy with and without scleral buckle for primary repair of rhegmatogenous retinal detachment (RRD).This retrospective cohort study draws on deidentified EHR data of over 126 million patients in the TriNetX Analytics platform, a federated health research network. Subjects were assigned to three cohorts: pneumatic retinopexy (PR) alone, scleral buckle (SB) alone, or pars plana vitrectomy with or without scleral buckle (PPV+/-SB). Univariate analyses and propensity score matching (PSM) sensitivity analyses were conducted. Main outcomes were the risk of diplopia, strabismus, sensorimotor examination, or strabismus interventions, including chemodenervation or surgery. Kaplan-Meier analysis was performed.A total of 25,169 subjects were identified: PR (n = 1,646), SB (n = 3,658), and PPV+/-SB (n = 19,865). SB had the highest rates of diplopia (2.73%) and strabismus (1.79%), followed by PPV+/-SB (diplopia, 2.28%; strabismus, 1.46%) and PR (diplopia, 1.54%; strabismus, 0.612%). SB and PPV+/-SB had a significantly higher risk of diplopia (P < 0.01) and strabismus (P < 0.001) compared to PR. No significant differences were observed between PPV+/-SB and SB (P = 0.106 and P = 0.139). Kaplan-Meier analysis indicated SB had the highest hazard during the first year after surgery. Strabismus interventions were rare, with surgery in ≤0.27% of the SB cohort, 0.22% of the PPV+/-SB cohort, and ≤0.61% of the PR cohort. No subjects underwent chemodenervation.The risk of diplopia and strabismus after RRD treatments is low. SB carries the highest risk, followed by PPV+/-SB and PR. These findings support informed decision making in selecting RRD repair techniques.

  View details for DOI 10.1016/j.jaapos.2025.104216

  View details for PubMedID 40355074

• Short-term effects of tetracycline use in patients with diabetic retinopathy. Canadian journal of ophthalmology. Journal canadien d'ophtalmologie Alshaikhsalama, A. M., Alsoudi, A. F., Wai, K. M., Koo, E., Mruthyunjaya, P., Weng, C. Y., Rahimy, E. 2025

  Abstract

  OBJECTIVE: To investigate the association between tetracycline use and the development of short-term vision threatening complications (VTC) among patients with diabetic retinopathy (DR).METHODS: Using a deidentified database, 4 596 patients with severe nonproliferative diabetic retinopathy (NPDR) or proliferative diabetic retinopathy (PDR) associated with tetracycline use versus 87,974 patients with NPDR or PDR but no tetracycline use, respectively, were included before propensity score matching (PSM). After PSM, 4 576 patients in each cohort were analyzed. Incidence of developing VTC, including diabetic macular edema (DME), vitreous hemorrhage (VH), tractional retinal detachment (TRD), neovascular glaucoma (NVG), and subsequent need for ocular interventions including intravitreal anti-vascular endothelial growth factor (VEGF) injections, panretinal photocoagulation (PRP), or pars plana vitrectomy (PPV).RESULTS: Patients with DR and repeated tetracycline use had a reduced risk of developing DME (RR: 0.45, 95% CI: 0.28-0.72; p = 0.009) and VH (RR: 0.37, 95% CI: 0.20-0.69; p = 0.001) compared to the tetracycline-naive cohort at 6 months and 1 year. Further, there was a reduced risk of subsequent need for anti-VEGF (RR: 0.25, 95% CI: 0.13-0.47; p = 0.003) and PRP (RR: 0.40, 95% CI: 0.19-0.84; p = 0.012) in the tetracycline cohort compared to the tetracycline-naive group at 6 months and 1 year. There were no significant differences in the development of NVG, TRD, or the requirement for PPV between both cohorts.CONCLUSIONS: Repeated tetracycline use was associated with a potentially reduced short-term risk of developing DME, VH, and needing subsequent anti-VEGF or PRP therapy versus tetracycline naive patients.

  View details for DOI 10.1016/j.jcjo.2025.04.009

  View details for PubMedID 40345242

• Re: Alshaikhsalama et al.: Association between obstructive sleep apnea and age-related macular degeneration development and progression<i> </i>(<i>Ophthalmol</i> Retina. 2024 Dec 9:S2468-6530(24)00580-3. doi: 10.1016/j.oret.2024.12.004. Online ahead of print.) REPLY OPHTHALMOLOGY RETINA Alshaikhsalama, A. M., Alsoudi, A. F., Wai, K. M., Koo, E., Mruthyunjaya, P., Rahimy, E. 2025; 9 (5): e41-e42

  View details for Web of Science ID 001495134400001

  View details for PubMedID 39923897

• Cardiovascular Morbidity and Mortality After Amaurosis Fugax. JAMA ophthalmology Wai, K. M., Loube, D. K., Pham, N. H., Ludwig, C. A., Koo, E., Mruthyunjaya, P., Rahimy, E. 2025

