Melissa Yuan

All Publications

• Severe Posterior Retinopathy of Prematurity: A Matched Cohort Analysis. Ophthalmology. Retina Chaaya, C., Yuan, M., Altamirano, F., Kahale, F., Alahmadi, R., Hu, D., Abidi, M., Hoyek, S., Fulton, A., Mantagos, I. S., Wu, C., Gonzalez, E., VanderVeen, D. K., Patel, N. A., Gise, R. 2026

  Abstract

  All infants diagnosed with severe posterior ROP required treatment and had a high rate of retreatment (26.1%). Compared to a cohort of treated infants with similar demographics, they showed higher rates of strabismus, amblyopia, and developmental delay.

  View details for DOI 10.1016/j.oret.2026.01.003

  View details for PubMedID 41539541

• Cost Analysis of Risk Stratified Retinopathy of Prematurity Screening. Ophthalmology. Retina Hwang, H. H., Piccini, A., Abidi, M., Altamirano, F., Hu, D., Hoyek, S., Chaaya, C., Yuan, M., Mahmoudinezhad, G., Berrocal, A., Gonzalez, E., Gise, R., Vanderveen, D. K., Patel, N. A. 2025

  Abstract

  Risk-stratified ROP screening has the potential to reduce the number of inpatient ROP exams while maintaining safety. Implementation of the TWO-ROP and FIRST-ROP algorithms would significantly reduce neonatal healthcare costs in the United States.

  View details for DOI 10.1016/j.oret.2025.12.021

  View details for PubMedID 41478559

• Systemic medications and their impact on age-related macular degeneration development and progression: a review of current evidence. Current opinion in ophthalmology Yuan, M., Alsoudi, A., Alshaikhsalama, A., Rahimy, E. 2025

  Abstract

  This review examines commonly prescribed systemic medications and their possible associations with age-related macular degeneration (AMD) development and progression. With the limitations and risks of current intravitreal therapies, there is growing interest in oral pharmacotherapy for AMD management. The following review synthesizes observational studies, meta-analyses, and ongoing clinical trials to evaluate the potential effects of commonly used systemic medications on AMD.Metformin demonstrates conflicting evidence, with several meta-analyses and large cohort study showing reduced AMD odds, while a recent randomized phase II trial found no effect on geographic atrophy progression. For statins, emerging evidence suggests that treatment duration exceeding 2 years and medium-intensity to high-intensity dosing may confer protection against AMD development. Aspirin demonstrates discordant results between different study designs: two large randomized controlled trials showed no benefit for AMD, while a 10-year observational study suggested protective effects.Fenofibrates show promise in preclinical models but require additional clinical investigation. Danicopan also shows modest effects in complement-related disorders and is currently undergoing a phase 2 trial to evaluate efficacy in patients with geographic atrophy. Finally, dopamine agonists appear to improve visual acuity and reduce subretinal fluid and central retinal thickness in newly diagnosed exudative AMD, as shown in an open-label pilot study, but require further investigation.Multiple systemic medications have highlighted mixed or stage-dependent benefits on AMD development and progression. Some agents such as metformin and aspirin have shown conflicting findings, having been evaluated in randomized trials and large observational studies. Other medications including GLP-1 agonists, dopamine agonists, statins, fenofibrates, and danicopan show early promise in more limited studies, but require further clinical validation.

  View details for DOI 10.1097/ICU.0000000000001198

  View details for PubMedID 41481850

• Retinopathy of Prematurity in the Extremely Premature: Disease Burden, Treatment Approaches, and Visual Outcomes in Micro- and Nano-Premature Infants. American journal of ophthalmology Yuan, M., Chaaya, C., Altamirano, F., Hu, D., Hoyek, S., Abidi, M., De Bruyn, H., Fulton, A., Mantagos, I. S., Wu, C., Gonzalez, E., VanderVeen, D. K., Patel, N. A., Gise, R. 2025

  Abstract

  To characterize the treatment and outcomes of retinopathy of prematurity (ROP) in high-risk extremely premature infants.Retrospective, single-center clinical cohort study METHODS: Infants meeting criteria for micro-prematurity (24-26 weeks gestational age (GA) and/or birth weight (BW) 600-799 grams) or nano-prematurity (<24 weeks GA and/or BW <600 grams) from 2013 to 2023 were included.3239 infants were screened, of which 702 infants were included and 525 infants were selected for analysis after excluding patients lost to follow-up ROP was observed 891 eyes (84.9%)225 eyes (21.4%) developed type 1 disease and required treatment. with laser and/or anti-VEGF. 132 eyes of 74 patients (12.6%) required re-treatment. Lower GA, lower BW, and central nervous system hemorrhagic injury were associated with treatment-warranted ROP on multivariable regression. The nano-premature demonstrated more severe ROP, more posterior disease, higher rates of treatment at earlier ages, increased incidence of treatment by all modalities, higher rates of amblyopia, worse final visual acuity, and more frequent developmental delay.While treatment can stabilize the disease, patients face ongoing challenges, including visual and developmental complications. Lower GA, lower BW, and central nervous system injury emerged as significant risk factors for treatment-warranted ROP. Nano-premature infants showed higher rates of more severe ROP, amblyopia, and poorer visual outcomes compared to micro-premature infants. These findings highlight the importance of screening and follow-up in this population and provide valuable natural history, treatment, and outcome information for ophthalmologists caring for these high-risk infants.

  View details for DOI 10.1016/j.ajo.2025.08.004

  View details for PubMedID 40796026

• Immune Recovery Uveitis: A Comprehensive Review. International ophthalmology clinics Yuan, M., Young, L. H. 2025; 65 (3): 142-151

  Abstract

  Immune reconstitution inflammatory syndrome (IRIS) describes a hyper-inflammatory state, often manifesting as paradoxical worsening of opportunistic or latent infections, in patients with previously suppressed immune systems who undergo treatment. Ocular IRIS is known as immune recovery uveitis (IRU), a challenging complication that can occur in patients with a compromised immune system, particularly those with human immunodeficiency virus (HIV) infection who initiate highly active antiretroviral therapy (HAART). IRU primarily manifests as posterior segment inflammation with vitritis, resulting in reduced vision and floaters in the affected eye. This review article aims to provide a comprehensive overview of immune recovery uveitis, encompassing its pathophysiology, clinical manifestations, diagnostic approaches, management strategies, and future prospects. Understanding IRU is crucial for ophthalmologists, infectious disease specialists, and other health care professionals involved in the care of individuals with HIV/AIDS, as timely intervention can help prevent vision-threatening complications and improve patients' quality of life.

  View details for DOI 10.1097/IIO.0000000000000565

  View details for PubMedID 40601519

• Opsoclonus in Children: Diagnosis, Etiology, and Ophthalmologic Assessment of Patients at a Tertiary Children's Hospital. Pediatric neurology Yuan, M., Jeon-Chapman, J., Estrela, T., Gise, R. 2025; 170: 74-79

  Abstract

  Opsoclonus is often associated with serious neurological and paraneoplastic pathology. Pediatric ophthalmologists play an important role in its diagnosis.This study was a retrospective chart review of patients seen for suspicion of opsoclonus.A total of 259 patients were identified for whom opsoclonus was suspected, of which 83 (32%) were found to be true opsoclonus. The ophthalmology consultation changed the course of evaluation in 44 of the 117 patients who received ophthalmologic evaluation (38%). Sixteen (9%) were found to have primary ophthalmic diagnoses. Of the 83 children with opsoclonus, 36 (43%) had paraneoplastic opsoclonus-myoclonus-ataxia syndrome (OMAS), 32 (39%) had nonparaneoplastic OMAS, one (1.2%) had optic pathway glioma, 5 (6.0%) had other neurological diseases, 2 (2.4%) had hydrocephalus, 6 (7.2%) had benign neonatal opsoclonus, and one (1.2%) had opsoclonus of unknown etiology. Most patients (78 patients; 94%) received brain magnetic resonance imaging (MRI), followed by MRI of the chest/abdomen/pelvis and urine catecholamines in 57 patients each (69%).Extensive evaluation is usually performed to rule out underlying neoplastic pathology and includes MRI of the brain, neck, chest, and abdomen and urine catecholamine studies. Pediatric ophthalmologists can help to make critical ophthalmic diagnoses in a minority of cases. If involved early in the diagnostic course, this may spare children unnecessary testing.

  View details for DOI 10.1016/j.pediatrneurol.2025.06.015

  View details for PubMedID 40627897

• Cost Savings of the "TWO-ROP" Algorithm based on a Validation Study Hwang, H., Lamarque, F., Hu, D., Mahmoudinezhad, G., Alhoyek, S., Chaaya, C., Yuan, M., Berrocal, A., Gonzalez, E., Gise, R., Vanderveen, D., Patel, N. A. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2025

  View details for Web of Science ID 001560173300047

• Attrition of Retinal Ganglion Cell Complex Following Non-Arteritic Anterior Ischemic Optic Neuropathy (NAION): A Disparity in the Structure-Function Relationship Anvarinia, Y., Krasniqi, D., Shah, M., Yuan, M., Zhang, K., Elze, T., Rizzo, J. F. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2025

  View details for Web of Science ID 001558421400012

• Evaluating the Utility of Initial Examinations in Retinopathy of Prematurity <i>Proposal of FIRST</i>-<i>ROP Algorithm for a</i> <i>Medium</i>-<i>Risk Cohort</i> OPHTHALMOLOGY Altamirano, F., Yuan, M., Hoyek, S., Hu, D., Abidi, M., Chaaya, C., De Bruyn, H., Fulton, A., Mantagos, I. S., Wu, C., Gise, R., Gonzalez, E., Vanderveen, D. K., Patel, N. A. 2025; 132 (6): 713-717

