Prithvi Mruthyunjaya, MD, MHS

All Publications

• A mystery choroidal mass. American journal of ophthalmology case reports Mishra, K., Mruthyunjaya, P. 2024; 36: 102115

  View details for DOI 10.1016/j.ajoc.2024.102115

  View details for PubMedID 39220378

  View details for PubMedCentralID PMC11365288

• 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

• Anti-VEGF Biosimilars for Retinal Diseases Survey 2023- India (Bio-INDAS) by the International Retina Biosimilar Study Group(Inter-BIOSGroup) in collaboration with the Vitreo-Retinal Society of India (VRSI). Eye (London, England) Sharma, A., Kaiser, P. K., Tadayoni, R., Holz, F. G., Nicholson, L., Vazquez-Alfageme, C., Sivaprasad, S., Wakabayashi, T., Woo, S. J., Sarraf, D., Kumar, N., Parachuri, N., Regillo, C. D., Rezaei, K. A., Khanani, A. M., Bandello, F., Shanamugam, M., Verma, L., Dogra, M. R., Ns, M., Agarwal, M., Loewenstein, A., Kuppermann, B. D., International Retina Biosimilar Study Group (Inter BIOS Group), Querques, G., Sheth, J., Ayachit, S., Mishra, C., Chakraborty, D., Banker, A., Ozdek, S., Laurent, K., Bilgic, A., Lanzetta, P., Baumal, C., Holekemp, N., Sakamoto, T., Tufail, A., Yannuzzi, N., Corradetti, G., Boyer, D., Rachitskaya, A., Peto, T., Wintergerst, M. W., Sarao, V., Parolini, B., Mruthyunjaya, P., Nguyen, Q. D., Do, D. V., Keane, P. A., Hassan, T., Sridhar, J., Eichenbaum, D., Grewal, D. S., March de Ribot, F., Splitzer, M., Zinkernagel, M. S., Ueda-Consolvo, T., Ishida, M., Nakamura, T., Yanagisawa, S., Tsuboi, K., Hayashi, A., Hilely, A., Zur, D. 2024

  View details for DOI 10.1038/s41433-024-03284-x

  View details for PubMedID 39187656

• 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

• 15-Gene Expression Profile and PRAME as Integrated Prognostic Test for Uveal Melanoma: First Report of Collaborative Ocular Oncology Group Study No. 2 (COOG2.1). Journal of clinical oncology : official journal of the American Society of Clinical Oncology Harbour, J. W., Correa, Z. M., Schefler, A. C., Mruthyunjaya, P., Materin, M. A., Aaberg, T. A., Skalet, A. H., Reichstein, D. A., Weis, E., Kim, I. K., Fuller, T. S., Demirci, H., Piggott, K. D., Williams, B. K., Shildkrot, E., Capone, A., Oliver, S. C., Walter, S. D., Mason, J., Char, D. H., Altaweel, M., Wells, J. R., Duker, J. S., Hovland, P. G., Gombos, D. S., Tsai, T., Javid, C., Marr, B. P., Gao, A., Decatur, C. L., Dollar, J. J., Kurtenbach, S., Zhang, S. 2024: JCO2400447

  Abstract

  Validated and accurate prognostic testing is critical for precision medicine in uveal melanoma (UM). Our aims were to (1) prospectively validate an integrated prognostic classifier combining a 15-gene expression profile (15-GEP) and PRAME RNA expression and (2) identify clinical variables that enhance the prognostic accuracy of the 15-GEP/PRAME classifier.This study included 1,577 patients with UM of the choroid and/or ciliary body who were enrolled in the Collaborative Ocular Oncology Group Study Number 2 (COOG2) and prospectively monitored across 26 North American centers. Test results for 15-GEP (class 1 or class 2) and PRAME expression status (negative or positive) were available for all patients. The primary end point was metastasis-free survival (MFS).15-GEP was class 1 in 1,082 (68.6%) and class 2 in 495 (31.4%) patients. PRAME status was negative in 1,106 (70.1%) and positive in 471 (29.9%) patients. Five-year MFS was 95.6% (95% CI, 93.9 to 97.4) for class 1/PRAME(-), 80.6% (95% CI, 73.9 to 87.9) for class 1/PRAME(+), 58.3% (95% CI, 51.1 to 66.4) for class 2/PRAME(-), and 44.8% (95% CI, 37.9 to 52.8) for class 2/PRAME(+). By multivariable Cox proportional hazards analysis, 15-GEP was the most important independent predictor of MFS (hazard ratio [HR], 5.95 [95% CI, 4.43 to 7.99]; P < .001), followed by PRAME status (HR, 1.82 [95% CI, 1.42 to 2.33]; P < .001). The only clinical variable demonstrating additional prognostic value was tumor diameter.In the largest prospective multicenter prognostic biomarker study performed to date in UM to our knowledge, the COOG2 study validated the superior prognostic accuracy of the integrated 15-GEP/PRAME classifier over 15-GEP alone and clinical prognostic variables. Tumor diameter was found to be the only clinical variable to provide additional prognostic information. This prognostic classifier provides an advanced resource for risk-adjusted metastatic surveillance and adjuvant trial stratification in patients with UM.

  View details for DOI 10.1200/JCO.24.00447

  View details for PubMedID 39052972

• 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

• Sensitivity of Magnetic Resonance Imaging in Detection of Choroidal Metastases OCULAR ONCOLOGY AND PATHOLOGY Yu, M. D., Miller, S., Ghoraba, H., Sabage, L. E., Fischbein, N. J., Mruthyunjaya, P. 2024; 10 (2): 80-87

  View details for DOI 10.1159/000537949

  View details for Web of Science ID 001243092700001

• Sensitivity of Magnetic Resonance Imaging in Detection of Choroidal Metastases. Ocular oncology and pathology Yu, M. D., Miller, S., Ghoraba, H., Sabage, L. E., Fischbein, N. J., Mruthyunjaya, P. 2024; 10 (2): 80-87

  Abstract

  The objective of this study was to determine the sensitivity of brain magnetic resonance imaging (MRI) in the detection of choroidal metastasis (CM) from systemic primary cancers.A retrospective chart review identified patients with clinically confirmed CM seen on the Oncology Service (Byers Eye Institute) between January 2018 and March 2022. Patients had an MRI brain and/or orbits performed within 3 months of CM diagnosis. Evaluation of CM detection by MRI was then divided into two parts: an initial "standard read," where determination of CM detection was based solely on the original radiology report, to reflect real-world performance, and a subsequent "dedicated read," for which a board-certified neuroradiologist, blinded to the laterality and location of the CM, reevaluated the studies to provide an objective "gold standard" interpretation regarding the radiographic detection of CM.The study included 42 eyes of 40 patients with confirmed CM. On standard read, MRI detection of CM occurred in 21 of 42 eyes (50%), with no significant difference between MRI brain and orbit protocols (p = 0.249). Features associated with improved detection were increased tumor basal diameter (p < 0.001) and ultrasonographic tumor thickness (p = 0.003). On dedicated read, MRI detection of CM improved to 26 of 33 eyes (76%; limited to eyes with full complement of pre- and post-gadolinium sequences). Post-gadolinium 3D fluid-attenuated inversion recovery (FLAIR) sequence with fat suppression was the most sensitive (88%) for CM detection. 42% and 58% of lesions were visualized using conventional pre-gadolinium T1- and T2-weighted imaging, respectively.MRI sensitivity to detect CM improved from 50% to 76% with focused reinterpretation. Increased utilization of the post-gadolinium 3D FLAIR sequence and increased ocular scrutiny in cancer patients undergoing brain imaging may facilitate earlier diagnosis of CM.

  View details for DOI 10.1159/000537949

  View details for PubMedID 38882019

  View details for PubMedCentralID PMC11178341

• 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

• Using Electronic Health Record Data to Determine the Safety of Aqueous Humor Liquid Biopsies for Molecular Analyses. Ophthalmology science Wolf, J., Chemudupati, T., Kumar, A., Franco, J. A., Montague, A. A., Lin, C. C., Lee, W. S., Fisher, A. C., Goldberg, J. L., Mruthyunjaya, P., Chang, R. T., Mahajan, V. B. 2024; 4 (5): 100517

  Abstract

  Knowing the surgical safety of anterior chamber liquid biopsies will support the increased use of proteomics and other molecular analyses to better understand disease mechanisms and therapeutic responses in patients and clinical trials. Manual review of operative notes from different surgeons and procedures in electronic health records (EHRs) is cumbersome, but free-text software tools could facilitate efficient searches.Retrospective case series.A total of 1418 aqueous humor liquid biopsies from patients undergoing intraocular surgery.Free-text EHR searches were performed using the Stanford Research Repository cohort discovery tool to identify complications associated with anterior chamber paracentesis and subsequent endophthalmitis. Complications of the surgery unrelated to the biopsy were not reviewed.Biopsy-associated intraoperative complications and endophthalmitis.A total of 1418 aqueous humor liquid biopsies were performed by 17 experienced surgeons. EHR free-text searches were 100% error-free for surgical complications, >99% for endophthalmitis (<1% false positive), and >93.6% for anesthesia type, requiring manual review for only a limited number of cases. More than 85% of cases were performed under local anesthesia without ocular muscle akinesia. Although the most common indication was cataract (50.1%), other diagnoses included glaucoma, diabetic retinopathy, uveitis, age-related macular degeneration, endophthalmitis, retinitis pigmentosa, and uveal melanoma. A 50- to 100-μL sample was collected in all cases using either a 30-gauge needle or a blunt cannula via a paracentesis. The median follow-up was >7 months. There was only one minor complication (0.07%) identified: a case of a small tear in Descemet membrane without long-term sequelae. No other complications occurred, including other corneal injuries, lens or iris trauma, hyphema, or suprachoroidal hemorrhage. There was no case of postoperative endophthalmitis.Anterior chamber liquid biopsy during intraocular surgery is a safe procedure and may be considered for large-scale collection of aqueous humor samples for molecular analyses. Free-text EHR searches are an efficient approach to reviewing intraoperative procedures.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.2024.100517

  View details for PubMedID 38881613

  View details for PubMedCentralID PMC11179400

• An Unusual Pigmented Lesion. Ophthalmology Thakur, S., Guo, L. Y., Mruthyunjaya, P. 2024

  View details for DOI 10.1016/j.ophtha.2024.01.030

  View details for PubMedID 38416081

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

  Abstract

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

  View details for DOI 10.1016/j.ajo.2024.02.023

  View details for PubMedID 38403098

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

  Abstract

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

  View details for DOI 10.1016/j.ophtha.2024.01.032

  View details for PubMedID 38296203

• Liquid Biopsy Proteomics in Ophthalmology. Journal of proteome research Wolf, J., Franco, J. A., Yip, R., Dabaja, M. Z., Velez, G., Liu, F., Bassuk, A. G., Mruthyunjaya, P., Dufour, A., Mahajan, V. B. 2024

  Abstract

  Minimally invasive liquid biopsies from the eye capture locally enriched fluids that contain thousands of proteins from highly specialized ocular cell types, presenting a promising alternative to solid tissue biopsies. The advantages of liquid biopsies include sampling the eye without causing irreversible functional damage, potentially better reflecting tissue heterogeneity, collecting samples in an outpatient setting, monitoring therapeutic response with sequential sampling, and even allowing examination of disease mechanisms at the cell level in living humans, an approach that we refer to as TEMPO (Tracing Expression of Multiple Protein Origins). Liquid biopsy proteomics has the potential to transform molecular diagnostics and prognostics and to assess disease mechanisms and personalized therapeutic strategies in individual patients. This review addresses opportunities, challenges, and future directions of high-resolution liquid biopsy proteomics in ophthalmology, with particular emphasis on the large-scale collection of high-quality samples, cutting edge proteomics technology, and artificial intelligence-supported data analysis.

  View details for DOI 10.1021/acs.jproteome.3c00756

  View details for PubMedID 38171013

• AI-Human Hybrid Workflow Enhances Teleophthalmology for the Detection of Diabetic Retinopathy. Ophthalmology science Dow, E. R., Khan, N. C., Chen, K. M., Mishra, K., Perera, C., Narala, R., Basina, M., Dang, J., Kim, M., Levine, M., Phadke, A., Tan, M., Weng, K., Do, D. V., Moshfeghi, D. M., Mahajan, V. B., Mruthyunjaya, P., Leng, T., Myung, D. 2023; 3 (4): 100330

  Abstract

  Detection of diabetic retinopathy (DR) outside of specialized eye care settings is an important means of access to vision-preserving health maintenance. Remote interpretation of fundus photographs acquired in a primary care or other nonophthalmic setting in a store-and-forward manner is a predominant paradigm of teleophthalmology screening programs. Artificial intelligence (AI)-based image interpretation offers an alternative means of DR detection. IDx-DR (Digital Diagnostics Inc) is a Food and Drug Administration-authorized autonomous testing device for DR. We evaluated the diagnostic performance of IDx-DR compared with human-based teleophthalmology over 2 and a half years. Additionally, we evaluated an AI-human hybrid workflow that combines AI-system evaluation with human expert-based assessment for referable cases.Prospective cohort study and retrospective analysis.Diabetic patients ≥ 18 years old without a prior DR diagnosis or DR examination in the past year presenting for routine DR screening in a primary care clinic.Macula-centered and optic nerve-centered fundus photographs were evaluated by an AI algorithm followed by consensus-based overreading by retina specialists at the Stanford Ophthalmic Reading Center. Detection of more-than-mild diabetic retinopathy (MTMDR) was compared with in-person examination by a retina specialist.Sensitivity, specificity, accuracy, positive predictive value, and gradability achieved by the AI algorithm and retina specialists.The AI algorithm had higher sensitivity (95.5% sensitivity; 95% confidence interval [CI], 86.7%-100%) but lower specificity (60.3% specificity; 95% CI, 47.7%-72.9%) for detection of MTMDR compared with remote image interpretation by retina specialists (69.5% sensitivity; 95% CI, 50.7%-88.3%; 96.9% specificity; 95% CI, 93.5%-100%). Gradability of encounters was also lower for the AI algorithm (62.5%) compared with retina specialists (93.1%). A 2-step AI-human hybrid workflow in which the AI algorithm initially rendered an assessment followed by overread by a retina specialist of MTMDR-positive encounters resulted in a sensitivity of 95.5% (95% CI, 86.7%-100%) and a specificity of 98.2% (95% CI, 94.6%-100%). Similarly, a 2-step overread by retina specialists of AI-ungradable encounters improved gradability from 63.5% to 95.6% of encounters.Implementation of an AI-human hybrid teleophthalmology workflow may both decrease reliance on human specialist effort and improve diagnostic accuracy.Proprietary or commercial disclosure may be found after the references.

  View details for DOI 10.1016/j.xops.2023.100330

  View details for PubMedID 37449051

  View details for PubMedCentralID PMC10336195

• Retinoblastoma Outcomes in the Americas: a prospective analysis of 491 children with retinoblastoma from 23 American countries. American journal of ophthalmology Berry, J. L., Pike, S., Rajagopalan, A., Reid, M. W., Fabian, I. D., Afshar, A. R., Alejos, A., Alemany-Rubio, E., Carreras, Y. A., Arazi, M., Astbury, N. J., Bascaran, C., Binkley, E., Blum, S., Boldt, H. C., Bonanomi, M. T., Bowman, R., Brennan, R. C., Burton, M. J., Calderón-Sotelo, P., Jara, D. A., Cano, M. R., Castillo, L., Cavieres, I., Cerna, D. Q., Chandramohan, A., Chantada, G. L., Corson, T. W., Cowan-Lyn, K. E., Davanzo, J. M., Demirci, H., Coronado, R. Y., Dimaras, H., Macedo, C. R., Ericksen, C., Fandiño, A. C., Fernández, D. D., Foster, A., Fu, L. D., Fuentes-Alabi, S. L., Garcia, J. L., Pacheco, H. N., Girón, A. V., Goenz, M. A., Gold, A. S., Gomel, N., Gonzalez, E., Perez, G. G., González-Rodríguez, L., Graells, J., Grigorovski, N. D., Hamel, P., Hansen, E. D., Harbour, J. W., Elizabeth Hartnett, M., Hassan, M., Hubbard, G. B., Kapelushnik, N., Kim, J. W., Larson, S. A., Laurenti, K. D., Leverant, A. A., Li, C., López, J. P., Luna-Fineman, S., Magrath, G. N., Mallipatna, A., Mattosinho, C. C., Mets, M. B., Miller, A., Mruthyunjaya, P., Murray, T. G., Oliver, S. C., Oporto, J., Ortega-Hernández, M., Ossandon, D., Morales, C. R., Paton, K. E., Plager, D. A., Polania, R. A., Ponce, J., Quintero D, K., Ramasubramanian, A., Ramirez-Ortiz, M. A., Randhawa, J. K., Romero, L., Salas, B., Sánchez, G. L., Orozco, A. J., Sgroi, M., Shah, A. S., Shields, C. L., Singh, A. D., Skalet, A. H., Stacey, A. W., Stahl, E. D., Strahlendorf, C., Suarez, M. E., Superstein, R., Leiva, F. F., Teixeira, L. F., Uner, O. E., Anchaya, J. K., Vaughan, L. O., Villegas, V. M., Wilson, M. W., Yaghy, A., Yee, R. I., López, A. M., Zondervan, M. 2023

  Abstract

  Globally, disparities exist in retinoblastoma treatment outcomes between high- and low-income countries, but independent analysis of American countries is lacking. We report outcomes of American retinoblastoma patients and explore factors associated with survival and globe salvage.Subanalysis of prospective cohort study data.Multicenter analysis at 57 American treatment centers in 23 countries of varying economic levels (low income=LIC, lower-middle=LMIC, upper-middle=UMIC, high=HIC) of 491 treatment-naïve retinoblastoma patients diagnosed in 2017 and followed through 2020. Survival and globe salvage rates analyzed with Kaplan-Meier analysis and Cox proportional hazard models.Of patients, 8 (1.6%), 58 (11.8%), 235 (47.9%) and 190 (38.7%) were from LIC, LMIC, UMIC and HIC, respectively. Three-year survival rates in LICs were 60.0% (95% CI, 12.6-88.2) compared to 99.2% (94.6-99.9) in HICs. Death was less likely in patients older than four years (vs. four or younger, HR=0.45 [95% CI, 0.27 - 0.78], P=0.048). Patients with more advanced tumors (e.g., cT3 vs. cT1, HR= 4.65 × 109 [95% CI, 1.25 × 109 - 1.72 × 1010], P<0.001) and females (vs. males, HR=1.98 [1.27-3.10], P=0.04) were more likely to die. Three-year globe salvage rates were 13.3% (95% CI, 5.1-25.6) in LMICs and 46.2% (38.8-53.3) in HICs. At three years, 70.1% of cT1 eyes (95% CI, 54.5-81.2) versus 8.9% of cT3 eyes (5.5-13.3) were salvaged. Advanced tumor stage was associated with higher enucleation risk (e.g., cT3 vs. cT1, SHR=4.98 [95% CI, 2.36-10.5), P<0.001).Disparities exist in survival and globe salvage in American countries based on economic level and tumor stage demonstrating a need for childhood cancer programs.

  View details for DOI 10.1016/j.ajo.2023.11.004

  View details for PubMedID 37949286

• Artificial Intelligence Improves Patient Follow-Up in a Diabetic Retinopathy Screening Program. Clinical ophthalmology (Auckland, N.Z.) Dow, E. R., Chen, K. M., Zhao, C. S., Knapp, A. N., Phadke, A., Weng, K., Do, D. V., Mahajan, V. B., Mruthyunjaya, P., Leng, T., Myung, D. 2023; 17: 3323-3330

  Abstract

  We examine the rate of and reasons for follow-up in an Artificial Intelligence (AI)-based workflow for diabetic retinopathy (DR) screening relative to two human-based workflows.A DR screening program initiated September 2019 between one institution and its affiliated primary care and endocrinology clinics screened 2243 adult patients with type 1 or 2 diabetes without a diagnosis of DR in the previous year in the San Francisco Bay Area. For patients who screened positive for more-than-mild-DR (MTMDR), rates of follow-up were calculated under a store-and-forward human-based DR workflow ("Human Workflow"), an AI-based workflow involving IDx-DR ("AI Workflow"), and a two-step hybrid workflow ("AI-Human Hybrid Workflow"). The AI Workflow provided results within 48 hours, whereas the other workflows took up to 7 days. Patients were surveyed by phone about follow-up decisions.Under the AI Workflow, 279 patients screened positive for MTMDR. Of these, 69.2% followed up with an ophthalmologist within 90 days. Altogether 70.5% (N=48) of patients who followed up chose their location based on primary care referral. Among the subset of patients that were seen in person at the university eye institute under the Human Workflow and AI-Human Hybrid Workflow, 12.0% (N=14/117) and 11.7% (N=12/103) of patients with a referrable screening result followed up compared to 35.5% of patients under the AI Workflow (N=99/279; χ2df=2 = 36.70, p < 0.00000001).Ophthalmology follow-up after a positive DR screening result is approximately three-fold higher under the AI Workflow than either the Human Workflow or AI-Human Hybrid Workflow. Improved follow-up behavior may be due to the decreased time to screening result.

  View details for DOI 10.2147/OPTH.S422513

  View details for PubMedID 38026608

  View details for PubMedCentralID PMC10665027

• Cross-Platform Identification and Validation of Uveal Melanoma Vitreous Protein Biomarkers. Investigative ophthalmology & visual science Velez, G., Wolf, J., Dufour, A., Mruthyunjaya, P., Mahajan, V. B. 2023; 64 (14): 14

  Abstract

  The purpose of this study was to profile protein expression liquid vitreous biopsies from patients with uveal melanoma (UM) using mass spectrometry to identify prognostic biomarkers, signaling pathways, and therapeutic targets.Vitreous biopsies were collected from two cohorts in a pilot study: comparative control eyes with epiretinal membranes (ERM; n = 3) and test eyes with UM (n = 8). Samples were analyzed using liquid chromatography-tandem mass spectrometry (LC-MS/MS). Identified proteins were compared to data from a targeted multiplex ELISA proteomics platform.A total of 69 significantly elevated proteins were detected in the UM vitreous, including LYVE-1. LC-MS/MS identified 62 significantly upregulated proteins in UM vitreous that were not previously identified by ELISA. Analysis of differential protein expression by tumor molecular classification (gene expression profiling [GEP] and preferentially expressed antigen in melanoma [PRAME]) further identified proteins that correlated with these classifications. Patients with high-risk GEP tumors displayed elevated vitreous expression of HGFR (fold-change [FC] = 2.66E + 03, P value = 0.003) and PYGL (FC = 1.02E + 04, P = 1.72E-08). Patients with PRAME positive tumors displayed elevated vitreous expression of ENPP-2 (FC = 3.21, P = 0.04), NEO1 (FC = 2.65E + 03, P = 0.002), and LRP1 (FC = 5.59E + 02, P value = 0.01). IGF regulatory effectors were highly represented (P value = 1.74E-16). Cross-platform analysis validated seven proteins identified by ELISA and LC-MS/MS.Proteomic analysis of liquid biopsies may provide prognostic information supporting gene expression of tumor biopsies. The use of multiple protein detection platforms in the same patient samples increases the sensitivity of candidate biomarker detection and allows for precise characterization of the vitreous proteome.