  View details for DOI 10.1001/jamaophthalmol.2025.0249

  View details for PubMedID 40111361

• In-clinic vitreous biopsy peel pack technique. International journal of retina and vitreous DeBoer, C., Zhao, C., Mruthyunjaya, P., Mahajan, V. B., Wai, K. M., Sanislo, S. R. 2025; 11 (1): 15

  Abstract

  Vitreous biopsy is a common technique used to guide management of acute endophthalmitis and help differentiate between infectious and inflammatory conditions. Currently, in-clinic vitreous biopsy is performed with a 25-gauge needle, without the ability to cut vitreous, potentially leading to reduced diagnostic yield. Recent work demonstrated the ability to perform vitreous biopsy with an off-the-shelf vitreous cutter. However, this was limited by complexity of assembly. Here, a technique using a single peel pack vitrectomy cutter is demonstrated for in-clinic vitreous biopsy.A 25-gauge vitreous cutter is opened from a peel pack. The drive line is identified, cut to length, and attached to a 10 mL syringe. A 1 mL syringe is attached to the aspiration line. After a trocar is used to place a cannula in the pars plana, the vitreous cutter is introduced into the eye. Cutting is performed by an assistant actuating the 10 mL syringe while the surgeon aspirates from the 1 mL syringe. After sample is collected, antimicrobials are injected if required and the cannula is removed.A peel pack technique simplifies assembly for an in-clinic vitreous biopsy using a manually actuated cutter.We present a novel, improved, and simplified technique for vitreous tap using a vitreous cutter provided in a single peel pack, actuated by a single syringe with minimal assembly prior to use. This technique may be more accessible for clinicians than prior techniques and does not require a surgical console.

  View details for DOI 10.1186/s40942-025-00639-8

  View details for PubMedID 39930526

  View details for PubMedCentralID PMC11808987

• Reply: Alshaikhsalama et al: Association between Obstructive Sleep Apnea and Age-related Macular Degeneration Development and Progression. Ophthalmology. Retina Alshaikhsalama, A. M., Alsoudi, A. F., Wai, K. M., Koo, E., Mruthyunjaya, P., Rahimy, E. 2025

  View details for DOI 10.1016/j.oret.2025.02.005

  View details for PubMedID 39923897

• Low Occurrence of Ocular Adverse Events after CAR-T Cell Therapy OCULAR ONCOLOGY AND PATHOLOGY Murty, T., Wai, K. M., Rahimy, E., Mruthyunjaya, P. 2025

  View details for DOI 10.1159/000543055

  View details for Web of Science ID 001438706600001

• 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

• The Interplay Between Ophthalmic and Systemic Outcomes in Patients With Sickle Cell Disease and Concurrent Retinopathy-A Population-Based Study. American journal of hematology Nangia, P., Wai, K. M., Scott, A. W., Rahimy, E., Mruthyunjaya, P. 2025

  View details for DOI 10.1002/ajh.27552

  View details for PubMedID 39754742

• Association between Obstructive Sleep Apnea and Age-related Macular Degeneration Development and Progression. Ophthalmology. Retina Alshaikhsalama, A. M., Alsoudi, A. F., Wai, K. M., Koo, E., Mruthyunjaya, P., Rahimy, E. 2024

  Abstract

  Evaluate the risk of age-related macular degeneration (AMD) development and progression in individuals with diagnosed obstructive sleep apnea (OSA).Retrospective cohort study.60,652 and 1,173,723 individuals with OSA or not, respectively, were included in the study before propensity score matching (PSM). After PSM and applying inclusion/exclusion criteria, 58,700 individuals in each cohort were subsequently analyzed.Collected data using TriNetX (Cambridge, MA, USA), a deidentified electronic health records research network. Individuals with an ICD-10 code for OSA confirmed with polysomnography and an additional code for CPAP use were compared to individuals without diagnosed OSA (control cohort) for the development of main outcome measures at five years. Secondary analyses were included to assess non-advanced AMD progression in individuals with and without diagnosed OSA at five years.The main outcome measures were the incidence of AMD, macular hemorrhage, legal blindness, and requiring anti-vascular endothelial factor (VEGF) intervention at five years. Individuals with non-advanced AMD with and without an OSA diagnosis were separately analyzed for progression to late AMD, and the development of macular hemorrhage, legal blindness, and requiring anti-VEGF therapy at five years.At five years, individuals with diagnosed OSA had a significantly elevated risk of nonexudative AMD (HR, 2.64, 95% CI, 2.37 - 2.96; P<.001), exudative AMD (HR, 2.48, 95% CI, 1.99 - 3.11; P=.002) and requiring anti-VEGF therapy (HR, 2.85, 95% CI, 2.26 - 3.59; P<.001) compared to the control cohort. In the secondary analysis, individuals with non-advanced AMD with diagnosed OSA were associated with an elevated risk of geographic atrophy (GA; HR, 7.00, 95% CI, 4.47 - 11.0; P=.03), exudative AMD (HR, 2.87, 95% CI, 2.37 - 3.48; P=.03), and requiring anti-VEGF injections (HR, 4.72, 95% CI, 3.59 - 6.22; P=.02) compared to those with non-advanced AMD without diagnosed OSA CONCLUSIONS: In a large, heterogenous database, an elevated risk of developing AMD and progression to later stages of the disease was observed among individuals with diagnosed OSA.