  Abstract

  To assess the utility of the first or second examinations for retinopathy of prematurity (ROP) in a medium-risk cohort of infants and to propose an optimization to the current ROP screening guidelines.Retrospective consecutive study.Infants screened for ROP between January 2017 and August 2023 at 3 different tertiary-level care neonatal intensive care units.Analysis of patients who did not meet criteria for microprematurity or nanoprematurity (those born at ≥ 27 weeks and weighing ≥ 800 g).The primary outcomes included the rates of ROP and treatment-warranted ROP (TW-ROP), the presence of TW-ROP at the first or second inpatient examinations, the number of inpatient examinations performed before the first ROP diagnosis, and the overall number of inpatient examinations performed.A total of 2004 neonates were screened for ROP, among whom 1125 (56.1%) met the inclusion criteria. Of those, 237 neonates (21.1%) had ROP. Eleven infants (1.0%) required treatment for active disease. The median postmenstrual age (PMA) at first ROP diagnosis was 35.3 weeks (interquartile range [IQR], 33.7-37 weeks; range, 30.3-46.7 weeks). The median PMA at stage 3 diagnosis was 39.3 weeks (IQR, 38.3-41.2 weeks; range, 35.1-44.4 weeks). The median PMA at first treatment was 39.6 weeks (IQR, 35.8-43.3 weeks; range, 35.3-49.6 weeks). The median number of inpatient examinations was 2.0 (IQR, 1-4 examinations) for traditional screening, 1.0 examination (IQR, 1-3 examinations) after eliminating the first ROP inpatient examination, and 1.0 examination (IQR, 1-2 examinations) after eliminating the first and second ROP examinations (P < 0.001). No patients met type 1 ROP treatment criteria at either the first or second inpatient examination (100% sensitivity for TW-ROP). In this cohort, starting examinations at 34 weeks' PMA could save 30.6% of inpatient examinations.In infants not meeting criteria for microprematurity or nanoprematurity, no type 1 ROP was diagnosed at either of the first 2 inpatient examinations. We propose an amendment algorithm (FIRST-ROP) in which ROP examinations start at 34 weeks' PMA for neonates born at ≥27 weeks gestational age and ≥800 grams.The author(s) have no proprietary or commercial interest in any materials discussed in this article.

  View details for DOI 10.1016/j.ophtha.2025.01.004

  View details for Web of Science ID 001505172800028

  View details for PubMedID 39793656

• Longitudinal Assessment of the Impact of GLP-1 Receptor Agonists On Retinal Microvasculature: An OCTA-Based Retrospective Study Shah, S., Ding, X., Hou, N., Nodecker, K., Ploumi, I., Velcani, F., Wang, L., Gumustop, S., Chen, C., Zhu, Y., Ganesan, O., Lu, E. S., Yuan, M., Vingopoulos, F., Romano, F., Wagner, S., Garg, I., Patel, N., Miller, J. B. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2025

  View details for Web of Science ID 001558835600030

• Evaluation of Systemic Diagnostics, Management Strategies and Outcomes in Admitted vs. Non-Admitted Patients with Central Retinal Artery Occlusion Zhang, J., Alhoyek, S., Bagheri, S., Yuan, M., Meshkin, R., Chaaya, C., Miller, J. B., Zacks, D. N., Miller, J. W., Vavvas, D. G., Patel, N. A. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2025

  View details for Web of Science ID 001561723700034

• Clinical Characteristics, Outcomes, and Complications Associated With Delayed Diagnosis of Intraocular Foreign Body. Journal of vitreoretinal diseases Yuan, M., Kozek, L. K., Hoyek, S., Davila, J., Kim, L., Vingopoulos, F., Gong, D., Young, L., Wu, F., Armstrong, G., Eliott, D., Breazzano, M. P., Seth, R., Russell, J. F., Sengillo, J., Lin, B., Fowler, B., Sobrin, L., Miller, J. B., Patel, N. A. 2025: 24741264251339090

  Abstract

  Purpose: To describe the clinical characteristics, outcomes, and complications in cases of intraocular foreign bodies (IOFBs) when the diagnosis is missed or delayed. Methods: This nonconsecutive case series was a retrospective multicenter study of adult patients with a delayed diagnosis of IOFB, defined as initially presenting elsewhere with a missed diagnosis or a delay of more than 24 hours to seek care. Results: Eighteen eyes were included. The mean (±SD) presenting logMAR visual acuity (VA) was 0.45 ± 0.70 (Snellen equivalent, 20/56). The most common presenting symptom was decreased vision (11 patients [61%]). The general emergency department setting accounted for most initial evaluations (11 patients [61%]); however, 6 patients (33%) were seen in an outpatient setting by an optometrist, ophthalmologist, or both. The most common anatomic locations of the IOFBs were in the iris/anterior chamber (4 [22%]) or lens (4 [22%]) followed by the pars plana/ciliary body (3 [17%]), vitreous (3 [17%]), or retina (3 [17%]). Complications at presentation included endophthalmitis (1 [6%]), retinal detachment (1 [6%]), and retinal tears (4 [22%]). Five patients (28%) had siderosis at presentation. The mean final logMAR VA was 0.13 ± 0.32 (Snellen equivalent, 20/26). At the last follow-up, 15 eyes (83%) had a VA of 20/30 or better. The median follow-up was 139 days (IQR, 86-557). Conclusions: Eyes with a delayed diagnosis of IOFBs often present with good vision and self-sealing wounds. Missed IOFBs can be associated with siderosis, RD, and endophthalmitis. Visual outcomes may be salvaged with prompt treatment.

  View details for DOI 10.1177/24741264251339090

  View details for PubMedID 40453423

  View details for PubMedCentralID PMC12122470

• Timing of Retinopathy of Prematurity Diagnosis and Treatment in Micro-Premature and Nano-Premature Infants During Inpatient Screening. Ophthalmology. Retina Yuan, M., Altamirano, F., Hu, D., Hoyek, S., Chaaya, C., Abidi, M., De Bruyn, H., Fulton, A., Mantagos, I. S., Wu, C., Gonzalez, E., VanderVeen, D. K., Gise, R., Patel, N. A. 2025

  Abstract

  We aimed to determine the timing of retinopathy of prematurity (ROP) diagnosis and treatment in a cohort of infants meeting criteria for micro and/or nano-prematurity with the goal of informing screening protocols in this high-risk group.Retrospective consecutive study.We included all screened infants who met the criteria for micro-prematurity (24-26 weeks GA and/or BW 600-799 grams) or nano-prematurity (<24 weeks GA and/or BW <600 grams).Data collected from 2013 to 2023 included GA at birth, BW, postmenstrual age (PMA) at ROP diagnosis, PMA at type 1 ROP diagnosis, and number of inpatient examinations.Rates of ROP and treatment-warranted ROP, timing to first ROP diagnosis and treatment-warranted ROP, and the number of examinations.3239 infants were screened during this time period for ROP, and 650 infants met inclusion criteria. The median GA at birth and BW were 25.3 weeks and 682.5 grams, respectively. 456 infants (70.2%) were micro-premature and 194 (29.8%) were nano-premature. ROP was detected in 524 patients (80.6%). The median PMA at first ROP diagnosis was 33.7 weeks. The median interval from birth to first ROP diagnosis was 8.4 weeks. The median exam number at first ROP diagnosis was the second exam. The median number of inpatient examinations was 9. Of ROP patients, 180 (34.4%) had ROP diagnosis at their first examination. A total of 126 (19.4% of all infants and 24.0% of those with ROP) infants met type 1 treatment criteria. The median PMA at type 1 ROP diagnosis was 37 weeks . The median interval from birth to type 1 ROP was 12 weeks. The median exam number at type 1 diagnosis was the 5th exam.In this modern cohort of high-risk extremely premature infants, 9 patients (1.4%) were diagnosed with type 1 ROP on the first or second inpatient exams. These infants had generally good outcomes after treatment, with only two eyes of one patient progressing to stage 4 disease. Our findings support maintaining current screening guidelines for high-risk extremely premature infants, while suggesting opportunities for optimizing screening approaches through risk stratification.

  View details for DOI 10.1016/j.oret.2025.05.026

  View details for PubMedID 40414563

• Choriocapillaris impairment in dry AMD: insights from swept-source OCT angiography and associations with structural biomarkers BRITISH JOURNAL OF OPHTHALMOLOGY Overbey, K., Romano, F., Ding, X., Bennett, C. F., Stettler, I., Garg, I., Ploumi, I., Vingopoulos, F., Yuan, M., Razavi, P., Finn, M., Lains, I., Patel, N. A., Kim, L., Wu, D., Eliott, D., Husain, D., Vavvas, D., Miller, J. W., Miller, J. B. 2025

  Abstract

  To assess choriocapillaris flow deficit percentage (CCFD%) across stages of dry age-related macular degeneration (AMD) using swept-source optical coherence tomography angiography (SS-OCTA).This cross-sectional, observational study included 270 eyes (182 patients), classified as early (70 eyes), intermediate (121 eyes) and geographic atrophy (GA, 79 eyes).Participants underwent a complete examination including macular 6×6 mm SS-OCTA scans (PLEX Elite 9000). Scans were reviewed and analysed for subretinal drusenoid deposits (SDDs), retinal pigment epithelium (RPE) atrophy size, incomplete RPE and outer retinal atrophy (iRORA) and drusen volume (3 mm). CCFD% was calculated after compensation and binarisation using Phansalkar's method (r=4-15 pixels) in various early treatment for diabetic retinopathy study sectors. Linear mixed-effects models adjusted for age evaluated associations with AMD stages and other imaging biomarkers.CCFD% progressively increased with advancing dry AMD stages. Intermediate AMD eyes showed higher CCFD% than early AMD ones across all regions (p<0.001). GA eyes exhibited significantly higher CCFD% compared with early (p<0.001) and intermediate AMD eyes (p<0.001).SDDs were significantly associated with higher CCFD% in early (p<0.01) and intermediate AMD (p<0.05) for almost all regions examined, but not in GA (p>0.05). iRORA presence in iAMD and larger RPE atrophy in GA correlated with increased CCFD% (p<0.001).This study provides a comprehensive reference database for CCFD% across the stages of dry AMD using SS-OCTA. CCFD% increased with AMD severity, iRORA, SDDs, particularly in early and intermediate stages, and RPE atrophy size. Our findings support CCFD% as a valuable biomarker for clinical and research applications, warranting longitudinal studies to validate its prognostic value.