  View details for DOI 10.1167/iovs.64.14.14

  View details for PubMedID 37955612

• 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

• Pegcetacoplan for the treatment of geographic atrophy secondary to age-related macular degeneration (OAKS and DERBY): two multicentre, randomised, double-masked, sham-controlled, phase 3 trials. Lancet (London, England) Heier, J. S., Lad, E. M., Holz, F. G., Rosenfeld, P. J., Guymer, R. H., Boyer, D., Grossi, F., Baumal, C. R., Korobelnik, J., Slakter, J. S., Waheed, N. K., Metlapally, R., Pearce, I., Steinle, N., Francone, A. A., Hu, A., Lally, D. R., Deschatelets, P., Francois, C., Bliss, C., Staurenghi, G., Mones, J., Singh, R. P., Ribeiro, R., Wykoff, C. C., OAKS and DERBY study investigators, Cole, A. O., Gerstenblith, A. T., Kotagiri, A., Edwards, A. O., Zambrano, A. D., Eaton, A. M., Rubowitz, A., Lyon, A. T., Chiang, A., Ho, A., Hu, A. Y., Guerami, A. H., Dessouki, A. L., de Carvalho, A. C., Emanuelli, A., Chang, A. A., Antoszyk, A. N., Francone, A. A., Prasad, A., Wolf, A., Khanani, A. M., Abbey, A. M., Moulana, A., Wihelm, B., Sikorski, B. L., Kuppermann, B. D., Wolff, B., Jewart, B. H., Do, B. K., Chan-Kai, B. T., Mein, C., Hoyng, C. B., Awh, C. C., Regillio, C., Zeolite, C., Baumal, C. R., Creuzot-Garcher, C., Maury, C. F., Wykoff, C. C., Newell, C. K., Jhaveri, C., Lohmann, C. P., Dinah, C. B., Ma, C., Crawford, C., Parke, D. W., Lavinsky, D., Roth, D., Pieramici, D. J., Moshfeghi, D. M., Levin, D., Saperstein, D. A., Brown, D., Gaucher, D., Lally, D. R., Liao, D. S., Brown, D. W., Goldstein, D., Marcus, D., Chan, D. G., Dhoot, D., Tacite, D., Zalewski, D., Espana, E. M., Lad, E. M., Souied, E. H., Suan, E. P., Eting, E., Sola, F. F., de Bats, F., Bandello, F., Gomez-Ulla, F., Devin, F., Holz, F. G., Chen, F. K., Makkouk, F., Dyer, G., Spital, G., Staurenghi, G., Stoller, G., Cousins, G., Salehi-Had, H., Agostini, H., Eleftheriadis, H., Weiss, H., Sultan, H. C., Masse, H., Pearce, I., Dias, I., Barbazetto, I., Rosenblatt, I., Suner, I. J., Kovach, J. L., Kaluzny, J., Borthwick, J., Howard, J. G., Wong, J., Ernest, J., Nemcansky, J., Ysasaga, J. E., Handza, J. M., Moreno, J. A., Korobelnik, J., Heier, J. S., Arnold, J. J., Brown, J., Bafalluy, J., Pearlman, J., Pitcher, J. D., Kitchens, J., Carlson, J. P., Gilhotra, J., Fein, J., Mones, J. M., Luna, J. D., Moreno, J. M., Coney, J. M., Sallum, J. M., Olsen, K. R., Blobner, K., Macoul, K. A., Oh, K. T., Malik, K. J., Hattenbach, L., Kodjikian, L., Neto, L. B., Singerman, L. J., Altay, L., Sheck, L., Feiner, L., Harris, L. D., Chishold, L. D., Rao, L. J., Nehemy, M. B., Elizalde, M. J., Gamulescu, M., Saravia, M. J., Johnson, M. W., McKibbin, M., Maccumber, M., Vidosevich, M., Ohr, M. P., Samuel, M. A., Singer, M. A., Cassell, M., Dollin, M., Elman, M. J., Ip, M. S., Goldstein, M., Busquets, M., Mititelu, M., Shah, M., Veith, M., Fineman, M., Varano, M., Christmas, N., Steinle, N. C., Chaudhry, N., Chinskey, N. D., Eter, N., London, N. J., Mathalone, N., Schlottmann, P. G., Coady, P., Higgins, P. M., Raskauskas, P. A., Yates, P. A., Bernstein, P., Mitchell, P., Monsour, P., Raphaelian, P. V., Stanga, P. E., Stodulka, P., Issa, P. C., Pavan, P., Ferrone, P. J., Oleksy, P., Abraham, P., Mruthyunjaya, P., Nguyen, Q. D., Reddy, R. K., Khurana, R. N., Tuli, R., Tadayoni, R., Katz, R. S., Arora, R., Schlingemann, R. O., Rosen, R. B., Gale, R., Scartozzi, R., Isernharge, R., Singh, R. P., Stoltz, R. A., Avery, R. L., Wirthlin, R. S., Guymer, R., Goldberg, R. A., Frenkel, R., Belfort, R. J., Mohand-Said, S., Grisanti, S., Razavi, S., Fraser-Bell, S., Shah, S. N., Wickremasinghe, S., Haug, S. J., Adrean, S. D., Priglinger, S. G., Esposti, S. D., Guest, S., Huddleston, S., Itty, S., Moon, S. J., Bhatia, S. P., Gupta, S., Patel, S. S., Garg, S. J., Joshi, S., Nghiem-Buffet, S., Johnson, T. M., Jaouni, T., Ach, T., Williams, T. R., Sheidow, T., Cleland, T. P., You, T. T., Peto, T., Konidaris, V., Gonzalez, V. H., Korda, V., Freeman, W. R., Bridges, W. Z., Barak, Y., Zagorski, Z., Yehoshua, Z., Dubska, Z. 2023; 402 (10411): 1434-1448

  Abstract

  BACKGROUND: Geographic atrophy is a leading cause of progressive, irreversible vision loss. The objectives of OAKS and DERBY were to assess the efficacy and safety of pegcetacoplan compared with sham treatment in patients with geographic atrophy.METHODS: OAKS and DERBY were two 24-month, multicentre, randomised, double-masked, sham-controlled, phase 3 studies, in which patients aged 60 years and older with geographic atrophy secondary to age-related macular degeneration were enrolled at 110 clinical sites and 122 clinical sites worldwide, respectively. Patients were randomly assigned (2:2:1:1) by central web-based randomisation system to intravitreal 15 mg per 0·1 mL pegcetacoplan monthly or every other month, or sham monthly or every other month using stratified permuted block randomisation (stratified by geographic atrophy lesion area at screening, history or presence of active choroidal neovascularisation in the eye not under assessment, and block size of six). Study site staff, patients, reading centre personnel, evaluating physicians, and the funder were masked to group assignment. Sham groups were pooled for the analyses. The primary endpoint was the change from baseline to month 12 in the total area of geographic atrophy lesions in the study eye based on fundus autofluorescence imaging, in the modified intention-to-treat population (ie, all patients who received one or more injections of pegcetacoplan or sham and had a baseline and at least one post-baseline value of lesion area). Key secondary endpoints (measured at 24 months) were change in monocular maximum reading speed of the study eye, change from baseline in mean functional reading independence index score, change from baseline in normal luminance best-corrected visual acuity score, and change from baseline in the mean threshold sensitivity of all points in the study eye by mesopic microperimetry (OAKS only). Safety analyses included patients who were randomly assigned and received at least one injection of pegcetacoplan or sham. The now completed studies are registered with ClinicalTrials.gov, NCT03525613 (OAKS) and NCT03525600 (DERBY).FINDINGS: Between Aug 30, 2018, and July 3, 2020, 1258 patients were enrolled in OAKS and DERBY. The modified intention-to-treat populations comprised 614 (96%) of 637 patients in OAKS (202 receiving pegcetacoplan monthly, 205 pegcetacoplan every other month, and 207 sham) and 597 (96%) of 621 patients in DERBY (201 receiving pegcetacoplan monthly, 201 pegcetacoplan every other month, and 195 sham). In OAKS, pegcetacoplan monthly and pegcetacoplan every other month significantly slowed geographic atrophy lesion growth by 21% (absolute difference in least-squares mean -0·41 mm2, 95% CI -0·64 to -0·18; p=0·0004) and 16% (-0·32 mm2, -0·54 to -0·09; p=0·0055), respectively, compared with sham at 12 months. In DERBY, pegcetacoplan monthly and pegcetacoplan every other month slowed geographic atrophy lesion growth, although it did not reach significance, by 12% (-0·23 mm2, -0·47 to 0·01; p=0·062) and 11% (-0·21 mm2, -0·44 to 0·03; p=0·085), respectively, compared with sham at 12 months. At 24 months, pegcetacoplan monthly and pegcetacoplan every other month slowed geographic atrophy lesion growth by 22% (-0·90 mm2, -1·30 to -0·50; p<0·0001) and 18% (-0·74 mm2, -1·13 to -0·36; p=0·0002) in OAKS, and by 19% (-0·75 mm2, -1·15 to -0·34; p=0·0004) and 16% (-0·63 mm2, -1·05 to -0·22; p=0·0030) in DERBY, respectively, compared with sham. There were no differences in key secondary visual function endpoints at 24 months. Serious ocular treatment-emergent adverse events were reported in five (2%) of 213, four (2%) of 212, and one (<1%) of 211 patients in OAKS, and in four (2%) of 206, two (1%) of 208, and two (1%) of 206 patients in DERBY receiving pegcetacoplan monthly, pegcetacoplan every other month, and sham, respectively, at 24 months. New-onset exudative age-related macular degeneration was reported in 24 (11%), 16 (8%), and four (2%) patients in OAKS, and in 27 (13%), 12 (6%), and nine (4%) patients in DERBY receiving pegcetacoplan monthly, pegcetacoplan every other month, and sham, respectively, at 24 months.INTERPRETATION: Pegcetacoplan, the first treatment approved by the US Food and Drug Administration for geographic atrophy, slowed geographic atrophy lesion growth with an acceptable safety profile.FUNDING: Apellis Pharmaceuticals.

  View details for DOI 10.1016/S0140-6736(23)01520-9

  View details for PubMedID 37865470

• Liquid-biopsy proteomics combined with AI identifies cellular drivers of eye aging and disease in vivo. Cell Wolf, J., Rasmussen, D. K., Sun, Y. J., Vu, J. T., Wang, E., Espinosa, C., Bigini, F., Chang, R. T., Montague, A. A., Tang, P. H., Mruthyunjaya, P., Aghaeepour, N., Dufour, A., Bassuk, A. G., Mahajan, V. B. 2023

  Abstract

  Single-cell analysis in living humans is essential for understanding disease mechanisms, but it is impractical in non-regenerative organs, such as the eye and brain, because tissue biopsies would cause serious damage. We resolve this problem by integrating proteomics of liquid biopsies with single-cell transcriptomics from all known ocular cell types to trace the cellular origin of 5,953 proteins detected in the aqueous humor. We identified hundreds of cell-specific protein markers, including for individual retinal cell types. Surprisingly, our results reveal that retinal degeneration occurs in Parkinson's disease, and the cells driving diabetic retinopathy switch with disease stage. Finally, we developed artificial intelligence (AI) models to assess individual cellular aging and found that many eye diseases not associated with chronological age undergo accelerated molecular aging of disease-specific cell types. Our approach, which can be applied to other organ systems, has the potential to transform molecular diagnostics and prognostics while uncovering new cellular disease and aging mechanisms.

  View details for DOI 10.1016/j.cell.2023.09.012

  View details for PubMedID 37863056

• 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

• Reply. Ophthalmology Zhang, C., Friedman, S., Mruthyunjaya, P., Parikh, R. 2023

  View details for DOI 10.1016/j.ophtha.2023.07.018

  View details for PubMedID 37642620

• Sensitivity of Magnetic Resonance Imaging in Detection of Choroidal Metastasis Yu, M., Ghoraba, H., Miller, S., Fischbein, N., Mruthyunjaya, P. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2023

  View details for Web of Science ID 001053795602239

• 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

• Validation of a Novel Approach to Estimate Choroidal Lesion Thickness Using 2D Ultra-widefield Optomap Images Ahluwalia, A., Yu, M., Heiferman, M., Korot, E., Yu, G., Mruthyunjaya, P. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2023

  View details for Web of Science ID 001053758302209

• The Biosimilar Paradox: How Anti-VEGF Biosimilars will Increase Patient and Overall Healthcare Costs Zhang, C., Friedman, S., Mruthyunjaya, P., Parikh, R. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2023

  View details for Web of Science ID 001053795602316

• Quantifying Optomap Images by Pixel Difference to Characterize Metastatic Choroidal Lesions and Estimate Lesion Thickness Yu, G., Yu, M., Ahluwalia, A., Heiferman, M., Korot, E., Amarikwa, L., Mruthyunjaya, P. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2023

  View details for Web of Science ID 001053795602246

• Unpredictability of Axial Elongation in Infants undergoing Cataract Surgery Abrant, A., Oke, I., McClatchey, S., Mruthyunjaya, P., Moshfeghi, D. M., Ludwig, C., Lambert, S. R. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2023

  View details for Web of Science ID 001053758303144

• Real world outcomes from artificial intelligence to detect diabetic retinopathy in the primary care setting: 12 month experience Knapp, A. N., Dow, E., Chen, K., Khan, N. C., Do, D. V., Mahajan, V., Mruthyunjaya, P., Leng, T., Myung, D. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2023

  View details for Web of Science ID 001053758300331

• The Biosimilar Paradox: How Anti-VEGF Biosimilars will Increase Patient and Overall Healthcare Costs. Ophthalmology Zhang, C., Friedman, S., Mruthyunjaya, P., Parikh, R. 2023

  Abstract

  Anti-vascular endothelial growth factor (anti-VEGF) medications for intraocular use are a major and increasing cost, and biosimilars may be a means of reducing the high cost of many biologic medications. However, a bevacizumab biosimilar, which is currently pending FDA approval (bevacizumab-vikg), may paradoxically increase the cost burden of intravitreal anti-VEGF, as "off-label" repackaged drug may no longer be allowed per the Drug Quality and Security Act (DQSA). We aim to investigate the potential impact of biosimilars on the health system and patient costs in the US.Cost analysis of anti-VEGF medications.Medicare data from October 2022, previously published market share data from 2019.Average sales price (ASP) of ranibizumab, aflibercept, and bevacizumab are calculated from Medicare allowable payments. ASPs of biosimilars are calculated from wholesale acquisition costs from a representative distributor. The cost of an intraocular bevacizumab formulation is modeled at $500 and $900/1.25mg dose.Overall costs of anti-VEGF drugs to Medicare Part B and patients.If an intraocular bevacizumab biosimilar were to be priced at $500, costs to Medicare would increase by $457 million from $3.01 billion to $3.47 billion (15.2% increase). Patient responsibility would increase by $117 million from $768 million to $884 million. Similarly, if intraocular bevacizumab were priced at $900, Medicare costs would increase by $897 million to $3.91 billion (29.8% increase), and patient responsibility would increase by $229 million to $997 million. If bevacizumab were $500/dose, switching all patients currently on ranibizumab or aflibercept to respective biosimilars would only compensate for 28.8% of the increased cost. Current prices of ranibizumab and aflibercept biosimilars would have to decrease by an aggregate of 15.7% to $616.80, $1027.97, and $1436.88/injection for ranibizumab 0.3 mg, 0.5 mg, and aflibercept, respectively.An FDA-approved bevacizumab biosimilar for ophthalmic use could significantly increase costs to the healthcare system and patients, raising concerns for access. This increase in cost would not be offset by ranibizumab and aflibercept biosimilar use at current prices. These data support the need for an exemption of section 503B of the DQSA and continued use of repackaged off-label bevacizumab.

  View details for DOI 10.1016/j.ophtha.2023.04.019

  View details for PubMedID 37116720

• Uveal Melanoma and the IRIS (R) Registry (Intelligent Research in Sight): A Pilot Analysis and Future Directions OPHTHALMOLOGY RETINA Uner, O. E., Aronow, M. E., Mruthyunjaya, P., Materin, M. A., Stacey, A. W., Wilson, M., Afshar, A., Skalet, A. H. 2023; 7 (3): 284-286

  View details for Web of Science ID 000956463200001

• Endoscopic enucleation and clinicopathologic correlation of a small choroidal melanoma hiding massive extrascleral extension. American journal of ophthalmology case reports Yu, M. D., Chiang, B., Pasricha, M. V., Erickson, B. P., Mruthyunjaya, P. 2023; 29: 101797

  Abstract

  Purpose: To report the unusual case of a previously stable choroidal nevus, closely followed for over 15 years, which underwent malignant transformation into small choroidal melanoma with massive extrascleral extension.Observations: A 67-year-old Caucasian female was referred to the Stanford Ocular Oncology Service with concern for malignant transformation of a previously stable choroidal nevus in her left eye. Her funduscopic examination demonstrated a dome-shaped choroidal lesion with overlying associated lipofuscin and subretinal fluid, consistent with a diagnosis of small choroidal melanoma. By B-scan ultrasonography, the lesion measured 8.0*6.0 mm in base and 2.1 mm in thickness. B-scan ultrasonography also disclosed an associated retroscleral mass, which appeared contiguous with the intraocular melanoma and was confirmed on subsequent orbital magnetic resonance imaging. A decision was made to proceed with enucleation. Under direct endoscopic visualization, the globe and extrascleral mass were fully isolated, mobilized, and removed in toto. At 24 months post-enucleation, the patient remains disease-free without evidence of systemic metastasis or local recurrence.Conclusions/importance: This case describes a small choroidal melanoma hiding massive extrascleral extension, underscoring the value of B-scan ultrasonography. This case also describes the unique management of choroidal melanoma with extrascleral extension using endoscopic enucleation. Performing enucleation under direct endoscopic visualization ensures complete resection and prevents inadvertent transection of the extrascleral component.

  View details for DOI 10.1016/j.ajoc.2023.101797

  View details for PubMedID 36703903

• Prediction for 2-Year Vision Outcomes Using Early Morphologic and Functional Responses in the Comparison of Age-related Macular Degeneration Treatments Trials. Ophthalmology. Retina Xue, K., Hua, P., Maguire, M. G., Daniel, E., Jaffe, G. J., Grunwald, J. E., Ying, G., Comparison of age-related macular degeneration Treatments Trials (CATT) Research Group, Williams, D. F., Beardsley, S., Bennett, S., Cantrill, H., Chan-Tram, C., Cheshier, H., Damato, K., Davies, J., Dev, S., Enloe, J., Follano, G., Gilbert, P., Johnson, J., Jones, T., Mayleben, L., Mittra, R., Moos, M., Neist, R., Oestreich, N., Quiram, P., Ramsay, R., Ryan, E., Schindeldecker, S., Snater, J., Steele, T., Selders, D., Tonsfeldt, J., Valardi, S., Fish, G. E., Aguado, H. A., Arceneaux, S., Arnwine, J., Bell, K., Bell, T., Boleman, B., Bradley, P., Callanan, D., Coors, L., Creighton, J., Crew, T., Cummings, K., Dock, C., Duignan, K., Fuller, D., Gray, K., Hendrix, B., Hesse, N., Jaramillo, D., Jost, B., Lash, S., Lonsdale, L., Mackens, M., Mutz, K., Potts, M., Sanchez, B., Snyder, W., Solley, W., Tarter, C., Wang, R., Williams, P., Perkins, S. L., Anderson, N., Arnold, A., Blais, P., Googe, J., Higdon, T. T., Hunt, C., Johnson, M., Miller, J., Moore, M., Morris, C. K., Morris, C., Oelrich, S., Oliver, K., Seitz, V., Whetstone, J., Doft, B. H., Bedel, J., Bergren, R., Borthwick, A., Conrad, P., Fec, A., Fulwylie, C., Ingram, W., Latham, S., Lester, G., Liu, J., Lobes, L., Lucko, N. M., Mechling, H., Merlotti, L., McBroom, K., Olsen, K., Puskas, D., Rath, P., Schmucker, M., Schueckler, L., Schultz, C., Shultz, H., Steinberg, D., Vyas, A., Whale, K., Yeckel, K., Orth, D. H., Arredondo, L. S., Brown, S., Ciscato, B. J., Civantos, J. M., Figliulo, C., Hasan, S., Kosinski, B., Muir, D., Nelson, K., Packo, K., Pollack, J. S., Rezaei, K., Shelton, G., Townsend-Patrick, S., Walsh, M., McDonald, H. R., Ansari, N., Bye, A., Fu, A. D., Grout, S., Indermill, C., Johnson, R. N., Jumper, J. M., Linares, S., Lujan, B. J., Munden, A., Persons, M., Rodriguez, R., Rose, J. M., Teske, B., Urias, Y., Young, S., Dreyer, R. F., Daniel, H., Connaughton, M., Handelman, I., Hobbs, S., Hoerner, C., Hudson, D., Kopfer, M., Lee, M., Lemley, C., Logan, J., Ma, C., Mallet, C., Milliron, A., Peters, M., Wohlsein, H., Pearlman, J. A., Andrews, M., Bartlett, M., Carlson, N., Cox, E., Equi, R., Gonzalez, M., Griffin, S., Hogue, F., Kennedy, L., Kryuchkov, L., Lopez, C., Lopez, D., Luevano, B., McKenna, E., Patel, A., Reed, B., Secor, N., Sison, I. R., Tsai, T., Varghis, N., Waller, B., Wendel, R., Yebra, R., Roth, D. B., Deinzer, J., Fine, H., Green, F., Green, S., Keyser, B., Leff, S., Leviton, A., Martir, A., Mosenthine, K., Muscle, S., Okoren, L., Parker, S., Prenner, J., Price, N., Rogers, D., Rosas, L., Schlosser, A., Studenko, L., Tantum, T., Wheatley, H., Trese, M. T., Aaberg, T., Bell, T., Bezaire, D., Bridges, C., Bryant, D., Capone, A., Coleman, M., Consolo, C., Cook, C., DuLong, C., Garretson, B., Grooten, T., Hammersley, J., Hassan, T., Jessick, H., Jones, N., Kinsman, C., Krumlauf, J., Lewis, S., Locke, H., Margherio, A., Markus, D., Marsh, T., Neal, S., Noffke, A., Oh, K., Pence, C., Preston, L., Raphaelian, P., Regan, V. R., Roberts, P., Ruby, A., Sarrafizadeh, R., Scherf, M., Scott, S., Sneed, S., Staples, L., Terry, B., Trese, M. T., Videtich, J., Williams, G., Zajechowski, M., Joseph, D. P., Blinder, K., Boyd, L., Buckley, S., Crow, M., Dinatale, A., Engelbrecht, N., Forke, B., Gabel, D., Grand, G., Grillion-Cerone, J., Holekamp, N., Kelly, C., Nobel, G., Pepple, K., Raeber, M., Rao, P. K., Ressel, T., Schremp, S., Sgorlon, M., Shears, S., Thomas, M., Timma, C., Vaughn, A., Walters, C., Weeks, R., Wehmeier, J., Wright, T., Berinstein, D. M., Ayyad, A., Barazi, M. K., Bickhart, E., Brady, T., Byank, L., Cronise, A., Denny, V., Dunn, C., Flory, M., Frantz, R., Garfinkel, R. A., Gilbert, W., Lai, M. M., Melamud, A., Newgen, J., Newton, S., Oliver, D., Osman, M., Sanders, R., von Fricken, M., Dugel, P., Arenas, S., Balea, G., Bartoli, D., Bucci, J., Cornelius, J. A., Dickens, S., Doherty, D., Dunlap, H., Goldenberg, D., Jamal, K., Jimenez, N., Kavanagh, N., Kunimoto, D., Martin, J., Miner, J., Mobley, S., Park, D., Quinlan, E., Sipperley, J., Slagle, C., Smith, D., Yafchak, M., Yager, R., Flaxel, C. J., Bailey, S., Francis, P., Howell, C., Hwang, T., Ira, S., Klein, M., Lauer, A., Liesegang, T., Lundquist, A., Nolte, S., Nolte, S. K., Pickell, S., Pope, S., Rossi, J., Schain, M., Steinkamp, P., Toomey, M. D., Vahrenwald, D., West, K., Hubbard, B., Andelman, S., Bergstrom, C., Brower, J., Cribbs, B., Curtis, L., Dobbs, J., DuBois, L., Gaultney, J., Gibbs, D., Jordan, D., Leef, D., Martin, D. F., Myles, R., Olsen, T., Schwent, B., Srivastava, S., Waldron, R., Antoszyk, A. N., Balasubramaniam, U., Brooks, D., Brown, J., Browning, D., Clark, L., Ennis, S., Held, S., Helms, J. V., Herby, J., Karow, A., Leotaud, P., Massimino, C., McClain, D., McOwen, M., Mindel, J., Pereira, C., Pierce, R., Powers, M., Price, A., Rohrer, J., Sanders, J., Avery, R. L., Avery, K., Basefsky, J., Beckner, L., Castellarin, A., Couvillion, S., Giust, J., Giust, M., Nasir, M., Pieramici, D., Rabena, M., Risard, S., See, R., Smith, J., Wan, L., Bakri, S. J., Abu-Yaghi, N., Barkmeier, A., Berg, K., Burrington, J., Edwards, A., Goddard, S., Howard, S., Iezzi, R., Lewison, D., Link, T., McCannel, C. A., Overend, J., Pach, J., Ruszczyk, M., Shultz, R., Stephan, C., Vogen, D., Bradford, R. H., Bergman, V., Burris, R., Butt, A., Daniels, B., Dwiggins, C., Fransen, S., Guerrero, T., Haivala, D., Harris, A., Icks, S., Kingsley, R., Redden, L., Richmond, R., Ross, B., White, K., Youngberg, M., Topping, T. M., Bennett, S., Chong, S., Ciotti, M., Cleary, T., Corey, E., Donovan, D., Frederick, A., Freese, L., Graham, M., Gud, N., Howard, T., Jones, M., Morley, M., Moses, K., Stone, J., Ty, R., Wiegand, T., Williams, L., Winder, B., Awh, C. C., Amonette, M., Arrindell, E., Beck, D., Busbee, B., Dilback, A., Downs, S., Guidry, A., Gutow, G., Hardin, J., Hines, S., Hutchins, E., LaCivita, K., Lester, A., Malott, L., McCain, M., Miracle, J., Moffat, K., Palazzotta, L., Robinson, K., Sonkin, P., Travis, A., Wallace, R. T., Winters, K. J., Wray, J., Harris, A. E., Bunnell, M., Crooks, K., Fitzgerald, R., Javid, C., Kew, C., Kill, E., Kline, P., Kreienkamp, J., Martinez, M., Moore, R. A., Saavedra, E., Taylor, L., Walsh, M., Wilson, L., Ciulla, T. A., Coyle, E., Harrington, T., Harris, C., Hood, C., Kerr, I., Maturi, R., Moore, D., Morrow, S., Savage, J., Sink, B., Steele, T., Thukral, N., Wilburn, J., Walker, J. P., Banks, J., Ciampaglia, D., Dyshanowitz, D., Frederick, J., Ghuman, A. T., Grodin, R., Kiesel, C., Knips, E., McCue, J., Ortiz, M., Peters, C., Raskauskas, P., Schoeman, E., Sharma, A., Wing, G., Youngblood, R., Chandra, S. R., Altaweel, M., Blodi, B., Burke, K., Dietzman, K. A., Gottlieb, J., Knutson, G., Krolnik, D., Nork, T. M., Olson, S., Peterson, J., Reed, S., Soderling, B., Somers, G., Stevens, T., Wealti, A., Bearelly, S., Branchaud, B., Bryant, J. W., Crowell, S., Fekrat, S., Gammage, M., Harrison, C., Jones, S., McClain, N., McCuen, B., Mruthyunjaya, P., Queen, J., Sarin, N., Skalak, C., Skelly, M., Suner, I., Tomany, R., Welch, L., Park, S. S., Cassidy, A., Chandra, K., Good, I., Imson, K., Sashi, Kaur, Metzler, H., Morse, L., Redenbo, E., Salvador, M., Telander, D., Thomas, M., Wallace, C., Barr, C. C., Battcher, A., Bottorff, M., Chasteen, M., Clark, K., Denning, D., Schoen, D., Schultz, A., Tempel, E., Wheeler, L., Whittington, G. K., Stone, T. W., Blevins, T., Buck, M., Cruz, L., Heath, W., Holcomb, D., Isernhagen, R., Kidd, T., Kitchens, J., Sears, C., Slade, E., Van Arsdall, J., VanHoose, B., Wolfe, J., Wood, W., Zilis, J., Crooks, C., Disney, L., Liu, M., Petty, S., Sall, S., Folk, J. C., Aly, T., Brotherton, A., Critser, D., Hinz, C. J., Karakas, S., Kirschner, V., Lester, C., Montague, C., Russell, S., Stockman, H., Taylor, B., Verdick, R., Walshire, J., Thompson, J. T., Connell, B., Constantine, M., Davis, J. L., Gwen Holsapple, Hunter, L., Lenane, C. N., Mitchell, R., Russel, L., Sjaarda, R., Brown, D. M., Benz, M., Burns, L., Carranza, J. G., Fish, R., Goates, D., Hay, S., Jeffers, T., Kegley, E., Kubecka, D., McGilvra, S., Richter, B., Sneed, V., Stoever, C., Tellez, I., Wong, T., Kim, I., Andreoli, C., Barresi, L., Brett, S., Callahan, C., Capaccioli, K., Carli, W., Coppola, M., Emmanuel, N., Evans, C., Fagan, A., Grillo, M., Head, J., Kieser, T., Lee, E., Lord, U., Miretsky, E., Palitsch, K., Petrin, T., Reader, L., Reznichenko, S., Robertson, M., Smith, J., Vavvas, D., Wells, J., Cahill, C., Clark, W. L., Henry, K., Johnson, D., Miller, P., Oliver, L., Spivey, R., Swinford, T., Taylor, M., Lambert, M., Chase, K., Fredrickson, D., Khawly, J., Lazarte, V., Lowd, D., Miller, P., Willis, A., Ferrone, P. J., Almonte, M., Arnott, R., Aviles, I., Carbon, S., Chitjian, M., DAmore, K., Elliott, C., Fastenberg, D., Golub, B., Graham, K., Lavorna, A., Murphy, L., Palomo, A., Puglisi, C., Rhee, D., Romero, J., Rosenblatt, B., Salcedo, G., Schlameuss, M., Shakin, E., Sookhai, V., Kaiser, R., Affel, E., Brown, G., Centinaro, C., Fine, D., Fineman, M., Formoso, M., Garg, S., Grande, L., Herbert, C., Ho, A., Hsu, J., Jay, M., Lavetsky, L., Liebenbaum, E., Maguire, J., Monsonego, J., O'Connor, L., Pierce, L., Regillo, C., Rosario, M., Spirn, M., Vander, J., Walsh, J., Davidorf, F. H., Barnett, A., Chang, S., Christoforidis, J., Elliott, J., Justice, H., Letson, A., McKinney, K., Perry, J., Salerno, J. A., Savage, S., Shelley, S., Singerman, L. J., Coney, J., DuBois, J., DuBois, K., Greanoff, G., Himmelman, D., Ilc, M., McNamara, E., Novak, M., Pendergast, S., Rath, S., Smith-Brewer, S., Tanner, V., Weiss, D. E., Zegarra, H., Halperin, L., Aramayo, P., Dhalla, M., Fernandez, B., Fernandez, C., Lopez, J., Lopez, M., Mariano, J., Murphy, K., Sherley, C., Veksler, R., Rahhal, F., Babikian, R., Boyer, D., Hami, S., Kessinger, J., Kurokouchi, J., Mukarram, S., Pachman, S., Protacio, E., Sierra, J., Tabandeh, H., Zamboni, A., Elman, M., Belz, J., Butcher, T., Cain, T., Coffey, T., Firestone, D., Gore, N., Singletary, P., Sotirakos, P., Starr, J., Meredith, T. A., Barnhart, C. J., Cantrell, D., Esquejo-Leon, R., Houghton, O., Kaur, H., NDure, F., Glatzer, R., Joffe, L., Schindler, R. 2023