  View details for DOI 10.1016/j.oret.2024.12.004

  View details for PubMedID 39662591

• Glaucoma tube shunt surgery with repeat penetrating keratoplasty in an aphakic patient. American journal of ophthalmology case reports Chiang, B., Wai, K., Naranjo, A., Smith, S., Rose-Nussbaumer, J., Liu, W. W. 2024; 36: 102145

  Abstract

  We present a complicated case of mixed mechanism glaucoma in the setting of failed corneal transplant and aphakia. The patient was a 54-year old male with HLA B27 uveitis and prior open globe injury. He was left aphakic after cataract extraction and had a subsequent corneal transplant for bullous keratopathy. Due to elevated intraocular pressure in the setting of a failed corneal graft, the decision was made to insert a pars plana tube shunt and perform repeat penetrating keratoplasty as a combined case with the glaucoma, cornea, and retina services. We illustrate the surgical steps and decision making and in this complex case.

  View details for DOI 10.1016/j.ajoc.2024.102145

  View details for PubMedID 39263687

  View details for PubMedCentralID PMC11388665

• 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

• Use of Artificial Intelligence-Based Detection of Diabetic Retinopathy in the US. JAMA ophthalmology Shah, S. A., Sokol, J. T., Wai, K. M., Rahimy, E., Myung, D., Mruthyunjaya, P., Parikh, R. 2024

  View details for DOI 10.1001/jamaophthalmol.2024.4493

  View details for PubMedID 39480408

• Curcuma-Based Nutritional Supplements and Risk of Age-Related Macular Degeneration. JAMA ophthalmology Alsoudi, A. F., Wai, K. M., Koo, E., Mruthyunjaya, P., Rahimy, E. 2024

  Abstract

  Curcuma-based nutritional supplements (CBNS) are natural anti-inflammatory and antioxidant agents that may confer benefits against age-related macular degeneration (AMD).To examine the association between the use of CBNS and the risk of development or progression of AMD.This was a retrospective cohort study with data collection in June of 2024. Data were gathered from the aggregated electronic health records research network, TriNetX (Cambridge, Massachusetts). Patients without AMD were included in the study before propensity score matching (PSM); these included those taking and not taking CBNS. Patients with no history of AMD were stratified by instances of CBNS prescription records. Patients with a history of early nonexudative AMD stratified by instances of CBNS prescription records were also identified. PSM was performed to control for baseline demographics and medical comorbidities.Patients were stratified by whether or not they were taking CBNS using RxNorm (National Library of Medicine) codes.Relative risk (RR) of developing nonexudative AMD, exudative AMD, advanced nonexudative AMD or geographic atrophy (GA), blindness, or requiring intravitreal anti-vascular endothelial growth factor (VEGF) therapy.A total of 66 804 patients (mean [SD] age, 64.9 [10.1] years; 44 124 female [66.1%]) taking CBNS and 1 809 440 patients (mean [SD] age, 67.0 [9.5] years; 999 534 female [55.2%]) not taking CBNS were included in this study. Among patients without a history of AMD aged 50 years or older, CBNS use was associated with lower rates of developing nonexudative AMD (RR, 0.23; 95% CI, 0.21-0.26; P < .001), advanced nonexudative AMD or GA (RR, 0.11; 95% CI, 0.07-0.17; P < .001), exudative AMD (RR, 0.28; 95% CI, 0.24-0.32; P < .001), blindness (RR, 0.46; 95% CI, 0.36-0.59; P < .001), or requiring intravitreal anti-VEGF therapy (RR, 0.15; 95% CI, 0.13-0.17; P < .001) when compared with matched patients not taking CBNS. Results were consistent among subsets of patients 60 and 70 years or older, respectively. Among patients with early nonexudative AMD, subsequent instances of CBNS prescription records were associated with lower rates of developing advanced nonexudative AMD or GA (RR, 0.58; 95% CI, 0.41-0.81; P < .001) when compared with matched patients with early nonexudative AMD without a CBNS prescription record.Results of this cohort study suggest that a reduced risk of developing AMD or progression to later stages of AMD was associated with subsequent use of CBNS. Further investigation to validate these findings, safety, and potential pharmacoprotective mechanisms of CBNS in AMD are suggested.