  View details for DOI 10.1136/bjo-2024-326416

  View details for Web of Science ID 001487848200001

  View details for PubMedID 40360203

• Antivascular Endothelial Growth Factor Injections for the Chronic Treatment of Macula-off, Fovea-on Diabetic Tractional Retinal Detachment With Vitreous Hemorrhage JOURNAL OF VITREORETINAL DISEASES Yuan, M., Hoyek, S., Kim, L. A., Chaaya, C., Patel, N. 2025; 9 (2): 236-240

  Abstract

  Purpose: To evaluate the use of antivascular endothelial growth factor (anti-VEGF) as treatment for tractional retinal detachments (TRDs) involving the macula. Methods: A case report was evaluated. Results: A 40-year-old man with a medical history notable for congenital heart disease and proliferative diabetic retinopathy presented with decreased vision. Surgery was not feasible for medical reasons, and panretinal photocoagulation was limited by retinal traction and hemorrhage. Despite initial progression of bilateral macula-off, foveal-on TRDs, the patient received intravitreal (IVT) bevacizumab regularly every 8 to 12 weeks. After initial improvement, both eyes remained anatomically stable with attached foveas over more than 1.5 years of follow-up. Conclusions: In cases in which surgery is not possible, macula-involving TRDs with neovascularization can be managed successfully with repeated IVT anti-VEGF injection monotherapy.

  View details for DOI 10.1177/24741264241297684

  View details for Web of Science ID 001445017300015

  View details for PubMedID 39544710

  View details for PubMedCentralID PMC11558646

• Orbital and Ocular Venous Congestion: A Rare Manifestation of Hypervascular Paget Disease of the Bone. Ophthalmic plastic and reconstructive surgery Yuan, M., Chiou, C. A., Hu, J. C., Zekavat, S. M., Eliott, D., Patel, A. B., Lefebvre, D. R. 2025

  Abstract

  A 73-year-old male with a history of incidentally diagnosed Paget disease of bone affecting the skull and left orbit 2 years prior presented with 3 months of vision loss, proptosis, and periorbital swelling of the OS. Examination showed best-corrected Snellen visual acuity of 20/150 in the affected eye, intact motility, 7mm of relative proptosis, significant dilated and tortuous "corkscrew" conjunctival vessels, serous choroidal and retinal detachments, optic nerve hyperemia, and venous tortuosity and dilation. Although the bony lesions in the left orbit were stable from 1 year prior on imaging, the diagnostic angiogram demonstrated osseous blush and hypervascularity of the lesion. It was thus determined that the abnormal bone of the left orbit with enhanced blood flow was adversely affecting the blood flow in the orbit and eye. The patient underwent coil embolization of the feeding vessels and external blood supply to the lateral orbital wall and hyperostotic Paget lesion via coil embolization of the left internal maxillary artery and left middle meningeal artery with improvement of the choroidal effusions and subretinal fluid, followed by bony orbital decompression with improvement in the proptosis. This is a novel case of orbital and ocular vascular congestion due to Paget disease.

  View details for DOI 10.1097/IOP.0000000000002909

  View details for PubMedID 39840752

• Clinical and imaging characteristics associated with foveal neovascularization in proliferative diabetic retinopathy GRAEFES ARCHIVE FOR CLINICAL AND EXPERIMENTAL OPHTHALMOLOGY Yuan, M., Romano, F., Ding, X., Garcia, M., Garg, I., Overbey, K., Bennett, C., Ploumi, I., Stettler, I., Lains, I., Vingopoulos, F., Rodriguez, J., Patel, N. A., Kim, L. A., Vavvas, D. G., Husain, D., Miller, J. W., Miller, J. B. 2025; 263 (3): 679-687

  Abstract

  To assess the prevalence of foveal neovascularization (FNV) and its associated clinical features in proliferative diabetic retinopathy (PDR) eyes.Cross-sectional observational study. Participants underwent ultra-widefield photography, optical coherence tomography (OCT), and swept-source OCT angiography (SS-OCTA). FNV was defined as a hyperreflective lesion breaching the internal limiting membrane and displaying flow signal on OCTA, within 1-mm of foveal avascular zone. Vascular metrics were obtained from the ARI Network portal. Ischemic index (ISI) and inner choroid flow deficit percentage were calculated using FIJI from 12 × 12 and 6 × 6-mm scans, respectively. Logistic regression models were used to compare eyes with and without FNV.We included 249 eyes of 164 patients (age: 58 [50-65] years). FNV was identified in 20 eyes (8%). Univariate logistic regression revealed significant associations between FNV and younger age (p = 0.03), higher maximal HbA1c (p = 0.04), worse visual acuity (VA) (p = 0.01), presence of disorganization of retinal inner layers (DRIL) (p = 0.01), no macular posterior vitreous detachment (PVD) (p = 0.03), neovascularization elsewhere (NVE) and at the disc (NVD) (p = 0.01 and p = 0.001), and greater ISI (p = 0.04). In multivariable analysis, a significant association remained between FNV and worse VA (p = 0.04), NVD (p < 0.001), DRIL (p < 0.001), and absence of macular PVD (p = 0.01). No associations were found with SS-OCTA vascular metrics.This study provides a comprehensive characterization of FNV in PDR. FNV was identified in 8% of our cohort, being more prevalent in younger patients with severe PDR, as evidenced by NVD and DRIL presence. The absence of macular PVD may explain its association with younger age.What is known • Neovascularization at the fovea occurs rarely in proliferative diabetic retinopathy. • OCT and OCT-angiography can be used to evaluate foveal neovascularization, which may be associated with choroidal vascular abnormalities. What is new • Foveal neovascularization was seen in 8% of eyes with proliferative diabetic retinopathy in this cohort. • Risk factors for foveal neovascularization included younger age, absence of macular posterior vitreous detachment, presence of neovascularization of the disc, and presence of disorganization of retinal inner layers. • We did not identify an association between foveal neovascularization and choroidal perfusion abnormalities in this study.

  View details for DOI 10.1007/s00417-024-06660-1

  View details for Web of Science ID 001355636500001

  View details for PubMedID 39542876

  View details for PubMedCentralID 8861405

• Multimodal Imaging Characteristics and Correlation to Outcomes in Patients With Central Retinal Artery Occlusion Presenting to a Large Academic Center AMERICAN JOURNAL OF OPHTHALMOLOGY Hoyek, S., Yuan, M., Bejjani, R., Zacks, D., Miller, J., Vavvas, D., Patel, N. 2025; 270: 35-51

  Abstract

  To characterize a large modern cohort of patients with central retinal artery occlusion (CRAO) by describing presenting features and outcomes relating to manually segmented optical coherence tomography (OCT) features, angiographic reperfusion, and visual recovery.Retrospective clinical cohort study.Patients with CRAO (ICD-10: H34.1) initially presenting to a tertiary referral center between January 2017 and December 2021 were included. Demographics, eye exam findings, fundus photographs, OCT, and fluorescein angiography were analyzed. Main outcome measures included total and inner retinal thickness on macular OCT, reperfusion, visual outcomes, and development of neovascularization.A total of 145 eyes of 144 patients with mean age at of 69.4 ± 13.6 years were included. The mean time to presentation was 1.6 ± 4.2 days, with 19% examined within 4.5 hours and 26% within 6 hours of vision loss. 19% had cilioretinal artery (CLRA) sparing. Mean initial visual acuity (VA) was 1.68 ± 1.10 Logarithm of the Minimum Angle of Resolution (LogMAR) (CLRA sparing) compared to 2.53 ± 0.58 LogMAR (non-CLRA sparing), P < .001. 32% had elevated inflammatory makers. Out of 47 eyes with final fluorescein angiography, one-third showed some reperfusion. Final vision was 1.40 ± 1.16 LogMAR (CLRA sparing) compared to 2.46 ± 0.81 (non-CLRA sparing), P < .001. A third of patients improved in VA in both groups, 27% of patients gained more than 2 lines of vision in the CLRA-sparing group and 36% in the non-CLRA-sparing group. 17% improved to better than 20/200 in CLRA-sparing and 4% in non-CLRA sparing. Overall, 11% developed neovascularization all in non-CLRA sparing. In a multiple linear regression, VA at presentation was associated with regaining vision of 2 lines or more (OR = 2.603, P = .007). OCT showed progressive thinning over time, reaching lowest measurements at 6 months, and stabilizing thereafter.In this modern cohort of acute CRAO patients, presentation to a tertiary facility within 12 hours of symptoms was seen in almost half of the patients. Final VA improved in almost a third of the patients, however, vision better than the legal blindness limit was rare (∼5%). Interestingly, a third of patients had some mild elevation of systemic inflammatory markers. Better VA at presentation was associated with visual gain, while baseline OCT values had poor correlation with final outcome.

  View details for DOI 10.1016/j.ajo.2024.10.004

  View details for Web of Science ID 001356696800001

  View details for PubMedID 39413899

• A 52-year-old man from Somalia with an asymptomatic macular hemorrhage. Retinal cases & brief reports Yuan, M., Ludwig, C. A., Bleicher, I., Hoyek, S., Eliott, D., Sobrin, L., Patel, N. 2024

  View details for DOI 10.1097/ICB.0000000000001659

  View details for PubMedID 39733267

• USE OF ADDITIONAL FACEDOWN POSITIONING WITH SILICONE OIL TAMPONADE FOR THE TREATMENT OF RETINAL REDETACHMENT. Retinal cases & brief reports Somisetty, A., Hoyek, S., Yuan, M., Somisetty, S., Kim, L. A., Patel, N. A. 2024; 18 (5): 628-632

  Abstract

  The purpose of this study was to highlight a potential alternative to additional surgery for management of retinal redetachment through the use of additional facedown positioning with silicone oil tamponade.Retrospective case series of two patients evaluated with examination, multimodal imaging, including fundus photography, optical coherence tomography, and fluorescein angiography.In Case 1, a 70-year-old female patient underwent surgery for a full-thickness macular hole with associated macula-off retinal detachment, but experienced a recurrent detachment and underwent a second surgery with silicone oil placement. Another recurrent detachment was found. The case was managed conservatively with facedown positioning, resulting in resolution of subretinal fluid and improvement in vision. At follow-up, the retina remained attached with stable vision. In Case 2, a 25-year-old male patient underwent a surgical repair for proliferative vitreoretinopathy retinal detachment with a scleral buckle, cryotherapy, and external drainage. After multiple redetachment surgeries with retinectomy and oil placement, another tractional redetachment of the fovea was noted. Management was with facedown positioning, and follow-up evaluation showed resolution of the subretinal fluid and improvement in vision with stability for greater than 2 months.For recurrent retinal redetachments with silicone oil in place, an additional week of facedown positioning can result in anatomical success and be a viable alternative or bridge to invasive surgical interventions. This approach may have greatest utility for patients who are poor surgical candidates without new peripheral pathology.