  Abstract

  OBJECTIVE: To predict 2-year visual acuity (VA) responses to anti-VEGF therapy, using early morphologic and functional responses in patients with neovascular age-related macular degeneration (nAMD).DESIGN: Cohort within a randomized clinical trial.PARTICIPANTS: A total of 1185 participants with untreated active nAMD and best-corrected visual acuity (BCVA) 20/25 to 20/320 at baseline.METHODS: Secondary analysis of data from participants randomized to either ranibizumab or bevacizumab and to 1 of 3 dosing regimens. Associations of 2-year BCVA responses with baseline morphologic and functional characteristics and their change from baseline at 3 months were assessed, using univariable and multivariable linear regression models for BCVA change and logistic regression models for ≥ 3-line BCVA gain from baseline. The performance of predictions for 2-year BCVA outcomes using these characteristics was assessed using R2 for BCVA change and area under the receiver operating characteristic curve (AUC) for ≥ 3-line BCVA gain.MAIN OUTCOME MEASURES: Best-corrected visual acuity change and ≥ 3-line gain from baseline at year2.RESULTS: In multivariable analyses that included previously reported significant baseline predictors (baseline BCVA, baseline macular atrophy, baseline retinal pigment epithelium elevation [RPEE], and maximum width and early BCVA change from baseline at 3 months), new RPEE occurrence at 3 months was significantly associated with more BCVA gain at 2 years (10.2 letters vs. 3.5 letters for RPEE resolved, P < 0.001), and none of the other morphologic responses at 3 months were significantly associated with BCVA responses at 2 years. These significant predictors moderately predicted 2-year BCVA gain with an R2= 0.36. Baseline BCVA and ≥ 3-line BCVA gain at 3 months predicted 2-year ≥ 3-line gain with AUC 0.83 (95% confidence interval, 0.81-0.86).CONCLUSIONS: Most structural responses on OCT at 3 months were not independently predictive of the 2-year BCVA responses, which were associated with baseline factors and the 3-month BCVA response to anti-VEGF therapy. A combination of baseline predictors, early BCVA, and morphologic responses at 3 months only moderately predicted the long-term BCVA responses. Future research is needed to better understand the factors contributing to the variation in long-term vision outcomes with anti-VEGF therapy.FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found after the references.

  View details for DOI 10.1016/j.oret.2023.02.008

  View details for PubMedID 36803692

• Bilateral optic nerve infiltration in high-grade systemic lymphoma with secondary combined central retinal artery and vein occlusions. Retina (Philadelphia, Pa.) Yu, G., Sandino, I., Mruthyunjaya, P., Ghoraba, H. H. 2023

  View details for DOI 10.1097/IAE.0000000000003764

  View details for PubMedID 36796038

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

  View details for Web of Science ID 000964933500001

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

  View details for Web of Science ID 000946461000002

• Private equity in ophthalmology and optometry: a time series analysis from 2012 to 2021. Digital journal of ophthalmology : DJO Patil, S. A., Vail, D. G., Cox, J. T., Chen, E., Mruthyunjaya, P., Tsai, J. C., Parikh, R. 2023; 29 (1): 6-13

  Abstract

  Purpose: To identify temporal and geographic trends in private equity (PE)-backed acquisitions of ophthalmology and optometry practices in the United States from 2012 to 2021.Methods: In this cross-sectional time series, acquisition data from 10/21/2019 to 9/1/2021 and previously published data from 1/1/2012 to 10/20/2019 were analyzed. Acquisition data were compiled from 6 financial databases, 5 industry news outlets, and publicly available press releases. Linear regression models were used to compare rates of acquisition. Outcomes included number of total acquisitions, practice type, locations, provider details, and geographic footprint.Results: A total of 245 practices associated with 614 clinical locations and 948 ophthalmologists or optometrists were acquired by 30 PE-backed platform companies between 10/21/2019 and 9/1/2021. Of 30 platform companies, 18 were new vis-a-vis our prior study. Of these acquisitions, 127 were comprehensive practices, 29 were retina practices, and 89 were optometry practices. From 2012 to 2021, monthly acquisitions increased by 0.947 acquisitions per year (P < 0.001*). Texas, Florida, Michigan, and New Jersey were the states with the greatest number of PE acquisitions, with 55, 48, 29, and 28 clinic acquisitions, respectively. Average monthly PE acquisitions were 5.71 per month from 1/1/2019 to 2/29/2020 (pre-COVID), 5.30 per month from 3/1/2020 to 12/31/2020 (COVID pre-vaccine [P = 0.81]), and 8.78 per month from 1/1/2021 to 9/1/2021 (COVID post-vaccine [P = 0.20]).Conclusions: PE acquisitions increased during the period 2012-2021 as companies continue to utilize regionally focused strategies for acquisitions.

  View details for DOI 10.5693/djo.01.2022.10.004

  View details for PubMedID 37101563

• Intraoperative Complications With Vitreous Biopsy for Molecular Proteomics OPHTHALMIC SURGERY LASERS & IMAGING RETINA Mishra, K., Velez, G., Chemudupati, T., Tang, P. H., Mruthyunjaya, P., Sanislo, S. R., Mahajan, V. B. 2023; 54 (1): 32-36

  Abstract

  To study the incidence of intraoperative complications while collecting a vitreous sample for proteomic biomarker analyses during small-gauge pars plana vitrectomy (PPV).A retrospective case series was assembled from the surgical logs and charts of patients who underwent 23-, 25-, and 27-gauge PPV along with an undiluted vitreous biopsy. Primary surgical indication and detailed operative reports were reviewed. Complications specific to vitreous biopsy were assessed while complications related to vitrectomy in general without biopsy were not tabulated.In 1190 eyes that underwent vitreous biopsy, the most common indications for PPV were rhegmatogenous retinal detachment (24.2%), epiretinal membrane (ERM) (21.7%), vitreous hemorrhage (11.0%), uveitis (8.3%), and macular hole (7.5%). An adequate sample of 0.5 cc to 1.0 cc was obtained in all cases. There was one sclerotomy break associated with biopsy, but no instances of lens touch, retinal contusion, retinal detachment, or intraocular hemorrhage.Undiluted vitreous biopsy obtained at the time of small-gauge vitrectomy is a generally safe procedure and may be considered for collection of samples for proteomic analysis. [Ophthalmic Surg Lasers Imaging Retina 2023;54:32-36.].

  View details for DOI 10.3928/23258160-20221214-02

  View details for Web of Science ID 001052416400004

  View details for PubMedID 36626208

• Uveal Melanoma and the Intelligent Research in Sight Registry: A Pilot Analysis and Future Directions. Ophthalmology. Retina Uner, O. E., Aronow, M. E., Mruthyunjaya, P., Materin, M. A., Stacey, A. W., Wilson, M., Afshar, A., Skalet, A. H. 2022

  View details for DOI 10.1016/j.oret.2022.10.019

  View details for PubMedID 36522810

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

  Abstract

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

  View details for DOI 10.1016/j.oret.2022.09.005

  View details for PubMedID 36216223

• Radio-luminescent imaging for rapid, high resolution eye plaque loading verification. Medical physics Yan, H., De Jean, P., Grafil, E., Ashraf, R., Niedermayr, T., Astrahan, M., Mruthyunjaya, P., Beadle, B., Xing, L., Liu, W. 2022

  Abstract

  BACKGROUND: Eye plaque brachytherapy (EPB) is currently an optimal therapy for intraocular cancers. Due to the lack of an effective and practical technique to measure the seed radioactivity distribution, current quality assurance (QA) practice according to the AAPM TG129 only stipulates that the plaque assembly be visually inspected. Consequently, uniform seed activity is routinely adopted to avoid possible loading mistakes of differential seed loading. However, modulated dose delivery, which represents a general trend in radiotherapy to provide more personalized treatment for a given tumor and patient, requires differential activities in the loaded seeds.PURPOSE: In this study, a fast and low-cost radio-luminescent imaging and dose calculating system to verify the seed activity distribution for differential loading was developed.METHODS: A proof-of-concept system consisting of a thin scintillator sheet coupled to a camera/lens system was constructed. A seed-loaded plaque can be placed directly on the scintillator surface with the radioactive seeds facing the scintillator. The camera system collects the radioluminescent signal generated by the scintillator at its opposite side. The predicted dose distribution in the scintillator's sensitive layer was calculated using a Monte Carlo simulation with the planned plaque loading pattern of I-125 seeds. Quantitative comparisons of the distribution of relative measured signal intensity and that of the relative predicted dose in the sensitive layer were performed by gamma analysis, similar to IMRT QA.RESULTS: Data analyses showed high gamma (3%/0.3mm, global, 20% threshold) passing rates for correct seed loadings and low passing rates with distinguished high gamma value area for incorrect loadings, indicating that possible errors may be detected. The measurement and analysis only required a few extra minutes, significantly shorter than the time to assay the extra verification seeds the physicist already must perform as recommended by TG129.CONCLUSIONS: Radio-luminescent QA can be used to facilitate and assure the implementation of intensity modulated, customized plaque loading. This article is protected by copyright. All rights reserved.

  View details for DOI 10.1002/mp.16003

  View details for PubMedID 36183146

• Update in Molecular Testing for Intraocular Lymphoma. Cancers Heiferman, M. J., Yu, M. D., Mruthyunjaya, P. 2022; 14 (19)

  Abstract

  The diagnosis of primary vitreoretinal lymphoma and central nervous system lymphoma is challenging. In cases with intraocular involvement, vitreous biopsy plays a pivotal role. Several diagnostic tests are employed to confirm a diagnosis and include cytologic evaluation, immunohistochemistry, flow cytometry, and cytokine analysis. The limitations of these conventional diagnostic tests stem from the often paucicellular nature of vitreous biopsy specimens and the fragility of malignant cells ex vivo. Several emerging molecular techniques show promise in improving the diagnostic yield of intraocular biopsy, possibly enabling more accurate and timely diagnoses. This article will review existing diagnostic modalities for intraocular lymphoma, with an emphasis on currently available molecular tests.

  View details for DOI 10.3390/cancers14194546

  View details for PubMedID 36230469

• Presumed bilateral diffuse uveal melanocytic proliferation - A case report and review of literature. American journal of ophthalmology case reports Parakh, S., Maheshwari, S., Das, S., Kumar, V., Agrawal, R., Gupta, V., Mruthyunjaya, P., Luthra, S. 2022; 27: 101582

  Abstract

  To describe a case of presumed bilateral diffuse uveal melanocytic proliferation (BDUMP) associated with renal cell carcinoma (RCC) and provide an updated review of literature.A 58-year-old man, with a history of radical nephrectomy for RCC 8 years ago, presented with gradual diminution of vision. Based on multimodal imaging and detailed systemic evaluation, a diagnosis of presumed BDUMP and metastatic RCC was made. He was started on sunitinib malate as palliative chemotherapy. However, he refused plasmapheresis for BDUMP. The patient rapidly developed bilateral exudative retinal detachment. Subsequently, he progressed to bilateral neovascular glaucoma secondary to closed funnel retinal detachment. Eventually, he was lost to follow up after 13 months.BDUMP portends an underlying advanced systemic malignancy. Studies have not conclusively proven any definite treatment for BDUMP and survival is generally poor. Ocular side effects of palliative targeted chemotherapy for the primary malignancy, such as sunitinib, should be borne in mind.

  View details for DOI 10.1016/j.ajoc.2022.101582

  View details for PubMedID 35619994

  View details for PubMedCentralID PMC9127154

• Predominantly Persistent Intraretinal Fluid in the Comparison of Age-related Macular Degeneration Treatments Trials OPHTHALMOLOGY RETINA Core, J. Q., Pistilli, M., Hua, P., Daniel, E., Grunwald, J. E., Toth, C. A., Jaffe, G. J., Martin, D. F., Maguire, M. G., Ying, G., Comparison Age-related Macular Deg 2022; 6 (9): 771-785

  Abstract

  To describe predominantly persistent intraretinal fluid (PP-IRF) and its association with visual acuity (VA) and retinal anatomic findings at long-term follow-up in eyes treated with pro re nata (PRN) ranibizumab or bevacizumab for neovascular age-related macular degeneration.Cohort within a randomized clinical trial.Participants in the Comparison of Age-related Macular Degeneration Treatments Trials (CATT) assigned to PRN treatment.The presence of intraretinal fluid (IRF) on OCT scans was assessed at baseline and monthly follow-up visits by Duke OCT Reading Center. Predominantly persistent intraretinal fluid through week 12, year 1, and year 2 was defined as the presence of IRF at the baseline and in ≥ 80% of follow-up visits. Among eyes with baseline IRF, the mean VA scores (letters) and changes from the baseline were compared between eyes with and those without PP-IRF. Adjusted mean VA scores and changes from the baseline were also calculated using the linear regression analysis to account for baseline patient features identified as predictors of VA in previous CATT studies. Furthermore, outcomes were adjusted for concomitant predominantly persistent subretinal fluid.Predominantly persistent intraretinal fluid through week 12, year 1, and year 2; VA score and VA change; and scar development at year 2.Among 363 eyes with baseline IRF, 108 (29.8%) had PP-IRF through year 1 and 95 (26.1%) had PP-IRF through year 2. When eyes with PP-IRF through year 1 were compared with those without PP-IRF, the mean 1-year VA score was 62.4 and 68.5, respectively (P = 0.002), and was 65.0 and 67.4, respectively (P = 0.13), after adjustment. Predominantly persistent intraretinal fluid through year 2 was associated with worse adjusted 1-year mean VA scores (64.8 vs. 69.2; P = 0.006) and change (4.3 vs. 8.1; P = 0.01) as well as worse adjusted 2-year mean VA scores (63.0 vs. 68.3; P = 0.004) and changes (2.4 vs. 7.1; P = 0.009). Predominantly persistent intraretinal fluid through year 2 was associated with a higher 2-year risk of scar development (adjusted hazard ratio = 1.49; P = 0.03).Approximately one quarter of eyes had PP-IRF through year 2. Predominantly persistent intraretinal fluid through year 1 was associated with worse long-term VA, but the relationship disappeared after adjustment for baseline predictors of VA. Predominantly persistent intraretinal fluid through year 2 was independently associated with worse long-term VA and scar development.

  View details for DOI 10.1016/j.oret.2022.03.024

  View details for Web of Science ID 000863104800004

  View details for PubMedID 35405352

• Intravitreal brolucizumab as treatment of early onset radiation retinopathy secondary to plaque brachytherapy for choroidal melanoma. American journal of ophthalmology case reports Villegas, N. C., Mishra, K., Steinle, N., Liu, W., Beadle, B., Mruthyunjaya, P. 2022; 27: 101581

  Abstract

  Purpose: To describe the efficacy and safety of brolucizumab (Beovu, Novartis Pharmaceuticals) in a case of cystoid macular edema associated with radiation retinopathy as a result of iodine-125 plaque brachytherapy (PBT) for choroidal melanoma, resistant to treatment with other anti-vascular endothelial growth factor (VEGF) agents.Observations: A 67-year-old woman with choroidal melanoma in the right eye and best-corrected visual acuity (BCVA) of 20/20, underwent uncomplicated PBT. On post-operative month 7, the patient developed early onset radiation retinopathy. She failed to improve significantly with sub-tenon triamcinolone and 3 injections of intravitreal bevacizumab; BCVA was 20/200. Intravitreal brolucizumab was administered, and one month after, macular edema had resolved completely on optical coherence tomography, and BCVA improved to 20/50. At last follow up, 1 month after the third brolucizumab injection, BCVA was 20/60 and there was sustained resolution of intraretinal fluid. There were no signs of intraocular inflammation, progressive RR or optic neuropathy on exam or fluorescein angiography.Conclusions: This case suggests a positive effect of brolucizumab in the management of radiation retinopathy following PBT refractory to other anti-VEGF agents. However, one must consider the risk of severe vision loss associated with retinal vasculitis from use of brolucizumab.