  View details for DOI 10.1001/jamaophthalmol.2024.4400

  View details for PubMedID 39446346

• Risk of Intestinal Complications, Extraintestinal Morbidity, and Mortality in Patients with Crohn's Disease and Ocular Involvement. Ocular immunology and inflammation Alsoudi, A. F., Wai, K. M., Koo, E., McConnell, R. A., Pham, N. H., Do, B. K., Ludwig, C. A., Kossler, A. L., Mruthyunjaya, P., Rahimy, E. 2024: 1-8

  Abstract

  Patients with Crohn's disease (CD) and subsequent ocular manifestations may have worse outcomes when compared to matched patients with CD without ocular disease.In this retrospective cohort study, an aggregated electronic health records research network, TriNetX (Cambridge, MA, USA), was used to identify patients diagnosed with CD stratified by the presence or absence of ocular involvement with at least 1 year of follow-up. Propensity score matching (PSM) was performed to control for baseline demographics and medical comorbidities.Patients with CD with ocular disease showed a greater risk of undergoing bowel resections (RR: 2.06, 95% CI: 1.48-2.85, p < 0.001), developing other CD-related gastrointestinal complications (RR: 1.31, CI: 1.15-1.49, p < 0.001), or acquiring Clostridioides difficile infections (RR: 2.19, CI: 1.89-2.54, p < 0.001). Further, patients with CD with ocular sequelae had a greater risk of developing NASH (RR: 1.43, CI: 1.31-1.56, p < 0.001), CD-related nutrient deficiencies (RR: 1.38, CI: 1.29-1.49, p < 0.001), iron deficiency anemia (RR: 1.41, CI: 1.33-1.50, p < 0.001), CD-related dermatological disease (RR: 1.84, CI: 1.65-2.05, p < 0.001), osteoporosis (RR: 1.49, CI: 1.37-1.64, p < 0.001) and primary sclerosing cholangitis (RR: 1.63, CI: 1.11-2.38, p = 0.011). Among patients with CD with ocular involvement, there was an elevated risk of MI (RR: 1.36, CI: 1.14-1.63, p < 0.001), stroke (RR: 1.42, CI: 1.18-1.70, p < 0.001), VTE (RR: 1.37, CI: 1.22-1.54, p < 0.001), and sepsis (RR: 1.53, CI: 1.37-1.71, p < 0.001).Patients who have CD and subsequent ocular involvement have an increased risk of local intestinal complications, extraintestinal morbidity, and cardiovascular complications when compared to patients with CD without ocular involvement.

  View details for DOI 10.1080/09273948.2024.2413895

  View details for PubMedID 39401331

• 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

  Abstract

  Assessing immune-related ocular toxicities from immune checkpoint inhibitors (ICIs) is crucial, though rare. This study, utilizing real-world data, examines the occurrence of ophthalmic immune-related adverse events (irAEs) after ICI treatment and their impact on overall survival.A retrospective cohort study METHODS: Data were obtained from TriNetX, an aggregated electronic health records database. Patients who developed ophthalmic irAEs within 1 year after the first instance of ICI therapy were included. Participants with defined ocular toxicities 6 months before ICI treatment were excluded. Subjects were paired with controls using propensity scores derived from demographics and cancer type. A Cox proportional hazard model was used to determine hazard ratios. A Kaplan-Meier survival function was evaluated with the log-rank test based on the development of ophthalmic irAEs in a 12-month landmark analysis.A cohort of 41,020 patients comprising 57.4% males with a mean age of 65.2±11.9 years was included. The five most prevalent ophthalmic irAEs in this cohort were dry eye syndrome (2%), conjunctivitis (0.87%), blepharitis (0.51%), anterior uveitis (0.39%), and keratitis (0.38%). Dry eye syndrome was the most common irAE among all ICI classes. Subjects taking CTLA-4 inhibitor plus PD-1 inhibitor and CTLA-4 inhibitors had higher rates of anterior uveitis (1.39% and 1.29%, respectively) than PD-1 inhibitors (0.27%) and PD-L1 inhibitors (0.14%) within 1 year after taking ICI. After a 12-month landmark analysis, there was a significant decreased chance of survival for the following categories: any ophthalmic irAE (HR, 1.37; 95% CI, 1.20-1.56; P < 0.0001), neuro-ophthalmic irAE (HR, 1.53; 95% CI, 1.09-2.14; P = 0.0124), and cornea and ocular surface irAE (HR, 1.34; 95% CI, 1.15-1.56; P < 0.0001).Ophthalmic irAEs involving the anterior segment are more frequent than the posterior segment, regardless of ICI class. Ophthalmic irAEs may also portend decreased survival. This insight could help guide clinicians aggressively manage irAEs and allow patients to continue ICI therapy despite having ocular issues.