  View details for DOI 10.1097/ICB.0000000000001461

  View details for PubMedID 37490752

• Progressive Choriocapillaris Changes on Optical Coherence Tomography Angiography Correlate With Stage Progression in AMD. Investigative ophthalmology & visual science Romano, F., Ding, X., Yuan, M., Vingopoulos, F., Garg, I., Choi, H., Alvarez, R., Tracy, J. H., Finn, M., Ravazi, P., Stettler, I. V., Laìns, I., Vavvas, D. G., Husain, D., Miller, J. W., Miller, J. B. 2024; 65 (8): 21

  Abstract

  We investigated the association between inner choroid flow deficit percentage (IC-FD%) using swept-source optical coherence tomography angiography (SS-OCTA) and progression of AMD.Retrospective, observational study including 64 eyes (42 participants) with early or intermediate AMD at baseline. Participants had two or more consecutive swept-source optical coherence tomography angiography covering a period of at least 18 months. Demographics, visual acuity, and AMD staging based on Beckman classification were reviewed. OCT was analyzed for hyperreflective foci, subretinal drusenoid deposits, hyporeflective drusen cores, and subfoveal choroidal thickness. IC-FD% was measured within the central 3- and 6-mm using a 16-µm slab, after compensation and binarization (Phansalkar method). Mixed-effects Cox regression models assessed the association between imaging biomarkers and AMD progression.During follow-up (37 ± 9 months), 4 eyes with early AMD (31%) progressed to intermediate AMD and 30 (59%) eyes with intermediate AMD developed late AMD (19 geographic atrophy; 11 wet AMD). Baseline hyporeflective drusen core was associated with geographic atrophy development (P < 0.01), whereas greater IC-FD% (3-mm) was associated with wet AMD (P = 0.03). Time-varying analysis showed that faster subfoveal choroidal thickness reduction and IC-FD% (6-mm) increase were associated with geographic atrophy onset (P < 0.05), whereas IC-FD% (3-mm) increase was associated with wet AMD (P = 0.03). Notably, greater IC-FD% increases in the 3 mm (area under the curve = 0.72) and 6 mm (area under the curve = 0.89) were better predictive of wet AMD and geographic atrophy development, respectively.Our longitudinal IC-FD% assessment emphasizes the role of progressive choriocapillaris changes as a biomarker for AMD progression. Our findings support that widespread choriocapillaris alterations (6 mm) may precede progression to geographic atrophy, whereas more central choriocapillaris loss (3 mm) may provide an ischemic stimulus for wet AMD.

  View details for DOI 10.1167/iovs.65.8.21

  View details for PubMedID 38990069

• Decreased Macular Choriocapillaris Perfusion Correlates with Contrast Sensitivity Function in Dry Age-related Macular Degeneration. Ophthalmology. Retina Romano, F., Vingopoulos, F., Yuan, M., Ding, X., Garcia, M., Ploumi, I., Rodriguez, J., Garg, I., Tracy, J. H., Bannerman, A., Choi, H., Stettler, I., Bennett, C., Overbey, K. M., Laìns, I., Kim, L. A., Vavvas, D. G., Husain, D., Miller, J. W., Miller, J. B. 2024

  Abstract

  To investigate the relationships between contrast sensitivity (CS), choriocapillaris perfusion and other structural optical coherence tomography (OCT) biomarkers in dry age-related macular degeneration (AMD).Cross-sectional, observational study.One hundred AMD eyes (22 early, 52 intermediate and 26 late) from 74 patients and 45 control eyes from 37 age-similar subjects.All participants had visual acuity (VA) assessment, quantitative contrast sensitivity function (qCSF) testing, macular OCT, and 6x6-mm swept-source OCT angiography (OCTA) scans on the same day. OCT volumes were analyzed for subretinal drusenoid deposits and hyporeflective drusen cores, and to measure thickness of the outer nuclear layer (ONL). OCTA scans were utilized to calculate drusen volume, inner choroid flow deficit percentage (IC-FD%), and to measure the area of choroidal hypertransmission defects (HTD). IC-FD% was measured from a 16 μm-thick choriocapillaris slab after compensation and binarization with Phansalkar's method. Generalized linear mixed-effects models were used to evaluate the associations between functional and structural variables.To explore the associations between qCSF-measured CS, ICFD% and various AMD imaging biomarkers.AMD exhibited significantly reduced qCSF metrics eyes across all stages compared to controls. Univariate analysis revealed significant associations between various imaging biomarkers, reduced qCSF metrics and VA in both groups. Multivariate analysis confirmed that higher IC-FD% in the central 5 mm was significantly associated with decreases in all qCSF metrics in AMD eyes (β= -0.74 to -0.25, all p<0.05), but not with VA (p>0.05). ONL thickness in the central 3 mm correlated with both VA (β= 2.85, p<0.001) and several qCSF metrics (β= 0.01-0.90, all p<0.05), especially in AMD eyes. Further, larger HTD areas were associated with decreased VA (β=-0.89, p<0.001) and reduced CS at low-intermediate frequencies across AMD stages (β= -0.30 to -0.29, p<0.001).The significant association between IC-FD% in the central 5 mm and qCSF-measured CS reinforces the hypothesis that decreased macular choriocapillaris perfusion contributes to visual function changes in AMD, which are more pronounced in CS than in VA.

  View details for DOI 10.1016/j.oret.2024.06.005

  View details for PubMedID 38878897

• A Comprehensive Assessment of Retinal Microvascular and Choroidal Alterations in Proliferative Diabetic Retinopathy using Swept-Source Optical Coherence Tomography Angiography (SS-OCTA) Razavi, P., Romano, F., Yuan, M., Ding, X., Garcia, M., Overbey, K. M., Garg, I., Bennett, C. F., Vingopoulos, F., Stettler, I., Finn, M., Ploumi, I., Vavvas, D. G., Husain, D., Miller, J. W., Miller, J. B. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2024

  View details for Web of Science ID 001313316206106

• Occlusive Retinal Vasculitis in a Pediatric Patient With Kikuchi-Fujimoto Disease and Sickle Cell Trait OPHTHALMIC SURGERY LASERS & IMAGING RETINA Lu, E. S., Hoyek, S., Yuan, M., Khatib, B., Gonzalez, E., Rothermel, H., Gise, R., Patel, N. A. 2024; 55 (4): 235-239

  Abstract

  A 13-year-old Black male patient with a history of Kikuchi-Fujimoto disease (KFD) and sickle cell trait presented with acute painless vision loss and no light perception vision (NLP) in his left eye. The examination was indicative of occlusive retinal vasculitis with near total central retinal artery occlusion (CRAO). He was started on oral steroids with dramatic reperfusion and improvement of the retinal hemorrhages. However, his vision remained at NLP. Oral steroids were tapered, and rituximab infusion was initiated. While ocular involvement is uncommon in KFD, vision-limiting complications, such as occlusive retinal vasculitis, ophthalmic artery occlusion, and CRAO can occur. Early systemic immunosuppression is key in achieving rapid remission. [Ophthalmic Surg Lasers Imaging Retina 2024;55:235-239.].

  View details for DOI 10.3928/23258160-20240123-01

  View details for Web of Science ID 001226580800003

  View details for PubMedID 38319054

• Comparison of Structural and Functional Features in Primary Angle Closure and Open Angle Glaucomas JOURNAL OF GLAUCOMA Sun, J. A., Yuan, M., Johnson, G. E., Pasquale, L. R., Boland, M. V., Friedman, D. S., Elze, T., Shen, L. Q., Wang, M. 2024; 33 (4): 254-261

  Abstract

  Using a large data set, we showed structural and functional differences between primary angle closure glaucoma (PACG) and primary open angle glaucoma (POAG). Primary angle closure glaucoma has relative structural preservation and worse functional loss inferiorly.To identify structural and functional differences in PACG and POAG.In this large cross-sectional study, differences in structural and functional damage were assessed among patients with POAG and PACG with optical coherence tomography and reliable visual field testing.In all, 283 patients with PACG and 4110 patients with POAG were included. Despite similar mean deviation on visual fields (mean [SD] -7.73 [7.92] vs. -7.53 [6.90] dB, P =0.72), patients with PACG had thicker global retinal nerve fiber layer (RNFL), smaller cup volume, smaller cup-to-disc ratio, and larger rim area than POAG (77 [20] vs. 71 [14] µm, 0.32 [0.28] vs. 0.40 [0.29] mm 3 , 0.6 [0.2] vs. 0.7 [0.1], 1.07 [0.40] vs. 0.89 [0.30] mm 2 , P <0.001 for all), while patients with POAG had more pronounced inferior RNFL thinning (82 [24] vs. 95 [35] µm, P <0.001). In a multivariable analysis, hyperopia [odds ratio (OR): 1.24, confidence interval (CI): 1.13-1.37], smaller cup-to-disc ratio (OR: 0.69, CI: 0.61-0.78), thicker inferior RNFL (OR: 1.15, CI: 1.06-1.26) and worse mean deviation (OR: 0.95, CI: 0.92-0.98) were associated with PACG. Functionally, POAG was associated with superior paracentral loss and PACG with inferior field loss. After adjusting for average RNFL thickness, PACG was associated with more diffuse loss than POAG (total deviation differences 1.26-3.2 dB).Patients with PACG had less structural damage than patients with POAG despite similar degrees of functional loss. Regional differences in patterns of functional and structural loss between POAG and PACG may improve disease monitoring for these glaucoma subtypes.