  View details for DOI 10.1016/j.ajoc.2022.101581

  View details for PubMedID 35599950

• The Global Retinoblastoma Outcome Study: a prospective, cluster-based analysis of 4064 patients from 149 countries LANCET GLOBAL HEALTH Alia, D. B., Tandili, A., Paiva, L., Wime, A., Chantada, G. L., Fandino, A. C., Sgroi, M., Papyan, R., Tamamyan, G., Camuglia, J. E., Gole, G. A., Clark, A., Lam, G. C., Elder, J. E., McKenzie, J. D., Staffieri, S. E., Jones, M. M., Manudhane, R., Sia, D., Ritter-Sovinz, P., Schwab, C., Balayeva, R., Khan, Z., Nuruddin, M., Roy, S. R., Rashid, R., Sultana, S., Shakoor, S. A., Naumenko, L., Zhilyaeva, K., Bartoszek, P., Brichard, B. G., De Potter, P., Bio, A., Salas, B., Coleoni Suarez, M., Mbumba, F. B., Bonanomi, M. C., Donato Macedo, C. R., Grigorovski, N. K., Mattosinho, C. S., Teixeira, L. F., Oscar, A. H., Veleva-Krasteva, N. V., Bouda, G. C., Kabore, R. L., Philbert, R., Evina, T. A., Nkumbe, H. E., Kamsang, P., Muyen, O. M., Dimaras, H., Mallipatna, A., Hamel, P., Superstein, R., Paton, K. E., Strahlendorf, C., Palet, J., Tyau-Tyau, H., Cavieres, I., Lopez, J. P., Oporto, J., Ossandon, D., Chen, W., Xiang, D., Du, Y., Li, K., Ji, X., Tang, J., Li, C., Xu, B., Qian, J., Xue, K., Sun, X., Wang, Y., Zhang, Y., Wu, S., Xiao, Y., Yang, H., Ye, H., Polania, R. A., Berete, R. C., Couitchere, L., Peric, S., Alemany-Rubio, E., Gonzalez-Rodriguez, L., Autrata, R., Kepak, T., Pochop, P., Svojgr, K., Gregersen, P. A., Urbak, S. F., Montero, M. M., Budiongo, A., Yanga, J. M., Amani, T., Lukamba, R. M., Numbi, M. N., Calle Jara, D. A., Villacis Chafla, E. G., Sanchez, G. L., Abouelnaga, S., Afifi, M. A., Elhaddad, A. M., Ali, A. M., Elzembely, M., Said, A. A., Ziko, O. O., Fuentes-Alabi, S. L., Goenz, M. A., Eerme, K., Klett, A., Hordofa, D. F., Mengesha, A. A., Sherief, S. T., Kivela, T. T., Nummi, K., Cassoux, N., Desjardins, L., Obono-Obiang, G., Kardava, T., Khotenashvili, Z., Bechrakis, N. E., Biewald, E. M., Schlueter, S., Ketteler, P., Amankwaa-Frempong, D., Essuman, V. A., Paintsil, V., Renner, L. A., Alejos, A., Giron, A., Carreras, Y., Fu, L. D., Maldonado, C., Wong, E. S., Yam, J. C., Csoka, M., Maka, E., Aggarwal, P., Gupta, V., Bhaduri, A., Bhattacharyya, A., Das, A., Chawla, B., Das, P., Das, S., Gupta, H., Gupta, S., Verma, N., Kaliki, S., Khetan, V., Maitra, P., Mahajan, A., Menon, V., Mishra, D. C., Palanivelu, M., Ramanjulu, R., Mudaliar, S. S., Nair, A., Natarajan, S., Seth, R., Singh, U., Bhat, S., Dudeja, G., Tripathy, D., Akib, I. R., Pagarra, H., Amiruddin, P. O., Kuntorini, M. W., Armytasari, I., Supriyadi, E., Sutyawan, I., Yuliawati, P., Lutfi, D., Soebagjo, H. D., Rahman, A., Sitorus, R. S., Victor, A. A., Tehuteru, E. S., Widiarti, W., Nency, Y. M., Faranoush, M., Mehrvar, A., Tashvighi, M., Sedaghat, A., Ghassemi, F., Khodabande, A., Abdulqader, R. A., Al-Shaheen, A. M., Al Ani, M. H., Haydar, H., Al-Badri, S. F., Al-Jadiry, M. F., Sabhan, A. H., Al-Jumaily, U., Al-Mafrachi, A. M., Al-Shammary, E. H., Al-Janabi, A., Qadir, A. O., Capra, M., Blum, S., Gomel, N., Fabian, I., Goldberg, H., Kapelushnik, N., Madgar, S., Vishnevskia-Dai, V., Frenkel, S., Pe'er, J., Gorfine, M., Refaeli, D., Steinberg, D. M., Lavy, Y., Toledano, H., Caspi, S., De Francesco, S., Hadjistilianou, T., Ida, R., Valente, P., Midena, E., Parrozzani, R., Cowan-Lyn, K. E., Vaughan, L. O., Suzuki, S., Mohammad, M. T., Yousef, Y. A., Manzhuova, L., Atsiaya, R., Matende, I. O., Begimkulova, A. S., Makimbetov, E. K., Keomisy, J., Sayalith, P., Valeina, S., Viksnins, M., Al-Haddad, C. E., Saab, R. H., Alsawidi, K. M., Elbahi, A. M., Krivaitiene, D., Tateshi, B., Randrianarisoa, H., Raobela, L., Msukwa, G., Nyirenda, C., Hamzah, N., Teh, K., Sylla, F., Traore, F., Cheikh, S., Zein, E., Perez, G., Sanchez Orozco, A., Ortega-Hernandez, M., Ramirez-Ortiz, M. A., Chuluunbat, T., Abdallah, E., Benmiloud, S., El Kettani, A., Hessissen, L., Almeida, A. A., Limbu, B., Rajkarnikar, P., Saiju, R., Moll, A. C., Wijsard, M., Cockcroft, R. L., Ng, Y., Dodgshun, A. J., Calderon-Sotelo, P., Abdullahi, S. U., Hassan, S., Umar, A. B., Abdulrahaman, A. A., Wali, A. H., Ademola-Popoola, D. S., Adio, A., Aghaji, A. E., Ezegwui, I. R., Akinsete, A., Musa, K. O., Fasina, O., Ibanga, A., Nkanga, E. D., Mustapha, T., Ribadu, D., Hummelen, M., Ahmad, A., Mushtaq, A., Qayyum, S., Chaudhry, S., Fadoo, Z., Jeeva, I., Masud, S., Hamid, S. A., Zia, N., Hassan, S., Siddiqui, S., Janjua, T., Yaqub, M. A., Khaqan, H. A., Quintero D, K., Yee, R., Jairaj, V., Cano, M. R., Fernandez, D. G., Diaz Coronado, R. Y., Zapata Lopez, A. M., Garcia, J. L., Ponce, J., Garcia Pacheco, H. N., Pascual Morales, C. R., Vasquez Anchaya, J., Tarrillo Leiva, F. F., Alcasabas, A. A., Mercado, G., Cieslik, K., Hautz, W., Rogowska, A., Castela, G., Silva, S., Jo, D., Kim, J., Comsa, C., Dragomir, M. D., Neroev, V., Saakyan, S., Polyakov, V., Ushakova, T. L., Yarovaya, V. A., Yarovoy, A. A., Theophile, T., Al Mesfer, S., Maktabi, A., Al-Dahmash, S. A., Alkatan, H. M., Moreira, C., Roth, P., Ilic, V. R., Nikitovic, M., Latinovic, S., Quah, B., Tan, D., Hederova, S., Husakova, K., Groznik, A., Pompe, M., Davidson, A., Du Bruyn, M., Du Plessis, J., Stones, D. K., Geel, J. A., Myezo, K. H., Kruger, M., Mayet, I., Naidu, G., Naidu, N., Mustak, H., Reynders, D., Wetter, J., Alarcon Portabella, S., Martin-Begue, N., Wolley Dod, C., Balaguer, J., Barranco, H., Catala-Mora, J., Correa Llano, M. G., Fernandez-Teijeiro, A., Garcia Aldana, D., Peralta Calvo, J., San Roman Pacheco, S., Gunasekera, D., Elhassan, M. A., Mohamedani, A. A., All-Eriksson, C., Bartuma, K., Popovic, M., Munier, F. L., Liu, C., Chiwanga, F. S., Kyara, A., Mndeme, F. G., Msina, M. S., Scanlan, T. A., Atchaneeyasakul, L., Buaboonnam, J., Dangboon, W., Singha, P., Hongeng, S., Kulvichit, K., Rojanaporn, D., Surukrattanaskul, S., Wangtiraumnuay, N., Wiwatwongwana, A., Wiwatwongwana, D., Wongwai, P., Sharma, M. K., Guedenon, K. M., Bouguila, H., Atalay, H. T., Hasanreisoglu, M., Ataseven, E., Kantar, M., Gunduz, A. K., Kebudi, R., Kiratli, H., Koc, I., Tuncer, S., Unal, E., Kalinaki, A., Matua, M., Waddell, K., Musika, A. A., Ssali, G., Al Harby, L., Reddy, M., Astbury, N. J., Bascaran, C., Bowman, R., Burton, M. J., Foster, A., Zondervan, M., Sagoo, M. S., Bobrova, N., Sorochynska, T., Lysytsia, L., Castillo, L., Afshar, A. R., Berry, J. L., Kim, J. W., Randhawa, J. K., Binkley, E., Boldt, H. C., Larson, S. A., Brennan, R. C., Chandramohan, A., Stacey, A. W., Corson, T. W., Plager, D. A., Davanzo, J. M., Singh, A. D., Demirci, H., Ericksen, C., Magrath, G. N., Gold, A. S., Murray, T. G., Gonzalez, E., Shah, A. S., Hansen, E. D., Hartnett, M., Harbour, J., Hubbard, G., Uner, O. E., Laurenti, K. D., Mets, M. B., Leverant, A. A., Ramasubramanian, A., Luna-Fineman, S., Miller, A., Skalet, A. H., Mruthyunjaya, P., Hassan, M., Oliver, S., Shields, C. L., Yaghy, A., Stahl, E. D., Wilson, M. W., Villegas, V. M., Islamov, Z., Usmanov, R. H., Graells, J., Romero, L., Pham, C. M., Trang, D. L., Al-Hussaini, H., Thawaba, A. M., Muma, K. M., Nyaywa, M., Global Retinoblastoma Study Grp 2022; 10 (8): E1128-E1140

  Abstract

  Retinoblastoma is the most common intraocular cancer worldwide. There is some evidence to suggest that major differences exist in treatment outcomes for children with retinoblastoma from different regions, but these differences have not been assessed on a global scale. We aimed to report 3-year outcomes for children with retinoblastoma globally and to investigate factors associated with survival.We did a prospective cluster-based analysis of treatment-naive patients with retinoblastoma who were diagnosed between Jan 1, 2017, and Dec 31, 2017, then treated and followed up for 3 years. Patients were recruited from 260 specialised treatment centres worldwide. Data were obtained from participating centres on primary and additional treatments, duration of follow-up, metastasis, eye globe salvage, and survival outcome. We analysed time to death and time to enucleation with Cox regression models.The cohort included 4064 children from 149 countries. The median age at diagnosis was 23·2 months (IQR 11·0-36·5). Extraocular tumour spread (cT4 of the cTNMH classification) at diagnosis was reported in five (0·8%) of 636 children from high-income countries, 55 (5·4%) of 1027 children from upper-middle-income countries, 342 (19·7%) of 1738 children from lower-middle-income countries, and 196 (42·9%) of 457 children from low-income countries. Enucleation surgery was available for all children and intravenous chemotherapy was available for 4014 (98·8%) of 4064 children. The 3-year survival rate was 99·5% (95% CI 98·8-100·0) for children from high-income countries, 91·2% (89·5-93·0) for children from upper-middle-income countries, 80·3% (78·3-82·3) for children from lower-middle-income countries, and 57·3% (52·1-63·0) for children from low-income countries. On analysis, independent factors for worse survival were residence in low-income countries compared to high-income countries (hazard ratio 16·67; 95% CI 4·76-50·00), cT4 advanced tumour compared to cT1 (8·98; 4·44-18·18), and older age at diagnosis in children up to 3 years (1·38 per year; 1·23-1·56). For children aged 3-7 years, the mortality risk decreased slightly (p=0·0104 for the change in slope).This study, estimated to include approximately half of all new retinoblastoma cases worldwide in 2017, shows profound inequity in survival of children depending on the national income level of their country of residence. In high-income countries, death from retinoblastoma is rare, whereas in low-income countries estimated 3-year survival is just over 50%. Although essential treatments are available in nearly all countries, early diagnosis and treatment in low-income countries are key to improving survival outcomes.Queen Elizabeth Diamond Jubilee Trust.

  View details for Web of Science ID 000863614200019

  View details for PubMedID 35839812

  View details for PubMedCentralID PMC9397647

• Predicting Systemic Health Features from Retinal Fundus Images Using Transfer-Learning-Based Artificial Intelligence Models. Diagnostics (Basel, Switzerland) Khan, N. C., Perera, C., Dow, E. R., Chen, K. M., Mahajan, V. B., Mruthyunjaya, P., Do, D. V., Leng, T., Myung, D. 2022; 12 (7)

  Abstract

  While color fundus photos are used in routine clinical practice to diagnose ophthalmic conditions, evidence suggests that ocular imaging contains valuable information regarding the systemic health features of patients. These features can be identified through computer vision techniques including deep learning (DL) artificial intelligence (AI) models. We aim to construct a DL model that can predict systemic features from fundus images and to determine the optimal method of model construction for this task. Data were collected from a cohort of patients undergoing diabetic retinopathy screening between March 2020 and March 2021. Two models were created for each of 12 systemic health features based on the DenseNet201 architecture: one utilizing transfer learning with images from ImageNet and another from 35,126 fundus images. Here, 1277 fundus images were used to train the AI models. Area under the receiver operating characteristics curve (AUROC) scores were used to compare the model performance. Models utilizing the ImageNet transfer learning data were superior to those using retinal images for transfer learning (mean AUROC 0.78 vs. 0.65, p-value < 0.001). Models using ImageNet pretraining were able to predict systemic features including ethnicity (AUROC 0.93), age > 70 (AUROC 0.90), gender (AUROC 0.85), ACE inhibitor (AUROC 0.82), and ARB medication use (AUROC 0.78). We conclude that fundus images contain valuable information about the systemic characteristics of a patient. To optimize DL model performance, we recommend that even domain specific models consider using transfer learning from more generalized image sets to improve accuracy.

  View details for DOI 10.3390/diagnostics12071714

  View details for PubMedID 35885619

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

  Abstract

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

  View details for DOI 10.3928/23258160-20220629-01

  View details for Web of Science ID 000827880200009

  View details for PubMedID 35858231

• Applicant Characteristics Associated with Retina Fellowship Match from 2010-2019. Ophthalmology. Retina Burton, E., Mishra, K., Arsiwala, L. T., Zafar, S., Justin, G. A., Mruthyunjaya, P., Woreta, F. A. 2022

  Abstract

  To describe trends in the surgical and medical retina fellowship match and applicant characteristics associated with matching in retina fellowship.Retrospective study.Ophthalmology fellowship applicants who applied through the San Francisco (SF) Match.Publicly available SF Match data were used to describe trends in the number of programs participating and positions offered, filled, and left vacant in the retina fellowship match from 2014 to 2019. De-identified applicant data for match cycles 2010-2017 were stratified by match status, and characteristics were compared across groups. Trends in matched applicant characteristics were evaluated using a linear regression on log-transformed variables. A multivariable logistic regression was used to determine applicant characteristics that were associated with a successful match MAIN OUTCOME MEASURES: Match status.From 2014 to 2019, the number of programs participating, positions filled, and positions left vacant in the retina fellowship match increased from 101 to 119 (p=0.010), 136 to 160 (p=0.005), and 18 to 37 (p=0.045), respectively. Compared with unmatched applicants, matched applicants were more likely to have graduated from a top 10 residency program, U.S. residency or medical school; hold a U.S. visa (J-1, H-1B, or O1); distribute more applications; complete more interviews; rank more programs; and score higher on USMLE step exams 1-3. Matched applicants completed a median of 10 interviews. After controlling for potential covariates, graduating from a U.S. residency (OR: 2.08, CI: [1.48, 2.92]), a top 10 residency (OR: CI: 1.74, [1.07, 2.84]), having an allopathic medical degree (MD, OR: 2.39, CI: [1.08 5.33]), completing more interviews (OR: 1.28, CI: [1.23, 1.33]), and scoring higher on USMLE Step 3 (OR: 1.01, CI: [1.01, 1.03]) were associated with matching into retina fellowship.Although the number of programs participating and positions offered in the retina fellowship match are increasing, the number of positions filled remained relatively stagnant. Factors associated with matching in both medical and surgical retina included graduating from a U.S. and top 10-ranked residency program, having an MD, completing more interviews, and scoring higher on USMLE Step 3.

  View details for DOI 10.1016/j.oret.2022.06.008

  View details for PubMedID 35772695

• Preferentially Expressed Antigen in Melanoma Immunohistochemistry Labeling in Uveal Melanomas OCULAR ONCOLOGY AND PATHOLOGY Ahmadian, S. S., Dryden, I. J., Naranjo, A., Toland, A., Cayrol, R. A., Born, D. E., Egbert, P. S., Brown, R. A., Mruthyunjaya, P., Lin, J. H. 2022; 8 (2): 133-140

  View details for DOI 10.1159/000524051

  View details for Web of Science ID 000812351000009

• Vitrectomy after Anti-VEGF or Pan-retinal Photocoagulation Therapy in Proliferative Diabetic Retinopathy Hwang, B., Azad, A. D., Chen, E., Rayess, N., Hinkle, J. W., Parikh, R., Mruthyunjaya, P. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2022

  View details for Web of Science ID 000844401306245

• Radio-Luminescent Imaging for Rapid, High Resolution Eye Plaque Loading Verification Liu, W., De Jean, P., Yan, H., Grafil, E., Ashraf, M., Niedermayr, T., Astrahan, M., Mruthyunjaya, P., Beadle, B., Xing, L. WILEY. 2022: E458

  View details for Web of Science ID 000808579201329

• A Novel Approach to Estimating Choroidal Lesion Thickness Using 2D Optomap Images Yu, M., Heiferman, M., Korot, E., Mruthyunjaya, P. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2022

  View details for Web of Science ID 000844437001047

• Predicting systemic health features from retinal fundus images using transfer-learning based AI models Khan, N. C., Perera, C., Dow, E. R., Leng, T., Mahajan, V. B., Mruthyunjaya, P., Do, D. V., Myung, D. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2022

  View details for Web of Science ID 000844437002058

• Integration of Artificial Intelligence into a Telemedicine-Based Diabetic Retinopathy Screening Program Chen, K., Dow, E. R., Khan, N. C., Levine, M., Perera, C., Phadke, A., Dang, J., Weng, K., Do, D. V., Mahajan, V. B., Mruthyunjaya, P., Mishra, K., Leng, T., Myung, D. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2022

  View details for Web of Science ID 000844401304101

• Loss of Cilia in Uveal Melanoma: Implications for Diagnosis Heiferman, M., Ning, K., Song, E., Kowal, T., Dryden, I., Tran, M., Dalal, R., Chu, P., Mruthyunjaya, P., Lin, J., Sun, Y. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2022

  View details for Web of Science ID 000844437000053

• PRAME Immunohistochemistry in Conjunctival Melanocytic Lesions Dryden, I., Steinbergs, K., Ahmadian, S., Lin, C., Mruthyunjaya, P., Lin, J. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2022

  View details for Web of Science ID 000844437002195

• The Effect of Obstructive Sleep Apnea Treatment and Severity on Choroidal Thickness in Patients With Central Serous Chorioretinopathy. Journal of vitreoretinal diseases Azad, A. D., Davila, J. R., Rayess, N., Cao, M., Mruthyunjaya, P., Pan, C. K. 2022; 6 (1): 22-30

  Abstract

  This work aimed to analyze the association of obstructive sleep apnea (OSA) with choroidal thickness (CT) in patients with central serous chorioretinopathy (CSC).We identified patients in the Stanford Research Repository with a diagnosis of CSC and OSA. Age- and sex-matched controls with either CSC or OSA only were also identified. CT was measured at 5 points (subfoveal, and 1500 and 3000 µm nasal and temporal) by 2 graders. In addition to OSA treatment and severity, we also investigated the association of Oxygen Desaturation Index and nocturnal oxygen saturation nadir with subfoveal CT (SFCT).A total of 57 patients and 72 eyes met the study inclusion criteria. The mean SFCT was significantly different across the 3 groups: OSA-only was the thinnest, followed by CSC with OSA, and CSC-only was the thickest (194.2 μm, 295.1 μm, and 357.8 μm, respectively, P < .001). SFCT was thicker in CSC with OSA compared with those with only OSA (P < .05). OSA treatment status and OSA severity did not show a significant difference in SFCT in multivariable modeling. Nocturnal oxygen saturation nadir was positively associated with SFCT, but this did not reach significance..SFCT is significantly different in patients with OSA alone, CSC with OSA, and CSC alone. While OSA treatment status did not demonstrate a significant difference in SFCT in this study, future studies should evaluate patients for OSA in patients known to have CSC and atypically thin CT to further investigate the novel metrics leveraged in this study.

  View details for DOI 10.1177/24741264211009677

  View details for PubMedID 37007726

  View details for PubMedCentralID PMC9976222

• Methicillin-resistant S. aureus endogenous endophthalmitis retinal detachment repairs. Ophthalmology. Retina Zhang, X., Seidelman, J., Grewal, D., Mahmoud, T. H., Mruthyunjaya, P., Postel, E., Chen, X., Brodie, F. 2022

  Abstract

  This case series reviews surgical approaches in 7 eyes with retinal detachments associated with endogenous methicillin-resistant Staphylococcus aureus endophthalmitis. A successful approach likely involves vitrectomy with scleral buckle and a low threshold for retinectomy.