  View details for DOI 10.1016/j.ajo.2024.08.044

  View details for PubMedID 39271090

• Reply to comment on: 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

  View details for DOI 10.1016/j.ajo.2024.08.036

  View details for PubMedID 39241978

• Initial Therapy of Panretinal Photocoagulation vs Anti-VEGF Injection for Proliferative Diabetic Retinopathy. JAMA ophthalmology Alsoudi, A. F., Wai, K. M., Koo, E., Parikh, R., Mruthyunjaya, P., Rahimy, E. 2024

  Abstract

  While combined treatment of anti-vascular endothelial growth factor (VEGF) injections plus panretinal photocoagulation (PRP) is a common approach for treating proliferative diabetic retinopathy (PDR) in the clinical practice setting, large randomized clinical trials typically use monotherapy. Subsequently, information is limited as to whether the order of treatment when combining PRP and anti-VEGF injections for PDR affects outcomes.To compare outcomes of patients with PDR treated with PRP and subsequent anti-VEGF injections with outcomes of matched patients treated with anti-VEGF injections and subsequent PRP.This retrospective cohort study used data from January 2003 to January 2024 in the TriNetX aggregated electronic health records network, with data analysis performed in January 2024. Patients with PDR treated with PRP and anti-VEGF injections were eligible for inclusion.Patients with new PDR diagnoses stratified by therapy with PRP and subsequent anti-VEGF injections or anti-VEGF injections and subsequent PRP.The primary outcome was the need for pars plana vitrectomy (PPV), defined by Current Procedural Terminology codes 67040 or 67113. The secondary outcome included incidence of PPV, vitreous hemorrhage (VH), or tractional retinal detachment (TRD). Relative risk ratios, relative risk differences, and 95% CIs were all calculated for univariate comparison of the cohorts and the development of primary outcomes after matching.Before propensity score matching (PSM), which controlled for baseline demographic characteristics and medical comorbidities, 2167 patients with PDR treated with PRP first and subsequent anti-VEGF injections and 1549 patients with PDR treated with anti-VEGF injections and subsequent PRP were included. Post-PSM, mean (SD) participant age was 63.0 (13.1) years in cohort 1 (PRP and subsequent anti-VEGF injection) and 63.0 (12.4) years in cohort 2 (anti-VEGF injection and subsequent PRP). Of 1377 total participants in each cohort, 641 patients (46.6%) and 663 patients (48.1%) in cohorts 1 and 2 were female, respectively. Treatment with PRP first and subsequent anti-VEGF injection was associated with higher rates of PPV at 5 years compared with patients treated with anti-VEGF injection and subsequent PRP (relative risk [RR], 1.88; 95% CI, 1.55-2.27; risk difference [RD], 8.93%; 95% CI, 6.31%-11.55%; P < .001), with similar associations at 6 months, 1 year, and 3 years. Treatment with PRP and subsequent anti-VEGF injection was associated with higher rates of VH at 5 years (RR, 1.40; 95% CI, 1.09-1.80; RD, 6.47%; 95% CI, 1.66%-11.29%; P < .001) and TRD at 5 years (RR, 1.85; 95% CI, 1.35-2.53; RD, 4.31%; 95% CI, 2.10%-6.52%; P < .001), with similar findings at 6 months, 1 year, and 3 years compared with patients treated with anti-VEGF injection and subsequent PRP.In this retrospective cohort study, findings suggest that patients with PDR treated with PRP first then subsequent anti-VEGF injection are more likely to undergo PPV for VH and TRD compared with matched patients treated with anti-VEGF agents first, then PRP. These findings support the need for further investigations to determine if the order of PRP and anti-VEGF injections should be considered when treating patients with PDR.

  View details for DOI 10.1001/jamaophthalmol.2024.3283

  View details for PubMedID 39207799

  View details for PubMedCentralID PMC11362971

• Risk of ocular neovascular conversion and systemic bleeding complications in patients with AMD on DOACs or Warfarin. Ophthalmology Alsoudi, A. F., Koo, E., Wai, K., Mruthyunjaya, P., Rahimy, E. 2024

  Abstract

  Conversion to neovascular disease in patients with non-neovascular age-related macular degeneration (AMD) initiated on direct oral anticoagulants (DOAC) compared to matched patients treated with warfarin.Retrospective cohort study.The study included 20,300 patients and 13,387 patients with non-neovascular AMD initiated on DOACs or warfarin, respectively, before propensity score matching (PSM).TriNetX (Cambridge, MA, USA), was used to identify patients diagnosed with non-neovascular AMD stratified by treatment with DOACs or warfarin with at least six months of follow-up. Propensity score matching was performed to control for baseline demographics and medical comorbidities.Relative risk (RR) of developing neovascular AMD, macular hemorrhage (MH), vitreous hemorrhage (VH), and requiring an ocular intervention (intravitreal anti-vascular endothelial growth factor (VEGF) therapy or pars plana vitrectomy (PPV)) within six months and one year. Patients with chronic atrial fibrillation (AF) on anticoagulation were separately evaluated for the same measures within 5 years after initiating therapy.Treatment with warfarin was associated with higher risk of developing neovascular AMD at six months (RR,1.24, 95% CI, 1.12 - 1.39; P<.001) and one year (RR, 1.26, 95% CI, 1.14 - 1.40; P<.001) when compared to matched patients treated with DOACs. There was an increased risk of requiring intravitreal anti-VEGF therapy (6 months: RR, 1.30; 95% CI, 1.13-1.49; P<.001; 1 year: RR, 1.31, 95% CI, 0.72 - 2.05; P<.001) and PPV (6 months: RR, 1.16; 95% CI, 1.16-3.94; P = .01; 1 year: RR, 2.29, 95% CI, 1.30 - 4.05; P=.003). Among patients with AMD and AF treated with warfarin, there was an increased risk of ocular complications (neovascular AMD: RR, 1.25; 95% CI, 1.14-1.38; P<.001; MH: RR, 1.86; 95% CI, 1.47-2.35; P<.001; VH: RR, 2.22; 95% CI, 1.51-3.26; P<.001) and need for intravitreal anti-VEGF therapy (RR, 1.34; 95% CI, 1.18-1.52; P<.001) over an extended 5-year period. There was no significant difference in the development of major systemic hemorrhagic events between the two cohorts over five years.Patients with non-neovascular AMD treated with warfarin were more likely to develop neovascular disease and require ocular intervention for hemorrhagic complications when compared to matched patients initiated on DOACs.