  View details for DOI 10.1097/IJG.0000000000002341

  View details for Web of Science ID 001233202500003

  View details for PubMedID 38031290

  View details for PubMedCentralID PMC10954413

• The Transition to Ophthalmology Residency: A National Survey of the Combined Ophthalmology PGY-1 Program. Journal of academic ophthalmology (2017) Azad, A. D., Yuan, M., Weinert, M., Rosenblatt, T. R., Miller, J. W., Lorch, A. 2023; 15 (2): e188-e196

  Abstract

  Background In 2017, the Accreditation Council for Graduate Medical Education announced all ophthalmology residency programs would provide a combined transitional or joint preliminary program for first postgraduate year (PGY-1) residents, with mandatory implementation by 2023. Purpose This study aimed to survey ophthalmology residency program directors, postgraduate year 2 (PGY-2) ophthalmology residents who were a part of the first, official combined ophthalmology PGY-1 year, and postgraduate year 3 (PGY-3) residents who were a PGY-1 resident the year prior to integration to evaluate characteristics and perspectives on the combined ophthalmology PGY-1 year. Methods A national, internet survey-based study approved by the Association of University Professors of Ophthalmology (AUPO) was disseminated to the AUPO listserv of program directors (PDs) and PGY-2 and PGY-3 ophthalmology residents from July to August 2022 and then again April to June 2023. Results Twenty-six PDs completed the survey (response rate 20.3% out of 128 PDs). Forty-one PGY-2 ophthalmology residents who underwent the combined ophthalmology PGY-1 year and 33 PGY-3 ophthalmology residents also completed the survey. Most PGY-1 curricula focused on exposure to comprehensive ophthalmology and provided indirect ophthalmoscope, slit lamp, and refraction skills training to residents. Early exposure to fundamentals and clinical workflows were commonly cited benefits to the integration. When PDs were surveyed about how well-prepared PGY-1 residents who went through the combined year are for the PGY-2 relative to the prior year's class, 16 (61.5%) responded "better prepared." PGY-2 residents also reported a relatively higher level of clinical preparedness and familiarity with ophthalmology co-residents than PGY-3 residents. Several areas of improvement cited by both PDs and residents were identified including a dedicated didactic curriculum and more time in ophthalmology during the PGY-1 year. Conclusions We found an overall net benefit from the integration of the combined ophthalmology PGY-1 year. Benefits include early exposure to clinical skills and knowledge specific to ophthalmology, leading to increased confidence and preparedness for the rigorous transition to ophthalmology residency. We also identified many areas for improvement to optimize the PGY-1 year including a formal curriculum and additional time in ophthalmology. Programs should work closely with their residents, faculty, and non-ophthalmology PDs to refine the PGY-1 for the benefit of future ophthalmologists.

  View details for DOI 10.1055/s-0043-1774393

  View details for PubMedID 37701864

• Defining Occult High-Risk Cysts of the Pineal Region: A Case Series OPERATIVE NEUROSURGERY Guadix, S. W., Marianayagam, N. J., Weidman, E. K., Yuan, M., Liechty, B., Greenfield, J. P., Souweidane, M. M. 2023; 24 (6): 572-581

  Abstract

  Absence of hydrocephalus on neuroimaging may impart a false sense of security for patients with pineal cysts. In this case series, we characterize a subset of patients with pineal cysts having an occult presentation. Unifying features of worsening paroxysmal headaches suggesting intermittent obstructive hydrocephalus and radiographic evidence of third ventricular invagination characterize these patients as high risk.To define features of occult, high-risk pineal cysts and outcomes of endoscopic cyst fenestration.Charts were retrospectively reviewed for patients with pineal cysts evaluated at our institution between 2018 and 2021 who underwent endoscopic cyst fenestration. To capture cysts presenting as occult, patients were excluded if hydrocephalus was noted at presentation. Relevant clinical history, imaging, operative data, and clinical outcomes were reviewed.Of 50 pineal cyst patients, 4 satisfied inclusion criteria. All patients presented with worsening paroxysmal headaches. In addition, 75% (3/4) also experienced intermittent syncope. Patients exhibited no hydrocephalus (n = 3) or fluctuating ventricular size on longitudinal imaging (n = 1). In all cases, high-resolution sagittal 3-dimensional T2 magnetic resonance imaging demonstrated invagination of the cyst anteriorly into the posterior third ventricle. All patients underwent endoscopic cyst fenestration with complete symptom resolution (mean follow-up of 20.6 months; range 3.5-37.4 months).The clinical history for occult, high-risk pineal cysts is notable for worsening paroxysmal headaches and episodic alterations of consciousness suggesting intermittent obstructive hydrocephalus. Because ventricular size can appear normal on standard imaging protocols, clinical suspicion should trigger workup with high-resolution magnetic resonance imaging designed to detect these cysts. Endoscopic cyst fenestration is a safe and efficacious management strategy.

  View details for DOI 10.1227/ons.0000000000000620

  View details for Web of Science ID 000989442400033

  View details for PubMedID 36716050

• Structural and Functional Differences between Primary Angle-Closure Glaucoma and Primary Open-Angle Glaucoma: A Large Single-Center Study Sun, J. A., Yuan, M., Pasquale, L. R., Elze, T., Wang, M., Shen, L. Q. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2023

  View details for Web of Science ID 001053758305286

• Effective Low-Cost Ophthalmological Screening With a Novel iPhone Fundus Camera at Community Centers CUREUS JOURNAL OF MEDICAL SCIENCE Cheng, D., Babij, R., Cabrera, D., Yuan, M., Port, A., Mckenney, A., Zhu, J., Van Tassel, S., Imperato-McGinley, J., Sun, G. 2022; 14 (8): e28121

  Abstract

  Ophthalmologic care is inaccessible to many people due to a variety of factors, including the availability of providers, cost of equipment for ophthalmologic care, and transportation to clinics and appointments. Because many causes of blindness are both highly prevalent and preventable once identified, it is essential to address gaps in care for underserved populations. We developed a novel 3D-printed mobile retinal camera. In this study, we organized recurring student-run screening events around New York City that took place in community centers and churches, at which we utilized our device to take retinal images. Our screening events reached a diverse population of New Yorkers, disproportionately those with lower household income, many of whom had not had recent eye exams. To validate the device for use in telehealth ophthalmologic visits, we transmitted the images to a remote ophthalmologist for evaluation and compared the result with an on-site attending physician's dilated eye exam. The subjective assessment indicated that 97% of images captured with the mobile retinal camera were acceptable for telehealth analysis. Remote image assessment by achieved 92% sensitivity and 83% specificity in detecting optic disc cupping, compared to the gold-standard on-site dilated eye exam. In addition, the device was portable, affordable, and able to be used by those with relatively little ophthalmologic training. We have demonstrated the utility of this affordable mobile retinal camera for telehealth ophthalmologic evaluation during community screening events that reached an underserved population to detect disease and connect with long-term care.

  View details for DOI 10.7759/cureus.28121

  View details for Web of Science ID 000843958300036

  View details for PubMedID 35990564

  View details for PubMedCentralID PMC9389029

• Examining the Role of Early Diagnostic Imaging for Craniosynostosis in the Era of Endoscopic Suturectomy: A Single Institution Experience Guadix, S. W., Valenti, A., Zappi, K. E., Garton, A. L. A., Yuan, M., Buontempo, M., Perera, I., Souweidane, M. M., Imahiyerobo, T., Hoffman, C. E. LIPPINCOTT WILLIAMS & WILKINS. 2022: 1363-1368

  Abstract

  Endoscopic suturectomy is a minimally invasive surgical treatment for single-suture craniosynostosis in children between 1 and 4 months of age. This study sought to characterize the role played by diagnostic imaging in facilitating early surgical management with endoscopic suturectomy. The authors also characterized the overall diagnostic utility of imaging in patients assessed for abnormal head shape at their institution, regardless of surgical status. A retrospective cohort of children diagnosed with singlesuture synostosis undergoing either primary endoscopic suturectomy or open calvarial reconstruction at the authors' institution from 1998 to 2018 was first reviewed. Of 132 surgical patients, 53 underwent endoscopic suturectomy and 79 underwent open repair. There was no difference in the proportion of endoscopic and open surgery patients imaged preoperatively before (24.5% versus 35.4%; P = 0.24) or after (28.3% versus 25.3%; P = 0.84) craniofacial assessment. Stratifying by historical epoch (1998-2010 versus 2011-2018), there was also no difference found between preoperative imaging rates (63.6% versus 56.4%; P = 0.35). In another cohort of 175 patients assessed for abnormal head shape, 26.9% were imaged to rule out craniosynostosis. Positive diagnostic imaging rates were recorded for suspected unicoronal (100%), metopic (87.5%), lambdoidal (75.0%), sagittal (63.5%), multisuture (50%), and bicoronal (0%) synostosis. The authors conclude that the use of diagnostic imaging at their institution has not increased despite higher utilization of endoscopic suturectomy and need for expedient identification of surgical candidates.However, their results suggest that imaging may play a greater diagnostic role for suspected bicoronal, sagittal, and multi-sutural synostosis among sutural subtypes of synostosis.