  View details for DOI 10.1016/j.oret.2022.04.010

  View details for PubMedID 35436599

• Thiazolidinedione use and retinal fluid in the comparison of age-related macular degeneration treatments trials. The British journal of ophthalmology Core, J. Q., Hua, P., Daniel, E., Grunwald, J. E., Jaffe, G., Maguire, M. G., Ying, G., Comparison of Age-related Macular Degeneration Treatments Trials (CATT) Research Group, Williams, D. F., Beardsley, S., Bennett, S., Cantrill, H., Chan-Tram, C., Cheshier, H., Davies, J., Dev, S., Enloe, J., Follano, G., Gilbert, P., Johnson, J., Jones, T., Mayleben, L., Mittra, R., Moos, M., Neist, R., Oestreich, N., Quiram, P., Ramsay, R., Ryan, E., Schindeldecker, S., Steele, T., Tonsfeldt, J., Valardi, S., Fish, G. E., Aguado, H. A., Arceneaux, S., Arnwine, J., Bell, K., Bell, T., Boleman, B., Bradley, P., Callanan, D., Coors, L., Creighton, J., Cummings, K., Dock, C., Duignan, K., Fuller, D., Gray, K., Hendrix, B., Hesse, N., Jaramillo, D., Jost, B., Lash, S., Lonsdale, L., Mackens, M., Mutz, K., Potts, M., Sanchez, B., Snyder, W., Solley, W., Tarter, C., Wang, R., Williams, P., Perkins, S. L., Anderson, N., Arnold, A., Blais, P., Googe, J., Higdon, T. T., Hunt, C., Johnson, M., Miller, J., Moore, M., Morris, C. K., Morris, C., Oelrich, S., Oliver, K., Seitz, V., Whetstone, J., Doft, B. H., Bedel, J., Bergren, R., Borthwick, A., Conrad, P., Fulwylie, C., Ingram, W., Latham, S., Lester, G., Liu, J., Lobes, L., Lucko, N. M., Merlotti, L., Olsen, K., Puskas, D., Rath, P., Schueckler, L., Schultz, C., Shultz, H., Steinberg, D., Vyas, A., Whale, K., Yeckel, K., Orth, D. H., Arredondo, L. S., Brown, S., Ciscato, B. J., Civantos, J. M., Figliulo, C., Hasan, S., Kosinski, B., Muir, D., Nelson, K., Packo, K., Pollack, J. S., Rezaei, K., Shelton, G., Townsend-Patrick, S., Walsh, M., Richard McDonald, H., Ansari, N., Bye, A., Fu, A. D., Grout, S., Indermill, C., Robert, N., Jumper, M., Linares, S., Lujan, B. J., Munden, A., Rodriguez, R., Rose, J. M., Teske, B., Urias, Y., Young, S., Dreyer, R. F., Daniel, H., Connaughton, M., Handelman, I., Hobbs, S., Hoerner, C., Hudson, D., Kopfer, M., Lee, M., Lemley, C., Logan, J., Ma, C., Mallet, C., Milliron, A., Peters, M., Wohlsein, H., Pearlman, J. A., Andrews, M., Bartlett, M., Carlson, N., Cox, E., Equi, R., Gonzalez, M., Griffin, S., Hogue, F., Kennedy, L., Kryuchkov, L., Lopez, C., Lopez, D., Luevano, B., McKenna, E., Patel, A., Reed, B., Secor, N., Sison, I. R., Tsai, T., Varghis, N., Waller, B., Wendel, R., Yebra, R., Roth, D. B., Deinzer, J., Fine, H., Green, F., Green, S., Keyser, B., Leff, S., Leviton, A., Martir, A., Mosenthine, K., Muscle, S., Okoren, L., Parker, S., Prenner, J., Price, N., Rogers, D., Rosas, L., Schlosser, A., Studenko, L., Tantum, T., Wheatley, H., Trese, M. T., Aaberg, T., Bezaire, D., Bridges, C., Bryant, D., Capone, A., Coleman, M., Consolo, C., Cook, C., DuLong, C., Garretson, B., Grooten, T., Hammersley, J., Hassan, T., Jessick, H., Jones, N., Kinsman, C., Krumlauf, J., Lewis, S., Locke, H., Margherio, A., Markus, D., Marsh, T., Neal, S., Noffke, A., Oh, K., Pence, C., Preston, L., Raphaelian, P., Regan, V. R., Roberts, P., Ruby, A., Sarrafizadeh, R., Scherf, M., Scott, S., Sneed, S., Staples, L., Terry, B., Trese, M. T., Videtich, J., Williams, G., Zajechowski, M., Joseph, D. P., Blinder, K., Buckley, L. B., Crow, M., Dinatale, A., Engelbrecht, N., Forke, B., Gabel, D., Grand, G., Grillion-Cerone, J., Holekamp, N., Kelly, C., Nobe, G., Pepple, K., Raeber, M., Kumar Rao, P., Ressel, T., Schremp, S., Sgorlon, M., Shears, S., Thomas, M., Timma, C., Vaughn, A., Walters, C., Weeks, R., Wehmeier, J., Wright, T., Berinstein, D. M., Ayyad, A., Barazi, M. K., Bickhart, E., Byank, L., Cronise, A., Denny, V., Dunn, C., Flory, M., Frantz, R., Garfinkel, R. A., Gilbert, W., Lai, M. M., Melamud, A., Newgen, J., Newton, S., Oliver, D., Osman, M., Sanders, R., Fricken, M. v., Dugel, P., Arenas, S., Balea, G., Bartoli, D., Bucci, J., Cornelius, J. A., Dickens, S., Dunlap, D. D., Goldenberg, D., Jamal, K., Jimenez, N., Kavanagh, N., Kunimoto, D., Martin, J., Miner, J., Mobley, S., Park, D., Quinlan, E., Sipperley, J., Slagle, C., Smith, D., Yager, R., Flaxel, C. J., Bailey, S., Francis, P., Howell, C., Hwang, T., Ira, S., Klein, M., Lauer, A., Liesegang, T., Lundquist, A., Nolte, S., Nolte, S. K., Pickell, S., Pope, S., Rossi, J., Schain, M., Steinkamp, P., Toomey, M. D., Vahrenwald, D., West, K., Hubbard, B., Andelman, S., Bergstrom, C., Brower, J., Cribbs, B., Curtis, L., Dobbs, J., DuBois, L., Gaultney, J., Gibbs, D., Jordan, D., Leef, D., Martin, D. F., Myles, R., Olsen, T., Schwent, B., Srivastava, S., Waldron, R., Antoszyk, A. N., Balasubramaniam, U., Brooks, D., Brown, J., Browning, D., Clark, L., Ennis, S., Helms, J. V., Herby, J., Karow, A., Leotaud, P., Massimino, C., McClain, D., McOwen, M., Mindel, J., Pereira, C., Pierce, R., Powers, M., Price, A., Rohrer, J., Sanders, J., Avery, R. L., Avery, K., Basefsky, J., Beckner, L., Castellarin, A., Couvillion, S., Giust, J., Giust, M., Nasir, M., Pieramici, D., Rabena, M., Risard, S., See, R., Smith, J., Bakri, S. J., Abu-Yaghi, N., Barkmeier, A., Berg, K., Burrington, J., Edwards, A., Goddard, S., Howard, S., Iezzi, R., Lewison, D., Link, T., McCannel, C. A., Overend, J., Pach, J., Ruszczyk, M., Shultz, R., Stephan, C., Vogen, D., Bradford, R. H., Bergman, V., Burris, R., Butt, A., Daniels, B., Dwiggins, C., Fransen, S., Guerrero, T., Haivala, D., Harris, A., Icks, S., Kingsley, R., Richmond, R., Ross, B., White, K., Youngberg, M., Topping, T. M., Bennett, S., Chong, S., Cleary, T., Corey, E., Donovan, D., Frederick, A., Freese, L., Graham, M., Gud, N., Howard, T., Jones, M., Morley, M., Moses, K., Stone, J., Ty, R., Wiegand, T., Williams, L., Winder, B., Awh, C. C., Arrindell, E., Beck, D., Busbee, B., Dilback, A., Downs, S., Guidry, A., Gutow, G., Hardin, J., Hines, S., Hutchins, E., LaCivita, K., Lester, A., Malott, L., McCain, M., Miracle, J., Moffat, K., Palazzotta, L., Robinson, K., Sonkin, P., Travis, A., Wallace, R., Winters, K. J., Wray, J., Harris, A. E., Bunnell, M., Crooks, K., Fitzgerald, R., Javid, C., Kew, C., Kill, E., Kline, P., Kreienkamp, J., Moore, R., Saavedra, E., Taylor, L., Walsh, M., Wilson, L., Ciulla, T. A., Coyle, E., Harrington, T., Harris, C., Maturi, R., Morrow, S., Savage, J., Sink, B., Steele, T., Thukral, N., Wilburn, J., Walker, J. P., Banks, J., Ciampaglia, D., Dyshanowitz, D., Frederick, J., Tom Ghuman, A., Grodin, R., Kiesel, C., Knips, E., Peters, C., Raskauskas, P., Schoeman, E., Sharma, A., Wing, G., Chandra, S. R., Altaweel, M., Blodi, B., Burke, K., Dietzman, K. A., Gottlieb, J., Knutson, G., Krolnik, D., Michael Nork, T., Olson, S., Peterson, J., Reed, S., Soderling, B., Somers, G., Stevens, T., Wealti, A., Bearelly, S., Branchaud, B., Bryant, J. W., Crowell, S., Fekrat, S., Gammage, M., Harrison, C., Jones, S., McClain, N., McCuen, B., Mruthyunjaya, P., Queen, J., Sarin, N., Skalak, C., Skelly, M., Suner, I., Tomany, R., Welch, L., Park, S. S., Cassidy, A., Chandra, K., Good, I., Imson, K., Kaur, S., Metzler, H., Morse, L., Redenbo, E., Salvador, M., Telander, D., Thomas, M., Wallace, C., Barr, C. C., Battcher, A., Bottorff, M., Chasteen, M., Clark, K., Denning, D., Schultz, A., Tempel, E., Whittington, G. K., Stone, T. W., Blevins, T., Buck, M., Cruz, L., Heath, W., Holcomb, D., Isernhagen, R., Kidd, T., Kitchens, J., Sears, C., Slade, E., Arsdall, J. V., VanHoose, B., Wolfe, J., Wood, W., Zilis, J., Crooks, C., Disney, L., Liu, M., Petty, S., Sall, S., Folk, J. C., Aly, T., Brotherton, A., Critser, D., Hinz, C. J., Karakas, S., Lester, C., Montague, C., Russell, S., Stockman, H., Taylor, B., Verdick, R., Thompson, J. T., Connell, B., Constantine, M., Davis, J. L., Holsapple, G., Hunter, L., Nicki Lenane, C., Mitchell, R., Russel, L., Sjaarda, R., Brown, D. M., Benz, M., Burns, L., Carranza, J. G., Fish, R., Goates, D., Hay, S., Jeffers, T., Kegley, E., Kubecka, D., McGilvra, S., Richter, B., Sneed, V., Stoever, C., Tellez, I., Wong, T., Kim, I., Barresi, C. A., Brett, S., Callahan, C., Capaccioli, K., Carli, W., Coppola, M., Emmanuel, N., Evans, C., Fagan, A., Grillo, M., Head, J., Kieser, T., Lord, U., Miretsky, E., Palitsch, K., Petrin, T., Reader, L., Reznichenko, S., Robertson, M., Vavvas, D., Wells, J., Cahill, C., Lloyd Clark, W., Henry, K., Johnson, D., Miller, P., Oliver, L., Spivey, R., Taylor, M., Lambert, M., Chase, K., Fredrickson, D., Khawly, J., Lazarte, V., Lowd, D., Miller, P., Willis, A., Ferrone, P. J., Almonte, M., Arnott, R., Aviles, I., Carbon, S., Chitjian, M., DAmore, K., Elliott, C., Fastenberg, D., Golub, B., Graham, K., Lavorna, A., Murphy, L., Palomo, A., Puglisi, C., Rhee, D., Romero, J., Rosenblatt, B., Salcedo, G., Schlameuss, M., Shakin, E., Sookhai, V., Kaiser, R., Affel, E., Brown, G., Centinaro, C., Fine, D., Fineman, M., Formoso, M., Garg, S., Grande, L., Herbert, C., Ho, A., Hsu, J., Jay, M., Lavetsky, L., Liebenbaum, E., Maguire, J., Monsonego, J., O'Connor, L., Regillo, C., Rosario, M., Spirn, M., Vander, J., Walsh, J., Davidorf, F. H., Barnett, A., Chang, S., Christoforidis, J., Elliott, J., Justice, H., Letson, A., McKinney, K., Perry, J., Salerno, J. A., Savage, S., Shelley, S., Lawrence, J., Coney, S. J., DuBois, J., DuBois, K., Greanoff, G., Himmelman, D., Ilc, M., Mcnamara, E., Novak, M., Pendergast, S., Rath, S., Brewe, S. S., Tanner, V., Weiss, D. E., Zegarra, H., Halperin, L., Aramayo, P., Dhalla, M., Fernandez, B., Fernandez, C., Lopez, J., Lopez, M., Mariano, J., Murphy, K., Sherley, C., Veksler, R., Rahhal, F., Babikian, R., Boyer, D., Hami, S., Kessinger, J., Kurokouchi, J., Mukarram, S., Pachman, S., Protacio, E., Sierra, J., Tabandeh, H., Zamboni, A., Elman, M., Butcher, T., Cain, T., Coffey, T., Firestone, D., Gore, N., Singletary, P., Sotirakos, P., Starr, J., Meredith, T. A., Barnhart, C. J., Cantrell, D., Leon, R. E., Houghton, O., Kaur, H., Ndure, F., Glatzer, R., Joffe, L., Schindler, R., Martin, D. F., Fine, S. L., Katz, M., Maguire, M. G., Brightwell-Arnold, M., Glaser, R., Hall, J., Harkins, S., Huang, J., Khvatov, A., McWilliams, K., Nolte, S. K., Peskin, E., Pistilli, M., Ryan, S., Schnader, A., Ying, G., Jaffe, G., Afrani-Sakyi, J., Balsley, B., Bennett, L. S., Brooks, A., Brower-Lingsch, A., Bruce, L., Burns, R., Busian, D., Choong, J., Cloaninger, L., DeCroos, F. C., DuBois, E., El-Dairi, M., Gach, S., Hall, K., Hawks, T., Huang, C., Heydary, C., Ho, A., Kini, S., McCall, M., Muhammad, D., Nicholson, J., Queen, J., Rieves, P., Shields, K., Skalak, C., Specker, A., Stinnett, S., Subramaniam, S., Tenbrink, P., Toth, C., Towe, A., Welch, K., Williams, N., Winter, K., Young, E., Grunwald, J. E., Alexander, J., Daniel, E., Flannagan, E., Revell Martin, E., Parker, C., Sepielli, K., Shannon, T., Whearry, C., Redford, M., Martin, D. F., Avery, R. L., Bakri, S. J., Daniel, E., Fine, S. L., Grunwald, J. E., Jaffe, G., Kopfer, M. R., Maguire, M. G., Meredith, T. A., Peskin, E., Redford, M., Williams, D. F., Martin, D. F., Bennett, L. S., Daniel, E., Ferris, F. L., Fine, S. L., Grunwald, J. E., Jaffe, G., Maguire, M. G., Peskin, E., Redford, M., Toth, C., Peskin, E., Brightwell-Arnold, M., DuPont, J., Maguire, M. G., McWilliams, K., Nolte, S. K., Friedman, L. M., Bressler, S. B., DeMets, D. L., Friedlander, M., Johnson, M. W., Lindblad, A., Losordo, D. W., Miller, F. G. 2022

  Abstract

  BACKGROUND: Thiazolidinediones, commonly used antidiabetic medications, have been associated with an increased risk of development of diabetic macular oedema and increased vascular endothelial cell permeability. Macular neovascularisation in age-related macular degeneration (AMD) and associated fluid leakage may be influenced by thiazolidinediones. This study aims to determine the association between thiazolidinedione usage and retinal morphological outcomes or visual acuity (VA) in patients treated with bevacizumab or ranibizumab for neovascular AMD (nAMD).METHODS: Secondary analysis of data from the Comparison of Age-related Macular Degeneration Treatments Trials. Participant self-reported diabetes status and thiazolidinedione usage at baseline. VA, intraretinal, subretinal and subretinal pigment epithelium fluid, and foveal thickness of retinal layers were evaluated at baseline and during 2-year follow-up. Comparisons of outcomes between thiazolidinedione usage groups were adjusted by macular neovascularisation lesion type in multivariable regression models.RESULTS: Patients taking thiazolidinedione (n=30) had lower adjusted mean VA score at baseline (difference -6.2 letters; p=0.02), greater proportion with intraretinal fluid (IRF) at year 2 (75% vs 50%, adjusted OR 2.8; p=0.04), greater mean decrease in subretinal tissue complex thickness from baseline at year 1 (difference -75.1um; p=0.02) and greater mean decrease in subretinal thickness at year 1 (difference -41.9um; p=0.001) and year 2 (difference -43.3um; p=0.001).CONCLUSIONS: In this exploratory analysis, patients with diabetes taking thiazolidinediones and treated with bevacizumab or ranibizumab for nAMD had worse baseline mean VA, greater reductions in subretinal and subretinal tissue complex thickness from baseline, and greater proportions with IRF comparing to patients not taking thiazolidinediones.TRIAL REGISTRATION NUMBER: ClinicalTrials.gov NCT00593450.

  View details for DOI 10.1136/bjophthalmol-2021-320665

  View details for PubMedID 35428655

• Preferentially Expressed Antigen in Melanoma Immunohistochemistry Labeling in Uveal Melanomas. Ocular oncology and pathology Ahmadian, S. S., Dryden, I. J., Naranjo, A., Toland, A., Cayrol, R. A., Born, D. E., Egbert, P. S., Brown, R. A., Mruthyunjaya, P., Lin, J. H. 2022; 8 (2): 133-140

  Abstract

  Uveal melanoma (UM) is the most common primary intraocular malignancy in adults, and despite treatment of the primary tumor, approximately 15%-50% of patients will develop metastatic disease. Based on gene expression profiling (GEPs), UM can be categorized as Class 1A (low metastatic risk), Class 1B (intermediate metastatic risk), or Class 2 (high metastatic risk). PReferentially expressed Antigen in MElanoma (PRAME) status is an independent prognostic UM biomarker and a potential target for immunotherapy in metastatic UM. PRAME expression status can be detected in tumors using reverse-transcription polymerase chain reaction (RT-PCR). More recently, immunohistochemistry (IHC) has been developed to detect PRAME protein expression. Here, we employed both techniques to evaluate PRAME expression in 18 UM enucleations.Tumor material from the 18 UM patients who underwent enucleation was collected by fine-needle aspiration before or during enucleation and sent for GEP and PRAME analysis by RT-PCR. Histologic sections from these patients were stained with an anti-PRAME monoclonal antibody. We collected patient demographics and tumor characteristics and included this with our analysis of GEP class, PRAME status by RT-PCR, and PRAME status by IHC. PRAME IHC and RT-PCR results were compared.Twelve males (12/18) and 6 females (6/18) with an average age of 60.6 years underwent enucleation for UM. TNM staging of the UM diagnosed Stage I in 2 patients (2/18), Stage II in 7 patients (7/18), Stage III in 8 patients (8/18), and Stage IV in 1 (1/18). GEP was Class 1A in 6 tumors (6/18), Class 1B in 6 tumors (6/18), and Class 2 in 6 tumors (6/18). PRAME IHC showed diffusely positive labeling of all UM cells in 2/18 enucleations; negative IHC labeling of UM cells in 9/18 enucleations; and IHC labeling of subsets of UM cells in 7/18 enucleations. Eleven of the 17 UMs tested for PRAME by both RT-PCR and IHC had consistent PRAME results. In the remaining 6/17 cases tested by both modalities, PRAME results were discordant between RT-PCR and IHC.We find that PRAME IHC distinguishes PRAME-positive and PRAME-negative UM tumor cells. Interestingly, IHC reveals focal PRAME expression in subsets of tumor cells consistent with tumor heterogeneity. PRAME RT-PCR and IHC provide concordant results in most of our cases. We suggest that discordance in PRAME results could arise from spatial or temporal variation in PRAME expression between tumor cells. Further studies are required to determine the prognostic implications of PRAME IHC in UM.

  View details for DOI 10.1159/000524051

  View details for PubMedID 35959159

  View details for PubMedCentralID PMC9218614

• Displacement of submacular hemorrhage with intravitreal tissue plasminogen activator following 27 gauge transvitreal fine needle aspiration biopsy for choroidal melanoma. American journal of ophthalmology case reports Narala, R., Bodnar, Z., Mruthyunjaya, P. 2022; 25: 101320

  Abstract

  Purpose: To describe the management of submacular hemorrhage (SMH), a vision threatening complication following transvitreal choroidal biopsy, with intravitreal tissue plasminogen activator (tPA) and pure perfluoropropane (C3F8) gas bubble injection.Observations: A 53 year old female with choroidal melanoma of the left eye underwent iodine-125 plaque brachytherapy placement and 27 gauge transvitreal fine needle aspiration choroidal biopsy for gene expression profiling. On postoperative day 2, large SMH was identified on dilated fundus examination. At the time of plaque brachytherapy removal, intravitreal tPA and pure C3F8 gas bubble injection with post operative positioning was also performed to attempt displacement of SMH. At postoperative month 1 following tPA and gas bubble displacement, the SMH was completely displaced inferotemporally outside of the macula and visual acuity improved from 20/70 at postoperative week 1 to 20/25 at postoperative month 1.Conclusions and importance: Subretinal hemorrhage can be a complication of transvitreal choroidal tumor biopsy but early detection and prompt treatment can result in good visual outcomes.

  View details for DOI 10.1016/j.ajoc.2022.101320

  View details for PubMedID 35243131

• Bilateral Serpiginous-Like Chorioretinitis Associated with Ciliochoroidal Melanoma: A Clinicopathologic Correlation. Retina (Philadelphia, Pa.) Al-Moujahed, A., Lin, J. H., Gagnon, M. R., Pulido, J., Mruthyunjaya, P., Jung, J. J. 2022

  Abstract

  PURPOSE: To report the clinicopathologic correlation of a case of bilateral serpiginous-like chorioretinitis (SLC) associated with unilateral ciliochoroidal melanoma.METHODS: A 71-year-old white female was diagnosed with progressive SLC in both eyes (OU) associated with ciliochoroidal melanoma in the right eye (OD). Clinical findings and imaging before and after enucleation OD were correlated to histologic and immunohistochemistry sections.RESULTS: Examination and imaging identified a peripheral bilobed amelanotic lesion with low reflectivity on B-scan ultrasound with an associated exudative detachment OD. Additionally, multiple areas of new SLC lesions in the macula and peripapillary region OD and along the inferior arcade in the left eye (OS) were observed. Oncologic evaluation confirmed a Class 2, ciliochoroidal melanoma, and the eye was enucleated. Autoimmune and infectious laboratory evaluation for the etiology of the SLC lesions were negative. Histopathology of the enucleated eye confirmed the diagnosis of uveal melanoma with lymphocytic inflammation at the edges of the tumor itself and in the areas of discrete SLC lesions. Immunohistochemistry identified similar predominantly cluster of differentiation (CD)3 and CD8 T-cells and fewer CD20 B-cells in both regions.CONCLUSION: Serpiginous-like chorioretinitis may present as a paraneoplastic, predominantly T-lymphocyte inflammation associated with intraocular tumor such as uveal melanoma.

  View details for DOI 10.1097/IAE.0000000000003435

  View details for PubMedID 35174798

• Proteomics in uveal melanoma. Current opinion in ophthalmology Heiferman, M. J., Mahajan, V. B., Mruthyunjaya, P. 1800

  Abstract

  PURPOSE OF REVIEW: This article reviews the latest proteomic research on uveal melanoma.RECENT FINDINGS: Proteomic analysis of uveal melanoma cell lines and tissue specimens has improved our understanding of the pathophysiology of uveal melanoma and helped identify potential prognostic biomarkers. Circulating proteins in patient serum may aid in the surveillance of metastatic disease. The proteomes of aqueous and vitreous biopsy specimens may provide safer biomarkers for metastatic risk and candidate therapeutic targets in uveal melanoma. Proteomic analysis has the potential to benefit patient outcomes by improving diagnosis, prognostication, surveillance, and treatment of uveal melanoma.SUMMARY: These recent findings demonstrate that proteomic analysis is an important area of research to better understand the pathophysiology of uveal melanoma and improve the personalized management of our patients.

  View details for DOI 10.1097/ICU.0000000000000835

  View details for PubMedID 35102096

• The Effect of Obstructive Sleep Apnea Treatment and Severity on Choroidal Thickness in Patients With Central Serous Chorioretinopathy JOURNAL OF VITREORETINAL DISEASES Azad, A. D., Davila, J. R., Rayess, N., Cao, M., Mruthyunjaya, P., Pan, C. K. 2022; 6 (1): 22-30

  View details for DOI 10.1177/24741264211009677

  View details for Web of Science ID 000904815900004

• Impact of Early COVID-19 Pandemic on Common Ophthalmic Procedures Volumes: A US Claims-Based Analysis. Ophthalmic epidemiology Azad, A. D., Mishra, K., Lee, E. B., Chen, E., Nguyen, A., Parikh, R., Mruthyunjaya, P. 1800: 1-9

  Abstract

  PURPOSE: The COVID-19 pandemic has had a profound effect on the delivery of healthcare in the United States and globally. The aim of this study was to evaluate the impact of COVID-19 on common ophthalmic procedure utilization and normalization to pre-pandemic daily rates.METHODS: Leveraging a national database, Clinformatics DataMart (OptumInsight, Eden Prairie, MN), procedure frequencies and daily averages, defined by Current Procedural Terminology codes, of common elective and non-elective procedures within multiple ophthalmology sub-specialties were calculated. Interrupted time-series analysis with a Poisson regression model and smooth spline functions was used to model trends in pre-COVID-19 (January 1, 2018-February 29, 2020) and COVID-19 (March 1, 2020-June 30, 2020) periods.RESULTS: Of 3,583,231 procedures in the study period, 339,607 occurred during the early COVID-19 time period. Anti-vascular endothelial growth factor injections (44,412 to 39,774, RR 1.01, CI 0.99-1.02; p =.212), retinal detachment repairs (1,290 to 1,086, RR 1.07, CI 0.99-1.15; p =.103), and glaucoma drainage implants/trabeculectomies (706 to 487, RR 0.93, CI 0.83-1.04; p =.200) remained stable. Cataract surgery (61,421 to 33,054, RR 0.77; CI 0.76-0.78; p <.001), laser peripheral iridotomy (1,875 to 890, RR 0.82, CI 0.76-0.88; p <.001), laser trabeculoplasty (2,680 to 1,753, RR 0.79, CI 0.74-0.84; p <.001), and blepharoplasty (1,522 to 797, RR 0.71, CI 0.66-0.77; p <.001) all declined significantly. All procedures except laser iridotomy returned to pre-COVID19 rates by June 2020.CONCLUSION: Most ophthalmic procedures that significantly declined during the COVID-19 pandemic were elective procedures. Among these, the majority returned to 2019 daily averages by June 2020.

  View details for DOI 10.1080/09286586.2021.2015394

  View details for PubMedID 34935591

• Intravitreal Pharmacotherapies for Diabetic Macular Edema: A Report by the American Academy of Ophthalmology. Ophthalmology Ehlers, J. P., Yeh, S., Maguire, M. G., Smith, J. R., Mruthyunjaya, P., Jain, N., Kim, L. A., Weng, C. Y., Flaxel, C. J., Schoenberger, S. D., Kim, S. J. 2021

  Abstract

  PURPOSE: To review the evidence on the safety and efficacy of current anti-vascular endothelial growth factor (VEGF) and intravitreal corticosteroid pharmacotherapies for the treatment of diabetic macular edema (DME).METHODS: Literature searches were last conducted on May 13, 2020, in the PubMed database with no date restrictions and limited to articles published in English. The combined searches yielded 230 citations, of which 108 were reviewed in full text. Of these, 31 were deemed appropriate for inclusion in this assessment and were assigned a level of evidence rating by the panel methodologist.RESULTS: Only the 21 articles with level I evidence were included in this assessment. Seventeen articles provided level I evidence for 1 or more anti-VEGF pharmacotherapies, including ranibizumab (14), aflibercept (5), and bevacizumab (2) alone or in combination with other treatments for DME. Level I evidence was identified in 7 articles on intravitreal corticosteroid therapy for treatment of DME: triamcinolone (1), dexamethasone (4), and fluocinolone acetonide (2).CONCLUSIONS: Review of the available literature indicates that intravitreal injections of anti-VEGF agents and corticosteroids are efficacious treatments for DME. Elevated intraocular pressure and cataract progression are important potential complications of corticosteroid therapy. Further evidence is required to assess the comparative efficacy of these therapies. Given the limited high-quality comparative efficacy data, choice of therapy must be individualized for each patient and broad therapeutic access for patients is critical to maximize outcomes.