  View details for DOI 10.1016/j.ophtha.2024.07.034

  View details for PubMedID 39116948

• 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

• Simplified Clinic-Based Vitreous Biopsy Technique Using A Vitreous Cutter and Manual Actuation DeBoer, C., Knapp, A. N., Wai, K., Mruthyunjaya, P., Mahajan, V. B., Sanislo, S. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2024

  View details for Web of Science ID 001313316202010

• Are patients with Graves' Ophthalmopathy at risk for hyperglycemia? Kikani, B., Wai, K., Rahimy, E., Dosiou, C., Kim, S. H., Mruthyunjaya, P., Kossler, A. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2024

  View details for Web of Science ID 001312227709008

• Risk of Intestinal Complications, Extraintestinal Morbidity, and Mortality in Patients with Crohn's Disease and Ocular Involvement Alsoudi, A., Wai, K., Koo, E., Pham, N., McConnell, R., Mruthyunjaya, P., Rahimy, E. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2024

  View details for Web of Science ID 001312227709169

• Comparative Efficacy of Corticosteroids and Teprotumumab in Thyroid Eye Disease Management: A Retrospective Cohort Study Choi, S., Chandraparnik, P., Wai, K., Mruthyunjaya, P., Kossler, A. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2024

  View details for Web of Science ID 001312227709010

• Immune Checkpoint Inhibitor-Induced Ophthalmic Adverse Events and Association with Survival: Results from a Real-World Database Quiruz, L., Yavari, N., Wai, K., Gupta, A., Rahimy, E., Kossler, A., Mruthyunjaya, P. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2024

  View details for Web of Science ID 001313316202108

• Geographic Atrophy Natural History Versus Treatment: Time to Fovea OPHTHALMIC SURGERY LASERS & IMAGING RETINA Zhang, C., Kahan, E., Begaj, T., Friedman, S. M., Deobhakta, A., Heyang, M., Shen, L., Moshfeghi, D., Wai, K., Parikh, R. 2024: 1-10

  Abstract

  The Food and Drug Administration recently approved treatments of geographic atrophy (GA). Our study aims to quantify the time for a lesion to reach the central fovea based on reduction of GA growth rates from therapeutics compared to the natural history.A previously published study calculates local border expansion rate of GA lesions at varying retinal eccentricities. In this study, we use these rates to model GA expansion toward the fovea and the effects of treatments that reduce growth in GA area by 15% to 45% on lesions of varying sizes with posterior margin 250, 500, 750, 1000, 1250, 1500, and 3000 µm from the fovea.Lesions with an area 8 mm2 and posterior edge 500 µm from the fovea will reach the fovea in 5.08 years with no treatment, but the same lesions will reach the fovea in 5.85, 6.52, 7.36, and 8.46 years with a treatment that reduces growth in GA area by 15%, 25%, 35%, and 45%, respectively.Distance of the posterior edge of the lesion was the primary factor in GA growth toward the fovea, and lesion size only minimally affects growth rates of GA. Based on the efficacy of current and future therapeutics and distance of GA to the fovea, our study provides the marginal time benefit of treatment to guide patients and clinicians, placing both the natural history of GA and the effects of current and future treatments into clinical context. [Ophthalmic Surg Lasers Imaging Retina 2024;55:XX-XX.].