  View details for DOI 10.1097/SCS.0000000000008534

  View details for Web of Science ID 000823174200060

  View details for PubMedID 35132031

• Utility of multimodality molecular profiling for pediatric patients with central nervous system tumors NEURO-ONCOLOGY ADVANCES Rajappa, P., Eng, K. W., Bareja, R., Bander, E. D., Yuan, M., Dua, A., Maachani, U., Snuderl, M., Pan, H., Zhang, T., Tosi, U., Ivasyk, I., Souweidane, M. M., Elemento, O., Sboner, A., Greenfield, J. P., Pisapia, D. J. 2022; 4 (1): vdac031

  Abstract

  As our molecular understanding of pediatric central nervous system (CNS) tumors evolves, so too do diagnostic criteria, prognostic biomarkers, and clinical management decision making algorithms. Here, we explore the clinical utility of wide-breadth assays, including whole-exome sequencing (WES), RNA sequencing (RNA-seq), and methylation array profiling as an addition to more conventional diagnostic tools for pediatric CNS tumors.This study comprises an observational, prospective cohort followed at a single academic medical center over 3 years. Paired tumor and normal control specimens from 53 enrolled pediatric patients with CNS tumors underwent WES. A subset of cases also underwent RNA-seq (n = 28) and/or methylation array analysis (n = 27).RNA-seq identified the driver and/or targetable fusions in 7/28 cases, including potentially targetable NTRK fusions, and uncovered possible rationalized treatment options based on outlier gene expression in 23/28 cases. Methylation profiling added diagnostic confidence (8/27 cases) or diagnostic subclassification endorsed by the WHO (10/27 cases). WES detected clinically pertinent tier 1 or tier 2 variants in 36/53 patients. Of these, 16/17 SNVs/INDELs and 10/19 copy number alterations would have been detected by current in-house conventional tests including targeted sequencing panels.Over a heterogeneous set of pediatric tumors, RNA-seq and methylation profiling frequently yielded clinically relevant information orthogonal to conventional methods while WES demonstrated clinically relevant added value primarily via copy number assessment. Longitudinal cohorts comparing targeted molecular pathology workup vs broader genomic approaches including therapeutic selection based on RNA expression data will be necessary to further evaluate the clinical benefits of these modalities in practice.

  View details for DOI 10.1093/noajnl/vdac031

  View details for Web of Science ID 000852789900046

  View details for PubMedID 35475276

  View details for PubMedCentralID PMC9034114

• Adverse events associated with femtosecond laser-assisted cataract surgery reported to the MAUDE database JOURNAL OF CATARACT AND REFRACTIVE SURGERY Koenig, L. R., Duong, A. T., Yuan, M., Van Tassel, S. H. 2022; 48 (2): 168-172

  Abstract

  To report real-world complications associated with femtosecond laser-assisted cataract surgery (FLACS).Deidentified database.Retrospective review.The U.S. Food and Drug Administration's Manufacturer and User Facility Device Experience (MAUDE) database was culled for adverse events involving ophthalmic femtosecond laser during cataract surgery from January 2010 to January 2020. Reports in which the narrative description was inadequate to determine the nature of the complication were excluded. Each report was reviewed for complications, which were subsequently assigned to a complication category as determined by these authors. The number of events per year was determined and compared.Between January 2010 and January 2020, the MAUDE database search yielded 2927 reports involving femtosecond laser, of which 1927 met inclusion criteria and were included for analysis. These reports revealed 2704 complications: 1115 capsule tears (41.2%), 329 of which required vitrectomy, 372 instances of suction loss, 321 other capsulotomy-related complications, and 432 corneal or incisional complications. Rare complications included 54 reports of miosis, 16 reports of endophthalmitis, and 4 reports of toxic anterior segment syndrome. The number of events in the MAUDE database increased year over year between 2011 and 2017, peaking in 2017 at 303 events.By drawing on real-world data in the MAUDE database, this study identified the complications of greatest importance in clinical practice. Surgeons should be aware of the spectrum of possible complications to best prepare for all potential outcomes and to effectively counsel patients.

  View details for DOI 10.1097/j.jcrs.0000000000000739

  View details for Web of Science ID 000927859200008

  View details for PubMedID 34321409

• Cerebrospinal fluid diversion for leptomeningeal metastasis: palliative, procedural and oncologic outcomes JOURNAL OF NEURO-ONCOLOGY Bander, E. D., Yuan, M., Reiner, A. S., Garton, A. L. A., Panageas, K. S., Brennan, C. W., Tabar, V., Moss, N. S. 2021; 154 (3): 301-313

  Abstract

  Leptomeningeal metastasis (LM) occurs in 3-5% of patients with solid metastatic tumors and often portends a severe prognosis including symptomatic hydrocephalus and intracranial hypertension. Cerebrospinal fluid (CSF) shunting can provide symptomatic relief in this patient subset; however, few studies have examined the role of shunting in the palliation, prognosis and overall oncologic care of these patients.To identify and evaluate risk factors associated with prognosis after CSF diversion and assess surgical, symptomatic and oncologic outcomes in this population.A retrospective study was conducted on patients with solid-malignancy LM treated with a shunt at a NCI-designated Comprehensive Cancer Center between 2010 and 2019.One hundred and ninety patients with metastatic LM underwent CSF diversion. Overall survival was 4.14 months from LM diagnosis (95% CI: 3.29-4.70) and 2.43 months (95% CI: 2.01-3.09) from shunting. Karnofsky performance status (KPS) at time of shunting and brain metastases (BrM) number at LM diagnosis demonstrated significant associations with survival (HR = 0.66; 95% CI [0.51-0.86], p = 0.002; HR = 1.40; 95% CI [1.01-1.93] per 10 BrM, p = 0.04, respectively). Eighty-three percent of patients experienced symptomatic relief, and 79% were discharged home or to rehabilitation facilities post-shunting. Post-shunt, 56% of patients received additional systemic therapy or started or completed WBRT. Complications included infection (5%), symptomatic subdural hygroma/hematoma (6.3%), and shunt externalization/removal/repair (8%). Abdominal seeding was not identified.CSF diversion for LM with hydrocephalus and intracranial hypertension secondary to metastasis can achieve symptomatic relief, hospital discharge, and return to further oncologic therapy, with a complication profile unique to this pathophysiology. However, decision-making in this population must incorporate end-of-life goals of care given limited prognosis.

  View details for DOI 10.1007/s11060-021-03827-2

  View details for Web of Science ID 000686042300001

  View details for PubMedID 34406564

  View details for PubMedCentralID PMC8504535

• Adverse Events Associated with Microinvasive Glaucoma Surgery Reported to the Food and Drug Administration Duong, A. T., Yuan, M., Koenig, L. R., Rodriguez, G. H., Van Tassel, S. H. ELSEVIER. 2021: 433-435

  View details for Web of Science ID 000677681700015

  View details for PubMedID 33421640

• Melanoma brain metastasis presentation, treatment, and outcomes in the age of targeted and immunotherapies CANCER Bander, E. D., Yuan, M., Carnevale, J. A., Reiner, A. S., Panageas, K. S., Postow, M. A., Tabar, V., Moss, N. S. 2021; 127 (12): 2062-2073

  Abstract

  Historically, the prognosis for patients who have melanoma brain metastasis (MBM) has been dismal. However, breakthroughs in targeted and immunotherapies have improved long-term survival in those with advanced melanoma. Therefore, MBM presentation, prognosis, and the use of multimodality central nervous system (CNS)-directed treatment were reassessed.In this retrospective study, the authors evaluated patients with MBM who received treatment at Memorial Sloan Kettering Cancer Center between 2010 and 2019. Kaplan-Meier methodology was used to describe overall survival (OS). Recursive partitioning analysis and time-dependent multivariable Cox modeling were used to assess prognostic variables and to associate CNS-directed treatments with OS.Four hundred twenty-five patients with 2488 brain metastases were included. The median OS after an MBM diagnosis was 8.9 months (95% CI, 7.9-11.3 months). Patients who were diagnosed with MBM between 2015 and 2019 experienced longer OS compared to those who were diagnosed between 2010 and 2014 (OS, 13.0 months [95% CI, 10.47-17.06 months] vs 7.0 months [95% CI, 6.1-8.3 months]; P = .0003). Prognostic multivariable modeling significantly associated shortened OS independently with leptomeningeal dissemination (P < .0001), increasing numbers of brain metastases at diagnosis (P < .0001), earlier MBM diagnosis year (P = .0008), higher serum levels of lactate dehydrogenase (P < .0001), receipt of immunotherapy before MBM diagnosis (P = .003), and the presence of extracranial disease (P = .02). The use of different CNS-directed treatment modalities was associated with presenting symptoms, diagnosis year, number and size of brain metastases, and the presence of extracranial disease. Multivariable analysis demonstrated improved survival for patients who underwent craniotomy (P = .01).The prognosis for patients with MBM has improved within the last 5 years, coinciding with the approval of PD-1 immune checkpoint blockade and combined BRAF/MEK targeting. Improving survival reflects and may influence the willingness to use aggressive multimodality treatment for MBM.Historically, melanoma brain metastases (MBM) have carried a poor survival prognosis of 4 to 6 months; however, the introduction of immunotherapy and targeted precision medicines has altered the survival curve for advanced melanoma. In this large, single-institution, contemporary cohort, the authors demonstrate a significant increase in survival of patients with MBM to 13 months within the last 5 years of the study. A worse prognosis for patients with MBM was significantly associated with the number of metastases at diagnosis, previous exposure to immunotherapy, spread of disease to the leptomeningeal compartment, serum lactate dehydrogenase elevation, and the presence of extracranial disease. The current age of systemic treatments has also been accompanied by shifts in the use of central nervous system-directed therapies.