  View details for DOI 10.1016/j.ophtha.2021.07.009

  View details for PubMedID 34446301

• Discontinuation and loss to follow-up rates in clinical trials of intravitreal anti-vascular endothelial growth factor injections. Graefe's archive for clinical and experimental ophthalmology = Albrecht von Graefes Archiv fur klinische und experimentelle Ophthalmologie Rosenblatt, T. R., Rayess, N., Al-Moujahed, A., Khurana, R. N., Mruthyunjaya, P. 2021

  Abstract

  PURPOSE: Clinical trials are often designed to include homogenous, highly specific patient populations with many resources to reduce patient dropout. Results may not translate to real-world settings. We evaluated discontinuation and loss to follow-up (LTFU) rates in clinical trials of anti-vascular endothelial growth factor (anti-VEGF) injections for diabetic macular edema (DME), age-related macular degeneration (AMD), and retinal vein occlusion (RVO).METHODS: Retrospective meta-epidemiological study. The authors queried ClinicalTrials.gov for all completed trials of anti-VEGF injections for DME, AMD, or RVO. Of 658 trials identified, 582 were excluded for being non-interventional, <100 patients, terminating early, or missing study results. The remaining 76 trials of 27,823 patients were analyzed for discontinuation and LTFU rates.RESULTS: Mean discontinuation rate was 12.44% (SD 8.12%, range 0-54.12%), with higher rates among control (18.87%) than treatment arms (10.78%, p = .006). Mean LTFU rate was 1.84% (SD 1.78%, range 0-7.76%), with no differences by disease, treatment type, or treatment frequency.CONCLUSION: Discontinuation rates of major intravitreal anti-VEGF clinical trials were highly variable, suggesting even trials struggle with overall patient retention. Though trial LTFU rates were low, real-world outcomes may differ due to higher reported LTFU rates, which should be considered when extrapolating trial results to clinical practice.

  View details for DOI 10.1007/s00417-021-05246-5

  View details for PubMedID 34415363

• Comparing clinical outcomes of macular hole surgeries performed by trainee surgeons using a 3D heads-up display viewing system versus a standard operating microscope. International ophthalmology Reddy, S., Mallikarjun, K., Mohamed, A., Mruthyunjaya, P., Dave, V. P., Pappuru, R. R., Chhablani, J., Narayanan, R. 2021

  Abstract

  PURPOSE: To compare the surgical outcomes of macular hole (MH) surgery performed by trainee surgeons using a three-dimensional heads-up display (3D HUD) versus a standard operating microscope (SOM).MATERIALS AND METHODS: A retrospective review of all consecutive medical records patients operated on for MHs by a trainee surgeon between 2017 and 2020 using either 3D HUD or SOM was performed. Minimum hole diameter, maximum hole diameter, total surgical time, and MH closure rates were compared between the two groups. MH retinal detachments, traumatic MHs, and MHs for which inverted internal limiting membrane flaps were used were excluded from the study.RESULTS: Trainee surgeons operated on 51 patients using 3D HUD and 63 patients using SOM. Age at presentation, intraocular pressure (IOP) at diagnosis, maximum hole diameter, minimum hole diameter, surgical time, duration between diagnosis and surgery were comparable between both groups. MH closure rate was significantly (p<0.004) higher in the 3D HUD group (n=44, 86.3%) than that of the SOM group (n=38, 60.3%). There were no postoperative adverse events such as glaucoma or retinal detachment in either group. Other than the viewing technique, there were no significant variables associated with MH closure in the two groups.CONCLUSION: Surgeries conducted by trainee surgeons using 3D HUD had higher MH closure rates than those using SOM.

  View details for DOI 10.1007/s10792-021-01792-3

  View details for PubMedID 34184150

• Comparison of PRAME antigen detection by Immunohistochemistry (IHC) and polymerase chain reaction (PCR) in Uveal Melanoma Naranjo, A., Ahmadian, S. S., Toland, A., Cayrol, R., Egbert, P. R., Born, D., Mruthyunjaya, P., Brown, R., Lin, J. H. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2021

  View details for Web of Science ID 000690761600101

• Clinical characteristics and gene expression profile status in young patients with uveal melanoma: Collaborative Ocular Oncology Group study #2 (COOG2) study Semenova, E., Decatur, C., Schefler, A., Aaberg, T., Marr, B., Correa, Z., Harbour, J., Mruthyunjaya, P., Materin, M. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2021

  View details for Web of Science ID 000690760500040

• Revisit rates and associated costs after emergency room encounters for ophthalmic conditions Azad, A., Chen, E., Parikh, R., Erickson, B., Mruthyunjaya, P. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2021

  View details for Web of Science ID 000690760500685

• A comparison of utilization and costs of fluocinolone acetonide and dexamethasone intravitreal implants for the treatment of non-infectious uveitis: A cross sectional study Park, J., Hwang, B., Al Moujahed, A., Azad, A. D., Huy Nguyen, Srivastava, S. K., Mruthyunjaya, P. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2021

  View details for Web of Science ID 000690761100500

• Medical Malpractice Lawsuits Involving Ophthalmology Trainees OPHTHALMOLOGY Watane, A., Kalavar, M., Chen, E. M., Mruthyunjaya, P., Cavuoto, K. M., Sridhar, J., Parikh, R. 2021; 128 (6): 938-942

  View details for Web of Science ID 000687323600025

• Design, Methods, and Rationale for the Collaborative Ocular Oncology Group 2 (COOG2) Study Schefler, A. C., Mruthyunjaya, P., Decatur, C., Materin, M., Correa, Z., Aaberg, T., Marr, B., Semenova, K., Harbour, J. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2021

  View details for Web of Science ID 000690761600108

• Discontinuation and Loss to Follow-Up Rates in Clinical Trials of Intravitreal AntiVascular Endothelial Growth Factor Injections Rosenblatt, T., Rayess, N., Al Moujahed, A., Mruthyunjaya, P. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2021

  View details for Web of Science ID 000690760500170

• Medical Malpractice Lawsuits Involving Ophthalmology Trainees OPHTHALMOLOGY Watane, A., Kalavar, M., Chen, E. M., Mruthyunjaya, P., Cavuoto, K. M., Sridhar, J., Parikh, R. 2021; 128 (6): 938-942

  View details for Web of Science ID 000654913100027

• Reply to Comment on: The Effect of Obstructive Sleep Apnea on Absolute Risk of Central Serous Chorioretinopathy AMERICAN JOURNAL OF OPHTHALMOLOGY Pan, C. K., Vail, D., Bhattacharya, J., Cao, M., Mruthyunjaya, P. 2021; 226: 271-272

  View details for Web of Science ID 000674592100031

• Trends in Anti-Vascular Endothelial Growth Factor Agents and Panretinal Photocoagulation Use in Diabetic Retinopathy OPHTHALMOLOGY RETINA Azad, A. D., Chen, E. M., Hinkle, J., Rayess, N., Wu, D., Eliott, D., Mruthyunjaya, P., Parikh, R. 2021; 5 (4): 390-392

  View details for Web of Science ID 000664195400018

• Comparison of PRAME Immunohistochemistry (IHC) and PRAME RT-PCR in 14 Uveal Melanomas Ahmadian, S., Toland, A., Cayrol, R., Egbert, P., Born, D., Brown, R., Lin, J., Mruthyunjaya, P. SPRINGERNATURE. 2021: 1020

  View details for Web of Science ID 000629690900847

• Comparison of PRAME Immunohistochemistry (IHC) and PRAME RT-PCR in 14 Uveal Melanomas Ahmadian, S., Toland, A., Cayrol, R., Egbert, P., Born, D., Brown, R., Lin, J., Mruthyunjaya, P. SPRINGERNATURE. 2021: 1020

  View details for Web of Science ID 000629694102184

• Liquid biopsy proteomics of uveal melanoma reveals biomarkers associated with metastatic risk. Molecular cancer Velez, G., Nguyen, H. V., Chemudupati, T., Ludwig, C. A., Toral, M., Reddy, S., Mruthyunjaya, P., Mahajan, V. B. 2021; 20 (1): 39

  View details for DOI 10.1186/s12943-021-01336-4

  View details for PubMedID 33627107

• Response criteria for intraocular retinoblastoma: RB-RECIST. Pediatric blood & cancer Berry, J. L., Munier, F. L., Gallie, B. L., Polski, A., Shah, S., Shields, C. L., Gombos, D. S., Ruchalski, K., Stathopoulos, C., Shah, R., Jubran, R., Kim, J. W., Mruthyunjaya, P., Marr, B. P., Wilson, M. W., Brennan, R. C., Chantada, G. L., Chintagumpala, M. M., Murphree, A. L. 2021: e28964

  Abstract

  Standardized guidelines for assessing tumor response to therapy are essential for designing and conducting clinical trials. The Response Evaluation Criteria In Solid Tumors (RECIST) provide radiological standards for assessment of solid tumors. However, no such guidelines exist for the evaluation of intraocular cancer, and ocular oncology clinical trials have largely relied on indirect measures of therapeutic response-such as progression-free survival-to evaluate the efficacy of treatment agents. Herein, we propose specific criteria for evaluating treatment response of retinoblastoma, the most common pediatric intraocular cancer, and emphasize a multimodal imaging approach for comprehensive assessment of retinoblastoma tumors in clinical trials.

  View details for DOI 10.1002/pbc.28964

  View details for PubMedID 33624399

• Do Racial/Ethnic Disparities in Rates of Enucleation for Uveal Melanoma Indicate Poor Quality of Care or Financial Obstacles?-Reply. JAMA ophthalmology Zubair, T., Rajeshuni, N., Mruthyunjaya, P. 2021

  View details for DOI 10.1001/jamaophthalmol.2020.6831

  View details for PubMedID 33570551

• Reply to Comment on: The Effect of Obstructive Sleep Apnea on Absolute Risk of Central Serous Chorioretinopathy. American journal of ophthalmology Pan, C. K., Vail, D., Bhattacharya, J., Cao, M., Mruthyunjaya, P. 2021

  View details for DOI 10.1016/j.ajo.2021.01.016

  View details for PubMedID 33567302

• White Paper on Ophthalmic Imaging for Choroidal Nevus Identification and Transformation into Melanoma. Translational vision science & technology Shields, C. L., Lally, S. E., Dalvin, L. A., Sagoo, M. S., Pellegrini, M., Kaliki, S., Gündüz, A. K., Furuta, M., Mruthyunjaya, P., Fung, A. T., Duker, J. S., Selig, S. M., Yaghy, A., Ferenczy, S. R., Eydelman, M. B., Blumenkranz, M. S. 2021; 10 (2): 24

  Abstract

  To discuss the evolution of noninvasive diagnostic methods in the identification of choroidal nevus and determination of risk factors for malignant transformation as well as introduce the novel role that artificial intelligence (AI) can play in the diagnostic process.White paper.Longstanding diagnostic methods to stratify benign choroidal nevus from choroidal melanoma and to further determine the risk for nevus transformation into melanoma have been dependent on recognition of key clinical features by ophthalmic examination. These risk factors have been derived from multiple large cohort research studies over the past several decades and have garnered widespread use throughout the world. More recent publications have applied ocular diagnostic testing (fundus photography, ultrasound examination, autofluorescence, and optical coherence tomography) to identify risk factors for the malignant transformation of choroidal nevus based on multimodal imaging features. The widespread usage of ophthalmic imaging systems to identify and follow choroidal nevus, in conjunction with the characterization of malignant transformation risk factors via diagnostic imaging, presents a novel path to apply AI.AI applied to existing ophthalmic imaging systems could be used for both identification of choroidal nevus and as a tool to aid in earlier detection of transformation to malignant melanoma.Advances in AI models applied to ophthalmic imaging systems have the potential to improve patient care, because earlier detection and treatment of melanoma has been proven to improve long-term clinical outcomes.

  View details for DOI 10.1167/tvst.10.2.24

  View details for PubMedID 34003909

• White Paper on Ophthalmic Imaging for Choroidal Nevus Identification and Transformation into Melanoma TRANSLATIONAL VISION SCIENCE & TECHNOLOGY Shields, C. L., Lally, S. E., Dalvin, L. A., Sagoo, M. S., Pellegrini, M., Kaliki, S., Gunduz, A., Furuta, M., Mruthyunjaya, P., Fung, A. T., Duker, J. S., Selig, S. M., Yaghy, A., Ferenczy, S. R., Eydelman, M. B., Blumenkranz, M. S. 2021; 10 (2)

  View details for DOI 10.1167/tvst.10.2.24

  View details for Web of Science ID 000632914000006

• Single-Blind and Double-Blind Peer Review: Effects on National Representation. Seminars in ophthalmology Kalavar, M. n., Watane, A. n., Wu, D. n., Sridhar, J. n., Mruthyunjaya, P. n., Parikh, R. n. 2021: 1–6

  Abstract

  Purpose: To assess whether the type of peer-review (single-blinded vs double-blinded) has an impact on nationality representation in journals.Methods: A cross-sectional study analyzing the top 10 nationalities contributing to the number of articles across 16 ophthalmology journals.Results: There was no difference in the percentage of articles published from the journal's country of origin between the top single-blind journals and double-blind journals (SB = 42.0%, DB = 26.6%, p = .49), but there was a significant difference between the percentage of articles from the US (SB = 48.0%, DB = 22.8%, p = .02). However, there was no difference for both country of origin (SB = 38.0%, DB = 26.6%, p = .43) and articles from the US (SB = 35.0%, DB = 22.8%, p = .21) when assessing the top eight double-blind journals matched with single-blind journals of a similar impact factor. The US (n = 16, 100%) and England (n = 16, 100%) most commonly made the top 10 lists for article contribution. This held true even for journals established outside the United States (US=11/12, England = 11/12).Conclusions: There was no significant difference in country-of-origin representation between single-blind journals and double-blind journals. However, higher income countries contributed most often to the journals studied even among journals based outside the US.

  View details for DOI 10.1080/08820538.2021.1896757

  View details for PubMedID 33760687

• Multiple genetically distinct uveal melanomas arise in the same eye of two patients with melanosis oculiUnilateral multifocal uveal melanoma in melanosis oculi. American journal of ophthalmology Wagley, S., Belin, P. J., Dollar, J. J., Harbour, J. W., Maltry, A. C., Mruthyunjaya, P., Schefler, A. C., Tang, P. H. 2021

  Abstract

  To determine whether unilateral multifocal uveal melanomas (UM) in the setting of ocular melanosis (melanosis oculi) represent genetically independent tumors.Clinical case series.Two patients with unilateral multifocal UM in the setting of melanosis oculi were included. Tumors were evaluated for gene expression profile (GEP) and next generation sequencing (NGS) for uveal melanoma-associated mutations. Histopathologic analysis of enucleated specimens was also performed when available.Patients were both female, ages 73 and 83 years. In Patient #1, the tumors both exhibited Class 2 GEP but each harbored a unique BAP1 mutation. In Patient #2, one tumor was Class 1 and harbored an SF3B1 mutation, whereas the other tumor was Class 2 and harbored a BAP1 mutation.Unilateral multifocal UM in the setting of melanosis oculi can arise due to the development of genetically independent primary tumors, which is detectable based on the mutation profile of each tumor. This is the first report of genetically-confirmed independent primary tumors in the setting of unilateral multifocal UM.

  View details for DOI 10.1016/j.ajo.2021.06.037

  View details for PubMedID 34283976

• Medical Malpractice Lawsuits Involving Ophthalmology Trainees. Ophthalmology Watane, A., Kalavar, M., Chen, E. M., Mruthyunjaya, P., Cavuoto, K. M., Sridhar, J., Parikh, R. 2020

  Abstract

  Improper informed consent, delayed evaluation, incorrect diagnosis or treatment, trainee inexperience, and improper supervision were the primary allegations in ophthalmic malpractice cases involving trainees.

  View details for DOI 10.1016/j.ophtha.2020.10.013

  View details for PubMedID 33068616

• Rationale for American Society of Retina Specialists Best Practice Recommendations for Conducting Vitreoretinal Surgery during the COVID-19 Era. Journal of vitreoretinal diseases Chao, D. L., Sridhar, J., Kuriyan, A. E., Leng, T., Barnett, B. P., Carlin, A. F., Wykoff, C. C., Gayer, S., Mruthyunjaya, P., Yonekawa, Y., Fawzi, A. A., Berrocal, A. M., Yeh, S., Ting, D., Modi, Y., Zacks, D. N., Yannuzzi, N., Afshari, N. A., Murray, T. 2020; 4 (5): 420-429

  Abstract

  Purpose: To detail the rationale behind recommendations recently published by the American Society of Retina Specialists (ASRS) outlining best practices for safety of vitreoretinal surgeons and staff while performing vitreoretinal surgery during the coronavirus disease (COVID)-19 pandemic.Methods: The committee for ASRS Best Practices for Retinal Surgery during the COVID-19 Pandemic reviewed existing evidence and information on SARS-CoV-2 transmission, and risk factors during vitreoretinal surgery. Recommendations were based on best available published data, cumulative clinical experiences, and recommendations and policies from other organizations. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to assess the strength of recommendations and confidence in the evidence. These serve as interim recommendations which are routinely updated given gaps of knowledge and lack of high-quality data on this evolving subject.Results: Relevant existing literature related to methods of transmission, and ocular manifestations of SARS-CoV-2 are summarized. The data and clinical experiences driving recommendations for pre-operative, intraoperative and post-operative surgical considerations, anesthesia choice, as well as considerations for intravitreal injections are provided.Conclusion: Recommendations are provided with the goal of protecting vitreoretinal surgeons and associated personnel from exposure to SARS-CoV-2 during interventional vitreoretinal procedures. This is a rapidly evolving topic with numerous remaining gaps in our current knowledge. As such, recommendations will evolve and the current manuscript is intended to serve as a foundation for continued dialogue on best practices.

  View details for DOI 10.1177/2474126420941707

  View details for PubMedID 34222758

• Reply to Comment on: Racial, Ethnic, and Socioeconomic Disparities in Retinoblastoma Enucleation: A Population-Based Study, SEER 18 2000-2014 AMERICAN JOURNAL OF OPHTHALMOLOGY Rajeshuni, N., Whittemore, A. S., Ludwig, C. A., Mruthyunjaya, P., Moshfeghi, D. M. 2020; 217: 351

  View details for Web of Science ID 000574918000040

• The Collaborative Ocular Oncology Group study number 2: A prospective multi-center evaluation of uveal melanoma prognostic biomarkers Decatur, C. L., Durante, M. A., Correa, Z. M., Aaberg, T. M., Mruthyunjaya, P., Schefler, A. C., Harbour, J. AMER ASSOC CANCER RESEARCH. 2020

  View details for DOI 10.1158/1538-7445.AM2020-5442

  View details for Web of Science ID 000590059301405

• Anti-Vascular Endothelial Growth Factor and Panretinal Photocoagulation Use After Protocol S for Proliferative Diabetic Retinopathy. Ophthalmology. Retina Azad, A. D., Chen, E. M., Hinkle, J., Rayess, N., Wu, D., Eliott, D., Mruthyunjaya, P., Parikh, R. 2020

  Abstract

  PURPOSE: To characterize the rates of pan-retinal laser photocoagulation (PRP) and anti-vascular endothelial growth factor (anti-VEGF) medications before and after publication of the DRCR.net Protocol S.DESIGN: A retrospective, cross-sectional study from January 1, 2012 to September 30, 2019 using a nationally representative claims-based database, Clinformatics Data Mart Database (OptumInsight, Eden Prairie, MN). Subjects, Participants, and/or Controls: Eyes newly diagnosed with proliferative diabetic retinopathy (PDR), continuous enrollment, and no prior treatment with PRP or anti-VEGF. Methods, Intervention, or Testing: Interrupted time series regression analysis was performed to identify the annual change in treatment rates before and after the publication of Protocol S (November 24, 2015).MAIN OUTCOME MEASURES: Annual rates of anti-VEGF or PRP treatments per 1,000 treated eyes with PDR.RESULTS: From 2012 to 2019, 10035 PRP or anti-VEGF treatments were given to 3685 PDR eyes. 63.6% (6379) of these were anti-VEGF agents and 36.4% (3656) were PRP treatments. 88.7% of eyes treated with anti-VEGF received the same agent throughout treatment and 7.7% were treated with both PRP and anti-VEGF agents. PRP rates declined from 784/1,000 treated eyes in 2012 to 566/1,000 in 2019 (pre-Protocol S: beta = -32 vs. post-Protocol S: beta = -77, p=0.005) while anti-VEGF rates increased from 876/1000 in 2012 to 1583/1000 in 2019 (beta = -48 vs. beta = 161, p=0.001). PRP rates in DME eyes did not significantly change from 474/1000 in 2012 to 363/1000 in 2019 (beta = -9 vs. beta = -58, p=0.091), but anti-VEGF rates increased significantly from 1533/1000 in 2012 to 2096/1000 in 2019 (beta = -57 vs. beta = 187, p=0.043). In eyes without DME, PRP use declined from 1017/1000 in 2012 to 707/1000 in 2019 (beta = -31 vs. beta = -111, p<0.001) and anti-VEGF use increased from 383/1000 in 2012 to 1226/1000 in 2019 (beta = -48 vs. beta = 140, p<0.001).CONCLUSIONS: Following the publication of Protocol S, PRP rates decreased while anti-VEGF rates increased largely from increases in bevacizumab use. PRP rates significantly declined among eyes without DME. Our findings indicate the impact that randomized controlled trials can have on real-world practice patterns.

  View details for DOI 10.1016/j.oret.2020.07.018

  View details for PubMedID 32693033

• Reply to Comment on: Racial, Ethnic, and Socioeconomic Disparities in Retinoblastoma Enucleation: A Population-Based Study, SEER 18 2000-2014. American journal of ophthalmology Rajeshuni, N., Whittemore, A. S., Ludwig, C. A., Mruthyunjaya, P., Moshfeghi, D. M. 2020

  View details for DOI 10.1016/j.ajo.2020.04.038

  View details for PubMedID 32660706

• Evaluation of Racial, Ethnic, and Socioeconomic Associations With Treatment and Survival in Uveal Melanoma, 2004-2014. JAMA ophthalmology Rajeshuni, N., Zubair, T., Ludwig, C. A., Moshfeghi, D. M., Mruthyunjaya, P. 2020

  Abstract

  Importance: Identifying disparities in uveal melanoma (UM) treatment patterns and survival across racial, ethnic, and socioeconomic (SES) groups reveals possible inequities in ophthalmologic health care.Objective: To examine the association of race, ethnicity, and SES with UM treatment and survival.Design, Setting, and Participants: A retrospective cohort analysis of 28% of the US population using the Surveillance, Epidemiology, and End Results (SEER) 18 registries from January 1, 2004, to December 31, 2014, was conducted. Data analysis was performed from April to July 2018. SEER identified 4475 individuals using International Classification of Diseases for Oncology, Third Edition site and morphology codes.Exposures: Race, ethnicity, and SES estimated by tertile using Yost Index composite scores.Main Outcomes and Measures: Treatment odds ratios (ORs), 1-year and 5-year survival estimates, mortality hazard ratios (HRs), and Kaplan-Meier survival curves. Hypothesis was formulated before data collection.Results: Multivariate analyses of 4475 individuals (2315 [51.7%] men; non-Hispanic white, 4130 [92.3%]; nonwhite, 345 [7.7%]) showed that patients who were nonwhite (OR, 1.45; 95% CI, 1.12-1.88) and socioeconomically disadvantaged (lower SES: OR, 2.21; 95% CI, 1.82-2.68; middle SES: OR, 1.86; 95% CI, 1.56-2.21) were more likely to receive primary enucleation. No interactions were observed between race/ethnicity, SES, and stage at diagnosis. From 2004 to 2014, rates of primary enucleation decreased across all racial/ethnic and SES groups, but disparities persisted. Socioeconomically disadvantaged patients had lower 5-year all-cause survival rates (lower SES: 69.2%; middle SES: 68.1%; and upper SES: 73.8%), although disease-specific survival did not vary significantly by racial/ethnic or SES strata. Mortality risk was associated with older age at diagnosis (56-68 years: HR, 1.70; 95% CI, 1.44-2.01; ≥69 years: HR, 3.32; 95% CI, 2.85-3.86), advanced stage of UM (stage 2: HR, 1.40; 95% CI, 1.19-1.65; stage 3: HR, 2.26; 95% CI, 1.87-2.73; and stage 4: HR, 10.09; 95% CI, 7.39-13.77), and treatment with primary enucleation (HR, 2.14; 95% CI, 1.88-2.44) with no racial/ethnic or SES variation.Conclusions and Relevance: In this study, SEER data from 2004 to 2014 suggest that nonwhite and socioeconomically disadvantaged patients with UM are more likely to be treated with primary enucleation, although no such variation appears to exist in disease-specific survival. These differences reveal opportunities to address issues regarding treatment choice in UM.