  View details for DOI 10.3928/23258160-20240418-01

  View details for Web of Science ID 001322740400001

  View details for PubMedID 38917392

• 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

• Recovery of Vision in Open Globe Injury Patients with Initial No Light Perception Vision. Ophthalmology. Retina Sherif, N. A., Hoyek, S., Wai, K., Makhoul, K. G., Bitar, R., Teiger, M., Lorch, A. C., Patel, N. A., Armstrong, G. W. 2024

  Abstract

  OBJECTIVE OR PURPOSE: To identify clinical characteristics of injured eyes associated with visual recovery in patients with open globe injuries (OGI) and presenting with no light perception (NLP) vision.DESIGN: Retrospective chart review.SUBJECTS, PARTICIPANTS, AND/OR CONTROLS: All patients presenting to Massachusetts Eye and Ear with OGI and NLP vision from January 1999 to March 2022.METHODS, INTERVENTION, OR TESTING: Manual data extraction to collect patient demographic characteristics, pre-operative, intraoperative, and post-operative characteristics of OGI injury, laceration versus rupture, history of intraocular surgery, time from injury to repair, timing of vitrectomy, lensectomy, choroidal drainage, and silicone oil placement, visual acuity (VA) at last follow-up, and subsequent B-scan ultrasound findings of retinal detachment, choroidal hemorrhage, vitreous hemorrhage, and disorganized intraocular contents. Patients with more than one week of follow-up and a documented VA at most recent follow-up were included. Exclusion criteria included age less than 10 years. Multivariable regression was performed.MAIN OUTCOMES: VA recovery defined as light perception or better in patients with OGI and initial NLP vision.RESULTS: 147 eyes with NLP vision after OGI were included. 25 (17%) eyes regained vision at last follow-up. The majority of patients recovered light perception vision (n=15, 60%) followed by 20/500 or better (n=5, 20%), hand motion (n=3, 12%), and count fingers (n=2, 8%). Most injuries were zone III (n=102, 69%) and presented with rupture (n=127, 86%). The mean time from OGI to surgical repair was 0.85 ± 1.7 days. B-scan was obtained in 104 (71%) cases. Pars plana vitrectomy was performed in 9 eyes (6%) with NLP at time of vitrectomy. Disorganized intraocular contents on B-scan (OR=0.170, 95%CI: 0.042-0.681, P=0.012) was the only clinical variable significantly associated with visual recovery, corresponding to a lack of visual improvement.CONCLUSION: Recovery of vision in OGI with NLP vision at presentation cannot be predicted based on presenting clinical features. B-scan findings of disorganized intraocular contents after initial OGI repair was the only factor negatively associated with vision recovery in this patient population. Therefore, all eyes presenting with an OGI and NLP vision should undergo primary repair in hopes of subsequent visual recovery.

  View details for DOI 10.1016/j.oret.2024.04.010

  View details for PubMedID 38636901

• 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

• Acute Subretinal Fluid Accumulation Induced by Futibatinib Therapy for Malignant Metastatic Breast Cancer OPHTHALMIC SURGERY LASERS & IMAGING RETINA Chhoy, B., Wai, K. M., Leng, T. 2024; 55 (2): 109-111

  Abstract

  Alport syndrome is characterized by type IV collagen network disruptions leading to renal, auditory, and ocular manifestations. This case report details a 24-year-old man with Alport syndrome who developed a rhegmatogenous retinal detachment following macular hole repair. The patient underwent a successful vitrectomy and internal limiting membrane peel for macular hole repair but returned with vision loss due to retinal detachment five weeks later, which necessitated a combined scleral buckle and vitrectomy. This is the first case describing rhegmatogenous retinal detachment post-macular hole repair in Alport syndrome. [Ophthalmic Surg Lasers Imaging Retina 2024;55:XX-XX.].

  View details for DOI 10.3928/23258160-20231205-02

  View details for Web of Science ID 001178161800006

  View details for PubMedID 38408224

• 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

• 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

• Biobanking of Human Aqueous and Vitreous Liquid Biopsies for Molecular Analyses. Journal of visualized experiments : JoVE Wolf, J., Chemudupati, T., Kumar, A., Rasmussen, D. K., Wai, K. M., Chang, R. T., Montague, A. A., Tang, P. H., Bassuk, A. G., Dufour, A., Mruthrunjaya, P., Mahajan, V. B. 2023

  Abstract

  A critical challenge in translational research is establishing a viable and efficient interface between patient care in the operating room (OR) and the research laboratory. Here, we developed a protocol for acquiring high-quality liquid biopsies for molecular analyses from the aqueous humor and the vitreous from patients undergoing eye surgery. In this workflow, a Mobile Operating Room Lab Interface (MORLI) cart equipped with a computer, a barcode scanner, and lab instruments, including onboard cold storage, is used to obtain and archive human biological samples. A web-based data privacy-compliant database enables annotating each sample over its lifetime, and a cartesian coordinate system allows tracking each barcoded specimen in storage, enabling quick and accurate retrieval of samples for downstream analyses. Molecular characterization of human tissue samples not only serves as a diagnostic tool (e.g., to distinguish between infectious endophthalmitis and other non-infectious intraocular inflammation) but also represents an important component of translational research, allowing the identification of new drug targets, development of new diagnostic tools, and personalized therapeutics.