  View details for DOI 10.1002/cncr.33459

  View details for Web of Science ID 000624272200001

  View details for PubMedID 33651913

  View details for PubMedCentralID PMC9275782

• Durable 5-year local control for resected brain metastases with early adjuvant SRS: the effect of timing on intended-field control NEURO-ONCOLOGY PRACTICE Bander, E. D., Yuan, M., Reiner, A. S., Panageas, K. S., Ballangrud, A. M., Brennan, C. W., Beal, K., Tabar, V., Moss, N. S. 2021; 8 (3): 278-289

  Abstract

  Adjuvant stereotactic radiosurgery (SRS) improves the local control of resected brain metastases (BrM). However, the dependency of long-term outcomes on SRS timing relative to surgery remains unclear.Retrospective analysis of patients treated with metastasectomy-plus-adjuvant SRS at Memorial Sloan Kettering Cancer Center (MSK) between 2013 and 2016 was conducted. Kaplan-Meier methodology was used to describe overall survival (OS) and cumulative incidence rates were estimated by type of recurrence, accounting for death as a competing event. Recursive partitioning analysis (RPA) and competing risks regression modeling assessed prognostic variables and associated events of interest.Two hundred and eighty-two patients with BrM had a median OS of 1.5 years (95% CI: 1.2-2.1) from adjuvant SRS with median follow-up of 49.8 months for survivors. Local surgical recurrence, other simultaneously SRS-irradiated site recurrence, and distant central nervous system (CNS) progression rates were 14.3% (95% CI: 10.1-18.5), 4.9% (95% CI: 2.3-7.5), and 47.5% (95% CI: 41.4-53.6) at 5 years, respectively. Median time-to-adjuvant SRS (TT-SRS) was 34 days (IQR: 27-39). TT-SRS was significantly associated with surgical site recurrence rate (P = 0.0008). SRS delivered within 1 month resulted in surgical site recurrence rate of 6.1% (95% CI: 1.3-10.9) at 1-year, compared to 9.2% (95% CI: 4.9-13.6) if delivered between 1 and 2 months, or 27.3% (95% CI: 0.0-55.5) if delivered >2 months after surgery. OS was significantly lower for patients with TT-SRS >~2 months. Postoperative length of stay, discharge to a rehabilitation facility, urgent care visits, and/or disease recurrence between surgery and adjuvant SRS associated with increased TT-SRS.Adjuvant SRS provides durable local control. However, delays in initiation of postoperative SRS can decrease its efficacy.

  View details for DOI 10.1093/nop/npab005

  View details for Web of Science ID 000661408200007

  View details for PubMedID 34055375

  View details for PubMedCentralID PMC8153823

• Impact of a Multidisciplinary Craniofacial Clinic for Patients With Craniofacial Syndromes on Patient Satisfaction and Outcome CLEFT PALATE-CRANIOFACIAL JOURNAL Hoffman, C., Yuan, M., Boyke, A., Perera, I., Rabbin-Birnbaum, C., O'Connor, A., Souweidane, M., Imahiyerobo, T. 2020; 57 (12): 1357-1361

  Abstract

  Multidisciplinary clinics are becoming widely utilized. Given the number of patients with craniofacial syndromes evaluated at our institution, and the burden of assessment by multiple subspecialists, we created an American Cleft Palate-Craniofacial Association-certified Craniofacial Multidisciplinary Clinic (CMC) composed of a nurse practitioner, neurosurgeon, plastic surgeon, otolaryngologist, oromaxillofacial surgeon, geneticist, pulmonologist, occupational therapist, dentist, and child life specialist to improve patient experience, lessen the burden of assessment, decrease time to surgery, and improve patients' understanding of the diagnosis and treatment plan specifically for patients with complex craniofacial syndromes. We reviewed the impact of this clinic after 1 year of implementation.Retrospective review was performed to identify patients with craniofacial syndromic diagnoses seen by the neurosurgery department before and after implementation of the CMC from February 2017 to present.The CMC is an outpatient clinic based in a tertiary care academic institution.Chart review was performed to identify demographic, diagnostic, clinical, and treatment data. We assessed clinic experience, and the impact on quality of clinical and surgical care was assessed via survey. We compared this cohort to patients with similar craniofacial syndromes treated prior to the CMC. Thirty patients seen at the CMC were identified, and data from a comparable cohort of 30 patients seen prior to the clinic's inception was reviewed.Our CMC survey response rate was 67% (n = 20/30) for the CMC patients. Second opinions sought by parents prior to CMC was higher (mean = 0.85, range: 0-3) than for patients seen at the CMC (mean = 0.16, range: 0-1). Mean time to surgery before the CMC was 10.1 months (range: 1-15) compared to 4 months (range: 3-5) after implementation. Parents agreed that they felt well-informed about their diagnosis (n = 18/20, 90%), and that the presence of a plastic surgeon (19/20, 95%) and a nurse practitioner (17/20, 85%) were valuable in coordination of their care. Following surgery, 76% (n = 13/17) of patients who received surgery were happy with the outcome, 76% (n = 13/17) were happy with the appearance of the scar, and 95% (n = 19/20) would recommend the CMC to others.Multidisciplinary evaluation of patients with complex craniofacial conditions provides comprehensive, efficient, and effective care, as well as improved parent satisfaction and knowledge base.

  View details for DOI 10.1177/1055665620948767

  View details for Web of Science ID 000595634600002

  View details for PubMedID 32851873

• Surgical Management of Complex Syndromic Craniosynostosis: Experience With a Rare Genetic Variant JOURNAL OF CRANIOFACIAL SURGERY Celie, K., Yuan, M., Hoffman, C., O'Connor, A., Bogue, J., Imahiyerobo, T. 2020; 31 (1): 294-299

  Abstract

  Patients with syndromic craniosynostosis (CS) can present with both intracranial and extracranial manifestations. Extracranial features include proptosis, exorbitism, and midface hypoplasia. Intracranial manifestations can include elevated intracranial pressure (ICP), brainstem compression, foramen magnum stenosis or jugular foramen hypoplasia with resultant venous hypertension and anomalous drainage. While fronto-orbital advancement, cranial vault remodeling, and posterior fossa decompression are standard surgical approaches to normalizing orbito-cranial volume and morphology, associated hydrocephalus, anomalous venous drainage, and tonsillar herniation often affect the timing, safety, and selection of corrective interventions. The surgical decision-making to circumvent venous emissaries, effectively time treatment of hydrocephalus, and address posterior versus anterior pathology primarily has not been widely described in the literature, and is important in the development of guidelines in these complex cases. In this report, we describe the surgical management of a patient with Jackson-Weiss syndrome presenting with delayed, but rapidly progressive bilateral lambdoid CS, severe proptosis, midface hypoplasia, elevated ICP, hydrocephalus, tonsillar ectopia, and severe venous hypertension with anomalous drainage. We review the literature related to management of complex synostosis and present our surgical decision-making in the setting of complex syndromic synostosis to aid in the formation of guidelines toward approaching these cases.

  View details for DOI 10.1097/SCS.0000000000005949

  View details for Web of Science ID 000529967300113

  View details for PubMedID 31764549

• Partial Resolution of Symptomatology in a Patient with Comorbid Bipolar Disorder and Borderline Personality Disorder Through Electroconvulsive Therapy PSYCHIATRIC ANNALS Yuan, M. 2019; 49 (12): 539-541

  View details for DOI 10.3928/00485713-20191118-01

  View details for Web of Science ID 000502076700007

• Developing a 3D composite training model for cranial remodeling JOURNAL OF NEUROSURGERY-PEDIATRICS Cheng, D., Yuan, M., Perera, I., O'Connor, A., Evins, A., Imahiyerobo, T., Souweidane, M., Hoffman, C. 2019; 24 (6): 632-641

  Abstract

  Craniosynostosis correction, including cranial vault remodeling, fronto-orbital advancement (FOA), and endoscopic suturectomy, requires practical experience with complex anatomy and tools. The infrequent exposure to complex neurosurgical procedures such as these during residency limits extraoperative training. Lack of cadaveric teaching tools given the pediatric nature of synostosis compounds this challenge. The authors sought to create lifelike 3D printed models based on actual cases of craniosynostosis in infants and incorporate them into a practical course for endoscopic and open correction. The authors hypothesized that this training tool would increase extraoperative facility and familiarity with cranial vault reconstruction to better prepare surgeons for in vivo procedures.The authors utilized representative craniosynostosis patient scans to create 3D printed models of the calvaria, soft tissues, and cranial contents. Two annual courses implementing these models were held, and surveys were completed by participants (n = 18, 5 attending physicians, 4 fellows, 9 residents) on the day of the course. These participants were surveyed during the course and 1 year later to assess the impact of this training tool. A comparable cohort of trainees who did not participate in the course (n = 11) was also surveyed at the time of the 1-year follow-up to assess their preparation and confidence with performing craniosynostosis surgeries.An iterative process using multiple materials and the various printing parameters was used to create representative models. Participants performed all major surgical steps, and we quantified the fidelity and utility of the model through surveys. All attendees reported that the model was a valuable training tool for open reconstruction (n = 18/18 [100%]) and endoscopic suturectomy (n = 17/18 [94%]). In the first year, 83% of course participants (n = 14/17) agreed or strongly agreed that the skin and bone materials were realistic and appropriately detailed; the second year, 100% (n = 16/16) agreed or strongly agreed that the skin material was realistic and appropriately detailed, and 88% (n = 14/16) agreed or strongly agreed that the bone material was realistic and appropriately detailed. All participants responded that they would use the models for their own personal training and the training of residents and fellows in their programs.The authors have developed realistic 3D printed models of craniosynostosis including soft tissues that allow for surgical practice simulation. The use of these models in surgical simulation provides a level of preparedness that exceeds what currently exists through traditional resident training experience. Employing practical modules using such models as part of a standardized resident curriculum is a logical evolution in neurosurgical education and training.

  View details for DOI 10.3171/2019.6.PEDS18773

  View details for Web of Science ID 000500271300003

  View details for PubMedID 31629320

• Cannabis use and psychiatric illness in the context of medical marijuana legalization: A clinical perspective GENERAL HOSPITAL PSYCHIATRY Yuan, M., Kanellopoulos, T., Kotbi, N. 2019; 61: 82-83

  Abstract

  More than half of the U.S. states have legalized medical marijuana. Emerging evidence suggests that medical marijuana legalization may increase marijuana use and cannabis use disorder (CUD). CUD is comorbid with, and exacerbates, numerous psychiatric conditions, including misuse of other substances. It is unclear if marijuana is a gateway to other drug use, if it is simply a marker of another variable or shared experiences. Thus, we aim to present a perspective of the potential impact of medical marijuana legalization on CUD, focusing on the relationship of CUD to other psychiatric disorders.Medical marijuana legalization may lead to problematic cannabis use in patients with depressive symptoms, individuals with genetic predispositions, and those with certain early life stressors or who use in order to cope. Past positive experience with marijuana use may contribute to patient desire to seek medical marijuana treatment. Despite approved indications, medical marijuana often only leads to partial relief of its intended target symptom. While recreational marijuana use increases likelihood of using other drugs and is detrimental to recovery from other substance use disorders, the relationship between medical marijuana use and polysubstance use or risk of addiction relapse is uncertain.Legalized medical marijuana use may increase rates of CUD, although further research is needed to clarify this association. Based on the literature, it is our perspective that patients with affective symptoms and those with other substance use disorders are at increased risk of developing CUD and its sequelae. Given the uncertainty surrounding how prescribed marijuana may interact with other disorders, it is paramount that clinicians make patient-specific judgments as to the risks and benefits of the treatment.