  View details for DOI 10.1001/jamaophthalmol.2020.2254

  View details for PubMedID 32614376

• Error in Author Name JAMA OPHTHALMOLOGY Vail, D., Pan, C. K., Mruthyunjaya, P. 2020; 138 (7): 803

  View details for DOI 10.1001/jamaophthalmol.2020.1841

  View details for Web of Science ID 000552116800019

  View details for PubMedID 32437508

  View details for PubMedCentralID PMC7243159

• Impact of Obstructive Sleep Apnea Treatment on Choroidal Thickness in Patients with Central Serous Chorioretinopathy Davila, J., Azar, A., Pasricha, M. V., Al-Moujahed, A., Mruthyunjaya, P., Pan, C. K. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2020

  View details for Web of Science ID 000554528301035

• A Phase 1b/2 Open-label Clinical Trial to Evaluate the Safety and Efficacy of AU-011 for the Treatment of Choroidal Melanoma Mruthyunjaya, P., Schefler, A. C., Kim, I. K., Bergstrom, C., Demirci, H., Tsai, T., Bhavsar, A. R., Capone, A., Marr, B., McCannel, T. A., Javid, C., Hovland, P. G., Seider, M. I., Rich, C., Shields, C. L. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2020

  View details for Web of Science ID 000554528302237

• Interim analysis of small choroidal melanocytic tumors with and without identifiable driver mutations Weis, E., Mruthyunjaya, P., Schefler, A. C., Correa, Z., Aaberg, T. M., Durante, M., Decatur, C., Harbour, J. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2020

  View details for Web of Science ID 000554528300098

• Proliferative diabetic retinopathy treatment trends following the Diabetic Retinopathy Clinical Research Network Protocol S trial: A US claims-based analysis Hinkle, J. W., Azad, A., Chen, E., Rayess, N., Mruthyunjaya, P., Parikh, R. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2020

  View details for Web of Science ID 000554528304145

• Global Retinoblastoma Presentation and Analysis by National Income Level JAMA ONCOLOGY Fabian, I., Abdallah, E., Abdullahi, S. U., Abdulqader, R. A., Boubacar, S., Ademola-Popoola, D. S., Adio, A., Afshar, A. R., Aggarwal, P., Aghaji, A. E., Ahmad, A., Akib, M. R., Al Harby, L., Al Ani, M. H., Alakbarova, A., Portabella, S., Al-Badri, S. F., Alcasabas, A. A., Al-Dahmash, S. A., Alejos, A., Alemany-Rubio, E., Bio, A., Carreras, Y., Al-Haddad, C., Al-Hussaini, H. Y., Ali, A. M., Alia, D. B., Al-Jadiry, M. F., Al-Jumaly, U., Alkatan, H. M., All-Eriksson, C., Al-Mafrachi, A. M., Almeida, A. A., Alsawidi, K. M., Al-Shaheen, A. M., Al-Shammary, E. H., Amiruddin, P. O., Antonino, R., Astbury, N. J., Atalay, H. T., Atchaneeyasakul, L., Atsiaya, R., Attaseth, T., Aung, T. H., Ayala, S., Baizakova, B., Balaguer, J., Balayeva, R., Balwierz, W., Barranco, H., Bascaran, C., Popovic, M., Benavides, R., Benmiloud, S., Guebessi, N., Berete, R. C., Berry, J. L., Bhaduri, A., Bhat, S., Biddulph, S. J., Biewald, E. M., Bobrova, N., Boehme, M., Boldt, H. C., Bonanomi, M. C., Bornfeld, N., Bouda, G. C., Bouguila, H., Boumedane, A., Brennan, R. C., Brichard, B. G., Buaboonnam, J., Calderon-Sotelo, P., Calle Jara, D. A., Camuglia, J. E., Cano, M. R., Capra, M., Cassoux, N., Castela, G., Castillo, L., Catala-Mora, J., Chantada, G. L., Chaudhry, S., Chaugule, S. S., Chauhan, A., Chawla, B., Chernodrinska, V. S., Chiwanga, F. S., Chuluunbat, T., Cieslik, K., Cockcroft, R. L., Comsa, C., Correa, Z. M., Correa Llano, M. G., Corson, T. W., Cowan-Lyn, K. E., Csoka, M., Cui, X., Da Gama, I., Dangboon, W., Das, A., Das, S., Davanzo, J. M., Davidson, A., De Potter, P., Delgado, K. Q., Demirci, H., Desjardins, L., Diaz Coronado, R. Y., Dimaras, H., Dodgshun, A. J., Donaldson, C., Donato Macedo, C. R., Dragomir, M. D., Du, Y., Du Bruyn, M., Edison, K. S., Sutyawan, I., El Kettani, A., Elbahi, A. M., Elder, J. E., Elgalaly, D., Elhaddad, A. M., Elhassan, M., Elzembely, M. M., Essuman, V. A., Evina, T. A., Fadoo, Z., Fandino, A. C., Faranoush, M., Fasina, O., Fernandez, D. G., Fernandez-Teijeiro, A., Foster, A., Frenkel, S., Fu, L. D., Fuentes-Alabi, S. L., Gallie, B. L., Gandiwa, M., Garcia, J. L., Garcia Aldana, D., Gassant, P. Y., Geel, J. A., Ghassemi, F., Giron, A., Gizachew, Z., Goenz, M. A., Gold, A. S., Goldberg-Lavid, M., Gole, G. A., Gomel, N., Gonzalez, E., Gonzalez Perez, G., Gonzalez-Rodriguez, L., Garcia Pacheco, H. N., Graells, J., Green, L., Gregersen, P. A., Grigorovski, N. K., Guedenon, K. M., Gunasekera, D., Gunduz, A. K., Gupta, H., Gupta, S., Hadjistilianou, T., Hamel, P., Hamid, S. A., Hamzah, N., Hansen, E. D., Harbour, J., Hartnett, M., Hasanreisoglu, M., Hassan, S., Hassan, S., Hederova, S., Hernandez, J., Carcamo Hernandez, L., Hessissen, L., Hordofa, D. F., Huang, L. C., Hubbard, G. B., Hummlen, M., Husakova, K., Al-Janabi, A., Ida, R., Ilic, V. R., Jairaj, V., Jeeva, I., Jenkinson, H., Ji, X., Jo, D., Johnson, K. P., Johnson, W. J., Jones, M. M., Kabesha, T., Kabore, R. L., Kaliki, S., Kalinaki, A., Kantar, M., Kao, L., Kardava, T., Kebudi, R., Kepak, T., Keren-Froim, N., Khan, Z. J., Khaqan, H. A., Khauv, P., Kheir, W. J., Khetan, V., Khodabande, A., Khotenashvili, Z., Kim, J. W., Kim, J., Kiratli, H., Kivela, T. T., Klett, A., Palet, J., Krivaitiene, D., Kruger, M., Kulvichit, K., Kuntorini, M. W., Kyara, A., Lachmann, E. S., Lam, C. S., Lam, G. C., Larson, S. A., Latinovic, S., Laurenti, K. D., Le, B. A., Lecuona, K., Leverant, A. A., Li, C., Limbu, B., Quah Boon Long, Lopez, J. P., Lukamba, R. M., Lumbroso, L., Luna-Fineman, S., Lutfi, D., Lysytsia, L., Magrath, G. N., Mahajan, A., Majeed, A., Maka, E., Makan, M., Makimbetov, E. K., Manda, C., Martin Begue, N., Mason, L., Mason, J. O., Matende, I. O., Materin, M., Mattosinho, C. S., Matua, M., Mayet, I., Mbumba, F. B., McKenzie, J. D., Medina-Sanson, A., Mehrvar, A., Mengesha, A. A., Menon, V., Mercado, G. D., Mets, M. B., Midena, E., Mishra, D. C., Mndeme, F. G., Mohamedani, A. A., Mohammad, M. T., Moll, A. C., Montero, M. M., Morales, R. A., Moreira, C., Mruthyunjaya, P., Msina, M. S., Msukwa, G., Mudaliar, S. S., Muma, K., Munier, F. L., Murgoi, G., Murray, T. G., Musa, K. O., Mushtaq, A., Mustak, H., Muyen, O. M., Naidu, G., Nair, A., Naumenko, L., Roth, P., Nency, Y. M., Neroev, V., Ngo, H., Nieves, R. M., Nikitovic, M., Nkanga, E. D., Nkumbe, H., Nuruddin, M., Nyaywa, M., Obono-Obiang, G., Oguego, N. C., Olechowski, A., Oliver, S. N., Osei-Bonsu, P., Ossandon, D., Paez-Escamilla, M. A., Pagarra, H., Painter, S. L., Paintsil, V., Paiva, L., Pal, B. P., Palanivelu, M., Papyan, R., Parrozzani, R., Parulekar, M., Morales, C., Paton, K. E., Pawinska-Wasikowska, K., Pe'er, J., Pena, A., Peric, S., Pham, C. M., Philbert, R., Plager, D. A., Pochop, P., Polania, R. A., Polyakov, V. G., Pompe, M. T., Pons, J. J., Prat, D., Prom, V., Purwanto, I., Qadir, A. O., Qayyum, S., Qian, J., Rahman, A., Rahman, S., Rahmat, J., Rajkarnikar, P., Ramanjulu, R., Ramasubramanian, A., Ramirez-Ortiz, M. A., Raobela, L., Rashid, R., Reddy, M., Reich, E., Renner, L. A., Reynders, D., Ribadu, D., Riheia, M. M., Ritter-Sovinz, P., Rojanaporn, D., Romero, L., Roy, S. R., Saab, R. H., Saakyan, S., Sabhan, A. H., Sagoo, M. S., Said, A. A., Saiju, R., Salas, B., San Roman Pacheco, S., Sanchez, G. L., Sayalith, P., Scanlan, T. A., Schefler, A. C., Schoeman, J., Sedaghat, A., Seregard, S., Seth, R., Shah, A. S., Shakoor, S. A., Sharma, M. K., Sherief, S. T., Shetye, N. G., Shields, C. L., Siddiqui, S., Cheikh, S., Silva, S., Singh, A. D., Singh, N., Singh, U., Singha, P., Sitorus, R. S., Skalet, A. H., Soebagjo, H. D., Sorochynska, T., Ssali, G., Stacey, A. W., Staffieri, S. E., Stahl, E. D., Stathopoulos, C., Kranjc, B., Stones, D. K., Strahlendorf, C., Suarez, M., Sultana, S., Sun, X., Sundy, M., Superstein, R., Supriyadi, E., Surukrattanaskul, S., Suzuki, S., Svojgr, K., Sylla, F., Tamamyan, G., Tan, D., Tandili, A., Tarrillo Leiva, F. F., Tashvighi, M., Tateshi, B., Tehuteru, E. S., Teixeira, L. F., Teh, K., Theophile, T., Toledano, H., Trang, D. L., Traore, F., Trichaiyaporn, S., Tuncer, S., Tyau-Tyau, H., Umar, A. B., Unal, E., Uner, O. E., Urbak, S. F., Ushakova, T. L., Usmanov, R. H., Valeina, S., Wijsard, M., Varadisai, A., Vasquez, L., Vaughan, L. O., Veleva-Krasteva, N. V., Verma, N., Victor, A. A., Viksnins, M., Villacos Chafla, E. G., Vishnevskia-Dai, V., Vora, T., Wachtel, A. E., Wackernagel, W., Waddell, K., Wade, P. D., Wali, A. H., Wang, Y., Weiss, A., Wilson, M. W., Wime, A. C., Wiwatwongwana, A., Wiwatwongwana, D., Dod, C., Wongwai, P., Xiang, D., Xiao, Y., Yam, J. C., Yang, H., Yanga, J. M., Yaqub, M. A., Yarovaya, V. A., Yarovoy, A. A., Ye, H., Yousef, Y. A., Yuliawati, P., Zapata Lopez, A. M., Zein, E., Zhang, C., Zhang, Y., Zhao, J., Zheng, X., Zhilyaeva, K., Zia, N., Ziko, O. O., Zondervan, M., Bowman, R., Global Retinoblastoma Study Grp 2020; 6 (5): 685–95

  View details for Web of Science ID 000536236800012

• Practice Patterns for the Treatment of Uveal Melanoma with Iodine-125 Plaque Brachytherapy: Ocular Oncology Study Consortium Report 5 OCULAR ONCOLOGY AND PATHOLOGY Binder, C., Mruthyunjaya, P., Schefler, A. C., Seider, M. I., Crilly, R., Hung, A., Meltsner, S., Mowery, Y., Kirsch, D. G., Teh, B. S., Jennelle, R. S., Studenski, M. T., Liu, W., Lee, C., Hayman, J. A., Kastner, B., Hadsell, M., Skalet, A. H., Ocular Oncology Study Consortium 2020; 6 (3): 210–18

  View details for DOI 10.1159/000504312

  View details for Web of Science ID 000533504400010

• Vitelliform Vitreoretinopathy: Clinical Implications of the Vitreomacular Interface. Oman journal of ophthalmology Garcia, G. A., Tang, P. H., Pan, C. K., Mruthyunjaya, P. 2020; 13 (2): 100–101

  Abstract

  Pathologies of the vitreomacular interface are implicated in a variety of sight-threatening clinical entities. The authors present a photo essay of a case of Terson syndrome with a striking premacular dehemoglobinized hemorrhage with ovoid morphology. This unique "vitelliform" finding highlights the distinct structure of the premacular vitreous space and its important implications in both health and disease.

  View details for DOI 10.4103/ojo.OJO_214_2019

  View details for PubMedID 32792808

• Practice Patterns for the Treatment of Uveal Melanoma with Iodine-125 Plaque Brachytherapy: Ocular Oncology Study Consortium Report 5. Ocular oncology and pathology Binder, C., Mruthyunjaya, P., Schefler, A. C., Seider, M. I., Crilly, R., Hung, A., Meltsner, S., Mowery, Y., Kirsch, D. G., Teh, B. S., Jennelle, R. L., Studenski, M. T., Liu, W., Lee, C., Hayman, J. A., Kastner, B., Hadsell, M., Skalet, A. H. 2020; 6 (3): 210-218

  Abstract

  Treatment planning for I-125 plaque therapy for uveal melanoma has advanced significantly since the Collaborative Ocular Melanoma Study trial, with more widely available image-guided planning and improved dosimetry.We evaluated real-world practice patterns for I-125 plaque brachytherapy in the United States by studying practice patterns at centers that comprise the Ocular Oncology Study Consortium (OOSC).The OOSC database and responses to a treatment practice survey were evaluated. The database contains treatment information from 9 institutions. Patients included in the database were treated between 2010 and 2014. The survey was conducted in 2018 and current treatment planning methods and prescriptions were queried.Examination of the OOSC database revealed that average doses to critical structures were highly consistent, with the exception of one institution. Survey responses indicated that most centers followed published guidelines regarding dose and prescription point. Dose rate ranged from 51 to 118 cGy/h. As of 2018, most institutions use pre-loaded plaques and fundus photographs and/or computed tomography or magnetic resonance imaging in planning.While there were differences in dosimetric practices, overall agreement in plaque brachytherapy practices was high among OOSC institutions. Clinical margins and planning systems were similar among institutions, while prescription dose, dose rates, and dosimetry varied.

  View details for DOI 10.1159/000504312

  View details for PubMedID 32509767

  View details for PubMedCentralID PMC7250354

• Ophthalmic Medication Expenditures and Out-of-pocket Spending: An analysis of US prescriptions from 2007-2016. Ophthalmology Chen, E. M., Kombo, N., Teng, C. C., Mruthyunjaya, P., Nwanyanwu, K., Parikh, R. 2020

  Abstract

  OBJECTIVE: To estimate temporal trends in total and out-of-pocket (OOP) expenditures for ophthalmic prescription medications among adults in the United States.DESIGN: A retrospective longitudinal cohort study.PARTICIPANTS: Participants in the 2007-2016 Medical Expenditure Panel Survey (MEPS), age 18 years or older. The MEPS is a nationally representative survey of the noninstitutionalized, civilian US population.METHODS: We estimated trends in national and per capita annual ophthalmic prescription expenditures by pooling data into 2-year cycles and using weighted linear regressions. We also identified characteristics associated with greater total or OOP expenditure with multivariable weighted linear regression. Costs were adjusted to 2016 US dollars using the Gross Domestic Product Price Index.MAIN OUTCOME MEASURES: Trends in total and OOP annual expenditures for ophthalmic medications from 2007-2016 as well as factors associated with greater expenditure.RESULTS: From 2007-2016, 9,989 (4.2%) MEPS participants reported ophthalmic medication prescription use. Annual ophthalmic medication utilization increased from 10.0 to 12.2 million individuals from 2007-2008 to 2015-2016. In this same time period, national expenditures for ophthalmic medications increased from $3.39 billion to $6.08 billion and OOP expenditures decreased from $1.34 to $1.18 billion. While the average number of ophthalmic prescriptions filled did not change over the study period (4.2, p=0.10), the average expenditure per prescription increased significantly from $72.30 to $116.42 (p<0.001). Per capita expenditure increased from $338.72 to $499.42 (p<0.001) and per capita OOP expenditure decreased from $133.48 to $96.67 (p<0.001) from 2007-2008 to 2015-2016 respectively. In 2015-2016, dry eye (29.5%) and glaucoma (42.7%) medications accounted for 72.2% of all ophthalmic medication expenditures. Patients who were older than 65 (p<0.001), uninsured (p<0.001), and visually impaired (p<0.001) were significantly more likely to have greater OOP spending on ophthalmic medications.CONCLUSION: Total ophthalmic medication expenditure in the United States increased significantly over the last decade while OOP expenses decreased. Increases in coverage, copayment assistance and utilization of expensive brand drugs may be contributing to these trends. Policy makers and physicians should be aware that rising overall drug expenditures may ultimately increase indirect costs to the patient and offset a decline in OOP prescription drug spending.

  View details for DOI 10.1016/j.ophtha.2020.04.037

  View details for PubMedID 32359935

• Considerations for the Management and Triage of Ocular Oncology Cases during the COVID-19 Pandemic. Ocular oncology and pathology Skalet, A. H., Allen, R. C., Shields, C. L., Wilson, M. W., Mruthyunjaya, P., Gombos, D. S. 2020; 6 (3): 1–4

  View details for DOI 10.1159/000507734

  View details for PubMedID 32411697

• Anti-Vascular Endothelial Growth Factor Therapy for Radiation Retinopathy Rayess, N., Mruthyunjaya, P. SLACK INC. 2020: S44–S49

  Abstract

  The purpose of this article is to review the role of anti-vascular endothelial growth factor (VEGF) therapy in treating patients with radiation retinopathy (RR).RR can be associated with a significant decrease in visual acuity (VA) related to the development of cystoid macular edema, macular ischemia, and proliferative retinopathy leading to neovascular glaucoma.Anti-VEGF therapy is effective at stabilizing VA in around 80% of patients and achieving reductions in central macular thickness when it is administered using a constant algorithm. Furthermore, consistent prophylactic anti-VEGF therapy reduces the risk of development of RR, neovascularization of the iris, and neovascularization glaucoma.Future studies are needed to determine the optimal regimen for anti-VEGF therapy according to patient risk factors and likelihood of developing RR. [Ophthalmic Surg Lasers Imaging Retina. 2020;51:S44-S49.].

  View details for DOI 10.3928/23258160-20200401-06

  View details for Web of Science ID 000565848800006

  View details for PubMedID 32348534

• Global Retinoblastoma Presentation and Analysis by National Income Level. JAMA oncology Global Retinoblastoma Study Group, Fabian, I. D., Abdallah, E., Abdullahi, S. U., Abdulqader, R. A., Adamou Boubacar, S., Ademola-Popoola, D. S., Adio, A., Afshar, A. R., Aggarwal, P., Aghaji, A. E., Ahmad, A., Akib, M. N., Al Harby, L., Al Ani, M. H., Alakbarova, A., Portabella, S. A., Al-Badri, S. A., Alcasabas, A. P., Al-Dahmash, S. A., Alejos, A., Alemany-Rubio, E., Alfa Bio, A. I., Alfonso Carreras, Y., Al-Haddad, C., Al-Hussaini, H. H., Ali, A. M., Alia, D. B., Al-Jadiry, M. F., Al-Jumaly, U., Alkatan, H. M., All-Eriksson, C., Al-Mafrachi, A. A., Almeida, A. A., Alsawidi, K. M., Al-Shaheen, A. A., Al-Shammary, E. H., Amiruddin, P. O., Antonino, R., Astbury, N. J., Atalay, H. T., Atchaneeyasakul, L., Atsiaya, R., Attaseth, T., Aung, T. H., Ayala, S., Baizakova, B., Balaguer, J., Balayeva, R., Balwierz, W., Barranco, H., Bascaran, C., Beck Popovic, M., Benavides, R., Benmiloud, S., Bennani Guebessi, N., Berete, R. C., Berry, J. L., Bhaduri, A., Bhat, S., Biddulph, S. J., Biewald, E. M., Bobrova, N., Boehme, M., Boldt, H. C., Bonanomi, M. T., Bornfeld, N., Bouda, G. C., Bouguila, H., Boumedane, A., Brennan, R. C., Brichard, B. G., Buaboonnam, J., Calderon-Sotelo, P., Calle Jara, D. A., Camuglia, J. E., Cano, M. R., Capra, M., Cassoux, N., Castela, G., Castillo, L., Catala-Mora, J., Chantada, G. L., Chaudhry, S., Chaugule, S. S., Chauhan, A., Chawla, B., Chernodrinska, V. S., Chiwanga, F. S., Chuluunbat, T., Cieslik, K., Cockcroft, R. L., Comsa, C., Correa, Z. M., Correa Llano, M. G., Corson, T. W., Cowan-Lyn, K. E., Csoka, M., Cui, X., Da Gama, I. V., Dangboon, W., Das, A., Das, S., Davanzo, J. M., Davidson, A., De Potter, P., Delgado, K. Q., Demirci, H., Desjardins, L., Diaz Coronado, R. Y., Dimaras, H., Dodgshun, A. J., Donaldson, C., Donato Macedo, C. R., Dragomir, M. D., Du, Y., Du Bruyn, M., Edison, K. S., Eka Sutyawan, I. W., El Kettani, A., Elbahi, A. M., Elder, J. E., Elgalaly, D., Elhaddad, A. M., Elhassan, M. M., Elzembely, M. M., Essuman, V. A., Evina, T. G., Fadoo, Z., Fandino, A. C., Faranoush, M., Fasina, O., Fernandez, D. D., Fernandez-Teijeiro, A., Foster, A., Frenkel, S., Fu, L. D., Fuentes-Alabi, S. L., Gallie, B. L., Gandiwa, M., Garcia, J. L., Garcia Aldana, D., Gassant, P. Y., Geel, J. A., Ghassemi, F., Giron, A. V., Gizachew, Z., Goenz, M. A., Gold, A. S., Goldberg-Lavid, M., Gole, G. A., Gomel, N., Gonzalez, E., Gonzalez Perez, G., Gonzalez-Rodriguez, L., Garcia Pacheco, H. N., Graells, J., Green, L., Gregersen, P. A., Grigorovski, N. D., Guedenon, K. M., Gunasekera, D. S., Gunduz, A. K., Gupta, H., Gupta, S., Hadjistilianou, T., Hamel, P., Hamid, S. A., Hamzah, N., Hansen, E. D., Harbour, J. W., Hartnett, M. E., Hasanreisoglu, M., Hassan, S., Hassan, S., Hederova, S., Hernandez, J., Hernandez, L. M., Hessissen, L., Hordofa, D. F., Huang, L. C., Hubbard, G. B., Hummlen, M., Husakova, K., Hussein Al-Janabi, A. N., Ida, R., Ilic, V. R., Jairaj, V., Jeeva, I., Jenkinson, H., Ji, X., Jo, D. H., Johnson, K. P., Johnson, W. J., Jones, M. M., Kabesha, T. B., Kabore, R. L., Kaliki, S., Kalinaki, A., Kantar, M., Kao, L., Kardava, T., Kebudi, R., Kepak, T., Keren-Froim, N., Khan, Z. J., Khaqan, H. A., Khauv, P., Kheir, W. J., Khetan, V., Khodabande, A., Khotenashvili, Z., Kim, J. W., Kim, J. H., Kiratli, H., Kivela, T. T., Klett, A., Komba Palet, J. E., Krivaitiene, D., Kruger, M., Kulvichit, K., Kuntorini, M. W., Kyara, A., Lachmann, E. S., Lam, C. P., Lam, G. C., Larson, S. A., Latinovic, S., Laurenti, K. D., Le, B. H., Lecuona, K., Leverant, A. A., Li, C., Limbu, B., Long, Q. B., Lopez, J. P., Lukamba, R. M., Lumbroso, L., Luna-Fineman, S., Lutfi, D., Lysytsia, L., Magrath, G. N., Mahajan, A., Majeed, A. R., Maka, E., Makan, M., Makimbetov, E. K., Manda, C., Martin Begue, N., Mason, L., Mason, J. O., Matende, I. O., Materin, M., Mattosinho, C. C., Matua, M., Mayet, I., Mbumba, F. B., McKenzie, J. D., Medina-Sanson, A., Mehrvar, A., Mengesha, A. A., Menon, V., Mercado, G. J., Mets, M. B., Midena, E., Mishra, D. K., Mndeme, F. G., Mohamedani, A. A., Mohammad, M. T., Moll, A. C., Montero, M. M., Morales, R. A., Moreira, C., Mruthyunjaya, P., Msina, M. S., Msukwa, G., Mudaliar, S. S., Muma, K. I., Munier, F. L., Murgoi, G., Murray, T. G., Musa, K. O., Mushtaq, A., Mustak, H., Muyen, O. M., Naidu, G., Nair, A. G., Naumenko, L., Ndoye Roth, P. A., Nency, Y. M., Neroev, V., Ngo, H., Nieves, R. M., Nikitovic, M., Nkanga, E. D., Nkumbe, H., Nuruddin, M., Nyaywa, M., Obono-Obiang, G., Oguego, N. C., Olechowski, A., Oliver, S. C., Osei-Bonsu, P., Ossandon, D., Paez-Escamilla, M. A., Pagarra, H., Painter, S. L., Paintsil, V., Paiva, L., Pal, B. P., Palanivelu, M. S., Papyan, R., Parrozzani, R., Parulekar, M., Pascual Morales, C. R., Paton, K. E., Pawinska-Wasikowska, K., Pe'er, J., Pena, A., Peric, S., Pham, C. T., Philbert, R., Plager, D. A., Pochop, P., Polania, R. A., Polyakov, V. G., Pompe, M. T., Pons, J. J., Prat, D., Prom, V., Purwanto, I., Qadir, A. O., Qayyum, S., Qian, J., Rahman, A., Rahman, S., Rahmat, J., Rajkarnikar, P., Ramanjulu, R., Ramasubramanian, A., Ramirez-Ortiz, M. A., Raobela, L., Rashid, R., Reddy, M. A., Reich, E., Renner, L. A., Reynders, D., Ribadu, D., Riheia, M. M., Ritter-Sovinz, P., Rojanaporn, D., Romero, L., Roy, S. R., Saab, R. H., Saakyan, S., Sabhan, A. H., Sagoo, M. S., Said, A. M., Saiju, R., Salas, B., San Roman Pacheco, S., Sanchez, G. L., Sayalith, P., Scanlan, T. A., Schefler, A. C., Schoeman, J., Sedaghat, A., Seregard, S., Seth, R., Shah, A. S., Shakoor, S. A., Sharma, M. K., Sherief, S. T., Shetye, N. G., Shields, C. L., Siddiqui, S. N., Sidi Cheikh, S., Silva, S., Singh, A. D., Singh, N., Singh, U., Singha, P., Sitorus, R. S., Skalet, A. H., Soebagjo, H. D., Sorochynska, T., Ssali, G., Stacey, A. W., Staffieri, S. E., Stahl, E. D., Stathopoulos, C., Stirn Kranjc, B., Stones, D. K., Strahlendorf, C., Suarez, M. E., Sultana, S., Sun, X., Sundy, M., Superstein, R., Supriyadi, E., Surukrattanaskul, S., Suzuki, S., Svojgr, K., Sylla, F., Tamamyan, G., Tan, D., Tandili, A., Tarrillo Leiva, F. F., Tashvighi, M., Tateshi, B., Tehuteru, E. S., Teixeira, L. F., Teh, K. H., Theophile, T., Toledano, H., Trang, D. L., Traore, F., Trichaiyaporn, S., Tuncer, S., Tyau-Tyau, H., Umar, A. B., Unal, E., Uner, O. E., Urbak, S. F., Ushakova, T. L., Usmanov, R. H., Valeina, S., van Hoefen Wijsard, M., Varadisai, A., Vasquez, L., Vaughan, L. O., Veleva-Krasteva, N. V., Verma, N., Victor, A. A., Viksnins, M., Villacis Chafla, E. G., Vishnevskia-Dai, V., Vora, T., Wachtel, A. E., Wackernagel, W., Waddell, K., Wade, P. D., Wali, A. H., Wang, Y., Weiss, A., Wilson, M. W., Wime, A. D., Wiwatwongwana, A., Wiwatwongwana, D., Wolley Dod, C., Wongwai, P., Xiang, D., Xiao, Y., Yam, J. C., Yang, H., Yanga, J. M., Yaqub, M. A., Yarovaya, V. A., Yarovoy, A. A., Ye, H., Yousef, Y. A., Yuliawati, P., Zapata Lopez, A. M., Zein, E., Zhang, C., Zhang, Y., Zhao, J., Zheng, X., Zhilyaeva, K., Zia, N., Ziko, O. A., Zondervan, M., Bowman, R. 2020