  View details for DOI 10.3791/65804

  View details for PubMedID 37747194

• 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

• Photographic Gel Artifact Simulating International Classification of Retinopathy of Prematurity Notch: Stanford University Network for Diagnosis of Retinopathy of Prematurity (SUNDROP) Report no. 16. Ophthalmology. Retina Wai, K. M., Moshfeghi, D. M. 2023; 7 (8): 732-736

  Abstract

  PURPOSE: To report a series of fundus photographs taken for retinopathy of prematurity (ROP) screening that contain artifacts with imaging characteristics mimicking a notch, a recently refined classification metric in the International Classification of Retinopathy of Prematurity, third edition.DESIGN: Retrospective case series.PARTICIPANTS: Infants requiring ROP screening in neonatal intensive care units from the Stanford University Network for Diagnosis of Retinopathy of Prematurity (SUNDROP) and TeleROP telemedicine screening programs.METHODS: Preterm infants meeting ROP examination criteria were screened with 130° wide-angle imaging systems. The images were taken by a trained nurse in the neonatal intensive care unit and transferred to an ROP specialist using a Health Insurance Portability and Accountability Act-compliant picture archiving and communication system for interpretation.MAIN OUTCOME MEASURES: Presence of an artifact that appeared consistent with a notch.RESULTS: We identified a total of 17 cases in ROP screening with artifact findings that had imaging characteristics similar to a notch. The artifactual appearance of the pseudo-notch was created by the camera illumination system within the gel-lens interface when the lens was not well apposed to the cornea. In telemedicine screening for ROP, we present fundus images of eyes with a pseudo-notch appearance; review of overlapping images can help differentiate between notch and artifact.CONCLUSIONS: Pediatric retinal specialists need to be aware that artifacts play a confounding role in screening for ROP, that can be mitigated through the use of overlapping and redundant images.FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found after the references.

  View details for DOI 10.1016/j.oret.2023.04.013

  View details for PubMedID 37548218

• 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

• 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 Syphilitic Posterior Placoid Chorioretinitis With Subfoveal Choroidal Neovascularization Managed With Anti-VEGF Therapy. Journal of vitreoretinal diseases Wai, K. M., Gong, D., Rodriguez, M., Cunningham, E. T., Vavvas, D. G., Eliott, D. 2022; 6 (3): 246-250

  Abstract

  We describe the development and management of choroidal neovascularization (CNV) in a patient with acute syphilitic posterior placoid chorioretinitis (ASPPC).A retrospective case review is presented.A 66-year-old man presented with unilateral blurry vision. He had a history of systemic syphilis infection twice, the last diagnosed 15 years before presentation and treated with intravenous ceftriaxone, resulting in seroreversion of an initially positive rapid plasma reagin (RPR). Examination revealed ASPPC with subfoveal CNV. Repeat testing revealed an RPR titer of 1:16 384. He was treated with 6 monthly intravitreal injections of bevacizumab and systemic antibiotics, resulting in resolution of his ASPPC and regression of his CNV.CNV is a rare complication of ASPPC. Multimodal imaging can be useful to suggest the diagnosis, and prompt treatment with systemic antibiotics and intravitreal anti-vascular endothelial growth factor agents can lead to resolution of ASPPC and regression of CNV, respectively.

  View details for DOI 10.1177/24741264211057663

  View details for PubMedID 35967270

  View details for PubMedCentralID PMC9368478

• Astrocytic TGF-beta Signaling Limits Inflammation and Reduces Neuronal Damage during Central Nervous System Toxoplasma Infection JOURNAL OF IMMUNOLOGY Cekanaviciute, E., Dietrich, H. K., Axtell, R. C., Williams, A. M., Egusquiza, R., Wai, K. M., Koshy, A. A., Buckwalter, M. S. 2014; 193 (1): 139-149

  Abstract

  The balance between controlling infection and limiting inflammation is particularly precarious in the brain because of its unique vulnerability to the toxic effects of inflammation. Astrocytes have been implicated as key regulators of neuroinflammation in CNS infections, including infection with Toxoplasma gondii, a protozoan parasite that naturally establishes a chronic CNS infection in mice and humans. In CNS toxoplasmosis, astrocytes are critical to controlling parasite growth. They secrete proinflammatory cytokines and physically encircle parasites. However, the molecular mechanisms used by astrocytes to limit neuroinflammation during toxoplasmic encephalitis have not yet been identified. TGF-β signaling in astrocytes is of particular interest because TGF-β is universally upregulated during CNS infection and serves master regulatory and primarily anti-inflammatory functions. We report in this study that TGF-β signaling is activated in astrocytes during toxoplasmic encephalitis and that inhibition of astrocytic TGF-β signaling increases immune cell infiltration, uncouples proinflammatory cytokine and chemokine production from CNS parasite burden, and increases neuronal injury. Remarkably, we show that the effects of inhibiting astrocytic TGF-β signaling are independent of parasite burden and the ability of GFAP(+) astrocytes to physically encircle parasites.

  View details for DOI 10.4049/jimmunol.1303284

  View details for Web of Science ID 000338438900019

  View details for PubMedCentralID PMC4075480