  View details for DOI 10.1016/j.genhosppsych.2019.08.003

  View details for Web of Science ID 000496919500012

  View details for PubMedID 31488324

• Rapidly Progressive Multisutural Craniosynostosis in a Patient With Jackson-Weiss Syndrome and a De Novo <i>FGFR2</i> Pathogenic Variant CLEFT PALATE-CRANIOFACIAL JOURNAL Celie, K., Yuan, M., Cunniff, C., Bogue, J., Hoffman, C., Imahiyerobo, T. 2019; 56 (10): 1386-1392

  Abstract

  Little is currently known about the mechanisms by which pathogenic variants of FGFR2 produce changes in the FGFR protein and influence the clinical presentation of affected individuals. We report on a patient with a de novo pathogenic variant of FGFR2 and a phenotype consistent with Jackson-Weiss syndrome who presented with delayed, rapidly progressive multisutural craniosynostosis and associated medical complications. Using 3-dimensional modeling of the FGFR protein, we provide evidence that this variant resulted in abnormal dimerization and constitutive activation of FGFR, leading to the Jackson-Weiss phenotype. Knowledge regarding the correlation between genotype and phenotype of persons with FGFR2-related craniosynostosis has the potential to allow for anticipation of medical complications, institution of early treatment, and improved clinical outcomes.

  View details for DOI 10.1177/1055665619851642

  View details for Web of Science ID 000490567600016

  View details for PubMedID 31122048

• The Relationship Between Tumor Volume and Timing of Post-resection Stereotactic Radiosurgery to Maximize Local Control: A Critical Review CUREUS JOURNAL OF MEDICAL SCIENCE Yuan, M., Behrami, E., Pannullo, S., Schwartz, T. H., Wernicke, A. 2019; 11 (9): e5762

  Abstract

  After maximally safe neurosurgical resection of brain metastases, stereotactic radiosurgery (SRS) is now recommended as an alternative to whole-brain radiation therapy (WBRT), which has been associated with cognitive decline. One complicating factor associated with SRS is that postoperative cavity dynamics can change dramatically, creating significant variability in the recommended timing of SRS. While SRS has been shown to improve local control (LC) in smaller tumor cavities, achieving excellent LC rates still remains a challenge in larger ones. Furthermore, factors predicting the optimal timing of SRS in relation to the cavity size need to be defined and implemented. Variables such as the delay between postoperative MRI and treatment are critical but poorly understood. One potential treatment option that may improve outcomes is brachytherapy, but the widespread implementation of this technique has been slow. This critical review analyzes the relationship between preoperative tumor volume, resection cavity size, and timing of SRS and explores how these variables must be understood in order to achieve the highest LC possible.

  View details for DOI 10.7759/cureus.5762

  View details for Web of Science ID 000487715500013

  View details for PubMedID 31723521

  View details for PubMedCentralID PMC6825444

• Neurosurgery Training Camp for Sub-Internship Preparation: Lessons From the Inaugural Course WORLD NEUROSURGERY Radwanski, R. E., Winston, G., Younus, I., ElJalby, M., Yuan, M., Oh, Y., Gucer, S., Hoffman, C. E., Stieg, P. E., Greenfield, J. P., Pannullo, S. C. 2019; 127: E707-E716

  Abstract

  Historically, medical student education in neurological surgery has generally limited student involvement to assisting in research projects with minimal formal clinical exposure before starting sub-internships and application for the neurosurgery match. Consequently, students have generally had little opportunity to acquire exposure to clinical neurosurgery and attain minimal proficiency. A medical student training camp was created to improve the preparation of medical students for the involvement in neurological surgery activities and sub-internships.A 1-day course was held at Weill Cornell Medicine, which consisted of a series of morning lectures, an interactive resident lunch panel, and afternoon hands-on laboratory sessions. Students completed self-assessment questionnaires regarding their confidence in several areas of clinical neurosurgery before the start of the course and again at its end.A significant increase in self-assessed confidence was observed in all skill areas surveyed. Overall, rising fourth year students who were starting sub-internships in the subsequent weeks reported a substantial increase in their preparedness for the elective rotations in neurosurgery.The preparation of medical students for clinical neurosurgery can be improved. Single-day courses such as the described training camp are an effective method for improving knowledge and skill gaps in medical students entering neurosurgical careers. Initiatives should be developed, in addition to this annual program, to increase the clinical and research skills throughout medical student education.

  View details for DOI 10.1016/j.wneu.2019.03.246

  View details for Web of Science ID 000473128300088

  View details for PubMedID 30947014

• Impact of an advanced practice provider-directed plagiocephaly clinic for neurosurgical practices JOURNAL OF NEUROSURGERY-PEDIATRICS Hoffman, C., Yuan, M., Boyke, A. E., O'Connor, A., Haussner, T., Perera, I., Souweidane, M. 2019; 23 (6): 715-718

  Abstract

  In recent years, the Weill Cornell neurosurgical team noticed an increase in referrals for plagiocephaly, likely due to increased infant back-sleeping and awareness. A plagiocephaly clinic staffed by a nurse practitioner and a physician assistant was established in 2016 to meet this demand, and to decrease the nonsurgical case burden on neurosurgeons. The purpose of this study was to examine the impact of a clinic directed by advanced nonphysician practice providers (NPPs) on parental satisfaction and nonsurgical work hours for staff neurosurgeons.Over a 1.5-year period (from January 1, 2016, to June 20, 2017), Likert scale-based surveys were administered to parents before and after their child's visit to the NPP-staffed clinic. Clinic hours were tracked to assess impact on the neurosurgeon's workload.All 185 patients seen in the plagiocephaly clinic over the 1.5-year period completed pre- and postvisit surveys. Parents all reported a significant reduction in their level of concern for their child's diagnosis after the evaluation, and 95.5% were "very likely" to recommend the clinic. All parents felt that there was an increase in their knowledge base after an appointment with an NPP. Additionally, over 1 year in the study, 170 visits to the NPP plagiocephaly clinic were recorded, resulting in 85 hours that neurosurgeons normally would have spent in the clinic that they now were able to spend in the operating room.This research provides evidence that an NPP-directed clinic can positively impact parental satisfaction and decrease nonsurgical case burden on neurosurgeons.

  View details for DOI 10.3171/2019.1.PEDS18385

  View details for Web of Science ID 000469930400009

  View details for PubMedID 30925478

• Executive Dysfunction and Language Deficits in a Pediatric Patient with OCD and MDD with Suicidality. Case reports in psychiatry Yuan, M. 2019; 2019: 6574304

  Abstract

  The role of neuropsychiatric testing in psychiatric disorders is becoming more prominent. Neuropsychological measures that are similar across symptom domains and phenomena such as suicidality may help clinicians guide treatment and tailor therapies to the patient in the most effective way possible. We report the case of a 16-year-old girl who presented with bizarre, intrusive suicidal thoughts in the setting of OCD and MDD. This case is unusual in that we have accurate neuropsychological determination of our patient's language and executive function deficits, and we propose a link between them and her expression of suicidality in the context of OCD and MDD.

  View details for DOI 10.1155/2019/6574304

  View details for PubMedID 31183239

• Ultrafast Cortical Gain Adaptation in the Human Brain by Trial-To-Trial Changes of Associative Strength in Fear Learning JOURNAL OF NEUROSCIENCE Yuan, M., Gimenez-Fernandez, T., Mendez-Bertolo, C., Moratti, S. 2018; 38 (38): 8262-8276

  Abstract

  In fear conditioning, more efficient sensory processing of a stimulus (the conditioned stimulus, CS) that has acquired motivational relevance by being paired with an aversive event (the unconditioned stimulus, US) has been associated with increased cortical gain in early sensory brain areas (Miskovic and Keil, 2012). Further, this sensory gain modulation related to short-term plasticity changes occurs independently of aware cognitive anticipation of the aversive US, pointing toward implicit learning mechanisms (Moratti and Keil, 2009). However, it is unknown how quickly the implicit learning of CS-US associations results in the adaptation of cortical gain. Here, using steady-state visually evoked fields derived from human Magnetoencephalography (MEG) recordings in two experiments (N = 33, 17 females and 16 males), we show that stimulus-driven neuromagnetic oscillatory activity increases and decreases quickly as a function of associative strength within three or four trials, as predicted by a computationally implemented Rescorla-Wagner model with the highest learning rate. These ultrafast cortical gain adaptations are restricted to early visual cortex using a delay fear conditioning procedure. Short interval (500 ms) trace conditioning resulted in the same ultrafast activity modulations by associative strength, but in a complex occipito-parieto-temporo-frontal network. Granger causal analysis revealed that reverberating top-down and bottom-up influences between anterior and posterior brain regions during trace conditioning characterized this network. Critically, in both delay and trace conditioning, ultrafast cortical gain modulations as a function of associative strength occurred independently of conscious US anticipation.SIGNIFICANCE STATEMENT In ever-changing environments, learned associations between a cue and an aversive consequence must change under new stimulus-consequence contingencies to be adaptive. What predicts potential dangers now might be meaningless in the next situation. Predictive cues are prioritized, as reflected by increased sensory cortex activity for these cues. However, this modulation also must adapt to altered stimulus-consequence contingencies. Here, we show that human visual cortex activity can be modulated quickly according to ultrafast contingency changes within a few learning trials. This finding extends to frontal brain regions when the cue and the aversive event are separated in time. Critically, this ultrafast updating process occurs orthogonally to aware aversive outcome anticipation and therefore relies on unconscious implicit learning mechanisms.

  View details for DOI 10.1523/JNEUROSCI.0977-18.2018

  View details for Web of Science ID 000444951900013

  View details for PubMedID 30104342

  View details for PubMedCentralID PMC6596159