  Abstract

  Importance: Early diagnosis of retinoblastoma, the most common intraocular cancer, can save both a child's life and vision. However, anecdotal evidence suggests that many children across the world are diagnosed late. To our knowledge, the clinical presentation of retinoblastoma has never been assessed on a global scale.Objectives: To report the retinoblastoma stage at diagnosis in patients across the world during a single year, to investigate associations between clinical variables and national income level, and to investigate risk factors for advanced disease at diagnosis.Design, Setting, and Participants: A total of 278 retinoblastoma treatment centers were recruited from June 2017 through December 2018 to participate in a cross-sectional analysis of treatment-naive patients with retinoblastoma who were diagnosed in 2017.Main Outcomes and Measures: Age at presentation, proportion of familial history of retinoblastoma, and tumor stage and metastasis.Results: The cohort included 4351 new patients from 153 countries; the median age at diagnosis was 30.5 (interquartile range, 18.3-45.9) months, and 1976 patients (45.4%) were female. Most patients (n=3685 [84.7%]) were from low- and middle-income countries (LMICs). Globally, the most common indication for referral was leukocoria (n=2638 [62.8%]), followed by strabismus (n=429 [10.2%]) and proptosis (n=309 [7.4%]). Patients from high-income countries (HICs) were diagnosed at a median age of 14.1 months, with 656 of 666 (98.5%) patients having intraocular retinoblastoma and 2 (0.3%) having metastasis. Patients from low-income countries were diagnosed at a median age of 30.5 months, with 256 of 521 (49.1%) having extraocular retinoblastoma and 94 of 498 (18.9%) having metastasis. Lower national income level was associated with older presentation age, higher proportion of locally advanced disease and distant metastasis, and smaller proportion of familial history of retinoblastoma. Advanced disease at diagnosis was more common in LMICs even after adjusting for age (odds ratio for low-income countries vs upper-middle-income countries and HICs, 17.92 [95% CI, 12.94-24.80], and for lower-middle-income countries vs upper-middle-income countries and HICs, 5.74 [95% CI, 4.30-7.68]).Conclusions and Relevance: This study is estimated to have included more than half of all new retinoblastoma cases worldwide in 2017. Children from LMICs, where the main global retinoblastoma burden lies, presented at an older age with more advanced disease and demonstrated a smaller proportion of familial history of retinoblastoma, likely because many do not reach a childbearing age. Given that retinoblastoma is curable, these data are concerning and mandate intervention at national and international levels. Further studies are needed to investigate factors, other than age at presentation, that may be associated with advanced disease in LMICs.

  View details for DOI 10.1001/jamaoncol.2019.6716

  View details for PubMedID 32105305

• The Effect of Obstructive Sleep Apnea on Absolute Risk of Central Serous Chorioretinopathy. American journal of ophthalmology Pan, C. K., Vail, D. n., Bhattacharya, J. n., Cao, M. n., Mruthyunjaya, P. n. 2020

  Abstract

  To determine the incidence of central serous chorioretinopathy (CSC) stratified by age, sex, and diagnosis with obstructive sleep apnea (OSA), and to determine whether some patients with newly diagnosed CSC may be candidates for OSA evaluation.Retrospective cohort study.We used the IBM Marketscan database to select 59,016,145 commercially-insured patients in the United States between 2007 and 2016. We identified patients' first diagnosis with CSC, and defined patients as having OSA if they had a diagnosis following a sleep study. We specified Cox proportional hazard models with interactions between age, sex, and OSA status to determine patients' risk of developing CSC. We estimated the positive predictive value (PPV) that a new diagnosis of CSC would have in predicting a subsequent diagnosis of OSA.Risk of CSC increased with age in years (HR=1.030, p<.001) and OSA diagnosis (HR=1.081, p=.033), and was lower in women (HR=0.284, p<.001). We estimated the annual incidence of CSC was 9.6 and 23.4 per 100,000 women and men, respectively. Incidence was higher in women and men with OSA (17.2 and 40.8 per 100,000). The PPV of CSC diagnosis as a predictor of OSA was highest in the fifth decade of life.The incidence of CSC in our patient sample is higher than previously reported. Risk of CSC is higher in men than in women, and OSA increases risk of CSC in both men and women. Some patients, particularly older males, may be good candidates for OSA evaluation following a CSC diagnosis.

  View details for DOI 10.1016/j.ajo.2020.05.040

  View details for PubMedID 32574769

• Trends in Anti-VEGF Agents and Panretinal Photocoagulation Use in Diabetic Retinopathy. Ophthalmology. Retina Azad, A. D., Chen, E. M., Hinkle, J. n., Rayess, N. n., Wu, D. n., Eliott, D. n., Mruthyunjaya, P. n., Parikh, R. n. 2020

  Abstract

  Enrollees with PDR with or without DME were identified from 2012 to 2019. We observed a decline in the utilization of PRP and an increase in anti-VEGF utilization.

  View details for DOI 10.1016/j.oret.2020.10.002

  View details for PubMedID 33039592

• Rates of reoperation in 10,114 Patients with Epiretinal Membranes Treated by Vitrectomy with or without Inner Limiting Membrane Peeling. Ophthalmology. Retina Rayess, N. n., Vail, D. n., Mruthyunjaya, P. n. 2020

  Abstract

  To compare rates of reoperation in patients with idiopathic epiretinal membrane (ERM) who received pars plan vitrectomy (PPV) with or without inner limiting membrane (ILM) peeling and to assess trends in the overall use of ILM peeling over time.Retrospective cohort study.Patients included in the IBM Marketscan database between January 1, 2008 and December 31, 2016 who had surgery for idiopathic ERM.Procedure claims with laterality codes were used to determine patients with idiopathic ERM who received PPV with or without ILM peel between 2008 and 2016, and to identify cases of reoperation and subsequent retinal detachment within 1 year of index surgery.The primary outcome was rate of reoperation for recurrent ERM according to whether or not patients receive an ILM peel during their index ERM surgery. We also assessed trends for index ERM surgery (ILM peel or no ILM peel) between 2008 to 2016, and the risk of developing retinal detachment within 1 year of the index ERM surgery.10,114 patients received ERM surgery and met inclusion criteria (5,310 without ILM peel and 4,804 ILM peel). The reoperation rate was significantly lower among patients who received PPV with ILM peel (0.88%) compared to patients without ILM peel (1.48%; p=0.007). In 2008, PPV without ILM peel represented 70% of ERM procedures, but PPV with ILM peeling accounted for 52% and 70% of ERM procedures in 2013 (P<0.001) and 2016 (P<0.001), respectively. The rates of retinal detachment were similar between patients who had an ILM peel (0.79%) and patients who did not receive an ILM peel (0.92%) during their primary ERM surgery (p=0.474) CONCLUSION: The increasing use of PPV with ILM peeling to address ERM removal is associated with significantly reduced reoperation rates within 1 year. Future studies are needed to determine the cost-effectiveness of performing an ILM peel for initial idiopathic ERM repairs and evaluate long term visual and structural changes related to ILM peeling.

  View details for DOI 10.1016/j.oret.2020.10.013

  View details for PubMedID 33127527

• CORRELATION OF GENE EXPRESSION PROFILE STATUS AND AMERICAN JOINT COMMISSION ON CANCER STAGE IN UVEAL MELANOMA. Retina (Philadelphia, Pa.) Berry, D. E., Schefler, A. C., Seider, M. I., Materin, M. n., Stinnett, S. n., Mruthyunjaya, P. n. 2020; 40 (2): 214–24

  Abstract

  To study the relationship between gene expression profile (GEP) subclass and American Joint Committee on Cancer (AJCC) stage in patients with uveal melanoma (UM).A retrospective, multicenter study was undertaken with patients entered from nine major ocular oncology centers from across the United States. Three hundred sixty eligible patients had UM and underwent I-125 plaque brachytherapy with concurrent tumor biopsy with GEP testing between January 1, 2010, and October 28, 2014. Patient demographics and UM features were analyzed by both GEP and AJCC status.Gene expression profile class divided the cohort into three groups: Class 1a (n = 186), Class 1b (n = 77), and Class 2 (n = 113). When classified using AJCC staging criteria, we found the following: Stage I in 91 cases (25.3%), Stage IIA in 143 cases (39.7%), Stage IIB in 89 cases (24.7%), Stage IIIA in 36 cases (10%), and Stage IIIB in 1 case (0.3%). There were no Stage IV cases, as lymph node and metastatic data were not collected as a part of this study. Among Stage I tumors, both high tumor height and high largest basal diameter were associated with a higher frequency of Class 2 status (P < 0.05). As UMs progress to a larger AJCC tumor group (T1-T4), the odds ratio of having a worse prognosis based on GEP class was 1.75 (95% CI, 1.36-2.25; P < 0.001). Similarly, as UMs progress to a higher AJCC stage, the odds ratio of having a worse prognosis based on GEP class was 1.69 (95% CI, 1.36-2.10; P < 0.001).This report details the differences in clinical features between GEP subclasses and how they are distributed among the AJCC stages. When the tumors were grouped by AJCC staging criteria, both larger AJCC tumor (T) group and worsening AJCC stage were associated with worsening predicted prognosis, based on GEP subclass.

  View details for DOI 10.1097/IAE.0000000000002385

  View details for PubMedID 31972790

• Dosimetry Modeling of Focused kV X-ray Radiotherapy for Wet Age-related Macular Degeneration. Medical physics Yan, H. n., Sun, W. n., Mruthyunjaya, P. n., Beadle, B. n., Yu, W. n., Kanwal, B. n., MacDonald, C. A., Liu, W. n. 2020

  Abstract

  Wet (neovascular) age-related macular degeneration (AMD) is the leading cause of blindness in the USA. The mainstay treatment requires monthly intravitreal injection of anti-vascular endothelial growth factor (VEGF) drugs, associated with multiple visits, high cost, and the risk of procedural injury and infection. Anti-VEGF drugs inhibit the formation of neovasculature but do not directly attack it. Radiotherapy can destroy neovasculature and potentially also inhibit wet-AMD associated inflammation and fibrosis not addressed by VEGF inhibitors. However, the current collimation-based radiotherapy device uses fixed 4 mm beams, which are prone to overtreat or undertreat the choroidal neovascularization (CNV) lesions because of their various sizes and shapes. This simulation study evaluates personalized conformal treatment with focused kV radiation using cutting-edge polycapillary x-ray optics.Simulation of the polycapillary optics was achieved via Monte Carlo (MC)-based 3D geometric ray tracing. Phase-space files modeling the focused photons were generated. The method was previously verified by phantom measurements. The ultrasmall ~0.2 mm beam focal spot perpendicular to the beam direction enables spatially fractionated grid therapy, which has been shown to preferentially damage abnormal neovascular blood vessels vs normal ones. Geant4-based MC simulations of scanning while rotating beam delivery were performed to conformally treat three clinical cases of large, medium, and small CNV lesions with regular and grid deliveries. Dose delivery uncertainties due to positioning errors were analyzed, including ±0.75 mm displacement in the three orthogonal directions and ±5° vertical/horizontal rotation of the eyeball.The simulated CNV treatments by 60 kVp focused x-ray beams show highly-conformal delivery of dose to the lesion plus margin (0.75 mm) with sharp dose fall-offs and controllable spatial modulation patterns. The 90%-10% isodose penumbra is <0.5 mm. With a 16 Gy prescription dose to the lesions, the critical structure doses are well below the tolerance. The average CNV dose varies within 10% (mostly within 4%) due to 0.75-mm linear displacements and 5-degree gaze angle rotation of the eyeball.Focused kV technique allows personalized treatment of CNV lesions and reduces unwanted radiation to adjacent healthy tissue. The simulated dose distribution is superior to currently available techniques.

  View details for DOI 10.1002/mp.14404

  View details for PubMedID 32683708

• Questions on Rhegmatogenous Retinal Detachment and the Day of the Week of Repair or Diagnosis-Reply. JAMA ophthalmology Vail, D. n., Pan, C. K., Mruthyunjaya, P. n. 2020

  View details for DOI 10.1001/jamaophthalmol.2020.1867

  View details for PubMedID 32437496

• "Giant cell arteritis manifesting as retinal arterial occlusion and paracentral acute middle maculopathy in a patient on pembrolizumab for metastatic uveal melanoma". American journal of ophthalmology case reports Narala, R. n., Reddy, S. A., Mruthyunjaya, P. n. 2020; 20: 100891

  Abstract

  To report the association of pembrolizumab, an immune checkpoint inhibitor (ICI), with giant cell arteritis (GCA) presenting as paracentral acute middle maculopathy (PAMM) secondary to retinal arterial occlusion.86-year old male with history of treated choroidal melanoma now with metastatic uveal melanoma to the liver on pembrolizumab, an ICI, who presented with acute vision loss in the uninvolved left eye. Spectral domain optical coherence tomography showed band-like increased hyperreflectivity in the middle retinal layers at the level of the inner nuclear layer consistent with PAMM. Intravenous fluorescein angiogram demonstrated significant delay in filling of the superotemporal and inferotemporal arteries with nonperfusion of the temporal retina consistent with multiple branch retinal arterial occlusions. Work-up for GCA was performed and temporal artery biopsy showed healed arteritis.Pembrolizumab can cause ocular and life-threatening systemic adverse effects and as use of ICIs has increased, it is important to be aware of these associations. There should be a low threshold for GCA work up in patients on ICI therapy who present with acute vision loss and evidence of retinal occlusive disease with or without classic GCA systemic symptoms.

  View details for DOI 10.1016/j.ajoc.2020.100891

  View details for PubMedID 32913923

  View details for PubMedCentralID PMC7472807

• Metastasis of Lung Adenocarcinoma to the Lacrimal Sac. Ophthalmic plastic and reconstructive surgery Eng, V. A., Lin, J. H., Mruthyunjaya, P. n., Erickson, B. P. 2020

  Abstract

  The authors report an unusual case of lung adenocarcinoma metastasis to the lacrimal sac. A 61-year-old woman with stage IV non-small cell lung cancer presented with left facial pain and epiphora. She was found to have an elevated tear meniscus associated with a firm, fixed medial canthal mass. Orbital imaging demonstrated nodular enlargement of the lacrimal drainage apparatus. Biopsy of the lacrimal sac was performed, and it revealed a metastatic lung adenocarcinoma. The patient received targeted radiation therapy to the lacrimal sac, and her dose of maintenance chemotherapy was increased. The patient's symptoms have since improved. This case of lung cancer involving the lacrimal sac highlights the importance of thorough oncologic surveillance, even with respect to locations atypical for metastatic spread.

  View details for DOI 10.1097/IOP.0000000000001827

  View details for PubMedID 32976332

• Association of Rhegmatogenous Retinal Detachment and Outcomes With the Day of the Week That Patients Undergo a Repair or Receive a Diagnosis. JAMA ophthalmology Vail, D., Pan, C., Pershing, S., Mruthyunjaya, P. 2019

  Abstract

  Importance: Because variation in care on weekends has been reported in many surgical fields, it is of interest if variations were noted for care patterns of rhegmatogenous retinal detachments (RRDs).Objective: To assess the association between modality of RRD repair and day of the week that patients receive a diagnosis or undergo RRD repair.Design, Setting, and Participants: A retrospective claims-based cohort analysis was performed of primary RRD surgery for 38 144 commercially insured patients in the United States who received a diagnosis of incident RRD between January 1, 2008, and December 31, 2016, and underwent repair within 14 days of diagnosis. Multinomial regression models were used to assess patients' likelihood of repair with different modalities, logistic regression models were used to assess patients' likelihood of reoperation, and linear regression models were used to assess time from diagnosis to repair. Data analysis was performed from March 9 to September 5, 2019.Exposures: Day of the week that the patient received a diagnosis of RRD or underwent RRD repair.Main Outcome and Measures: Modality of repair, time from diagnosis to repair, and 30-day reoperation rate.Results: Among the 38 144 patients in the study (23 031 men [60.4%]; mean [SD] age at diagnosis, 56.8 [13.4] years), pneumatic retinopexy (PR) was more likely to occur when patients received a diagnosis of RRD on Friday (relative risk ratio [RRR], 1.37; 95% CI, 1.17-1.60), Saturday (RRR, 1.73; 95% CI, 1.36-2.20), or Sunday (RRR, 1.53; 95% CI, 1.08-2.17) compared with Wednesday. Pneumatic retinopexy was more likely to be used for surgical procedures on Friday (RRR, 1.55; 95% CI, 1.33-1.80), Saturday (RRR, 2.03; 95% CI, 1.61-2.56), Sunday (RRR, 2.28; 95% CI, 1.55-3.35), or Monday (RRR, 1.70; 95% CI, 1.46-1.98). Patients undergoing PR on Sundays were more likely to receive another procedure (PR, scleral buckle, or pars plana vitrectomy) within 30 days (odds ratio, 1.62; 95% CI, 1.07-2.45). An association between the need for reoperation for repairs performed via scleral buckle or pars plana vitrectomy and the day of the week of the initial repair was not identified. Patients who received a diagnosis on a Friday waited a mean of 0.28 days (95% CI, 0.20-0.36 days) longer for repair than patients who received a diagnosis on a Wednesday.Conclusions and Relevance: These findings suggest that management of RRD varies according to the day of the week that diagnosis and repair occurs, with PR disproportionately likely to be used to repair RRDs during the weekend. Ophthalmologists should be aware that these results suggest that patients undergoing PR on Sundays may be more likely to require reoperation within 30 days.

  View details for DOI 10.1001/jamaophthalmol.2019.5253

  View details for PubMedID 31855233

• Racial, Ethnic, and Socioeconomic Disparities in Retinoblastoma Enucleation: A Population-Based Study, SEER 18 2000-2014 AMERICAN JOURNAL OF OPHTHALMOLOGY Rajeshuni, N., Whittemore, A. S., Ludwig, C. A., Mruthyunjaya, P., Moshfeghi, D. M. 2019; 207: 215–23

  View details for DOI 10.1016/j.ajo.2019.04.015

  View details for Web of Science ID 000504341100022

• Association Between Cilioretinal Arteries and Advanced Age-Related Macular Degeneration Secondary Analysis of the Comparison of Age-Related Macular Degeneration Treatment Trials (CATT) JAMA OPHTHALMOLOGY Bavinger, J., Ying, G., Daniel, E., Grunwald, J. E., Maguire, M. G., Williams, D. F., Beardsley, S., Bennett, S., Cantrill, H., Chan-Tram, C., Cheshier, H., Damato, K., Davies, J., Dev, S., Enloe, J., Follano, G., Gilbert, P., Johnson, J., Jones, T., Mayleben, L., Mittra, R., Moos, M., Neist, R., Oestreich, N., Quiram, P., Ramsay, R., Ryan, E., Schindeldecker, S., Snater, J., Steele, T., Selders, D., Tonsfeldt, J., Valardi, S., Fish, G., Aguado, H. A., Arceneaux, S., Arnwine, J., Bell, K., Bell, T., Boleman, B., Bradley, P., Callanan, D., Coors, L., Creighton, J., Crew, T., Cummings, K., Dock, C., Duignan, K., Fuller, D., Gray, K., Hendrix, B., Hesse, N., Jaramillo, D., Jost, B., Lash, S., Lonsdale, L., Mackens, M., Mutz, K., Potts, M., Sanchez, B., Snyder, W., Solley, W., Tarter, C., Wang, R., Williams, P., Perkins, S. L., Anderson, N., Arnold, A., Blais, P., Googe, J., Higdon, T. T., Hunt, C., Johnson, M., Miller, J., Moore, M., Morris, C. K., Morris, C., Oelrich, S., Oliver, K., Seitz, V., Whetstone, J., Doft, B. H., Bedel, J., Bergren, R., Borthwick, A., Conrad, P., Fec, A., Fulwylie, C., Ingram, W., Latham, S., Lester, G., Liu, J., Lobes, L., Lucko, N. M., Mechling, H., Merlotti, L., McBroom, K., Olsen, K., Puskas, D., Rath, P., Schmucker, M., Schueckler, L., Schultz, C., Shultz, H., Steinberg, D., Vyas, A., Whale, K., Yeckel, K., Orth, D. H., Arredondo, L. S., Brown, S., Ciscato, B. J., Civantos, J. M., Figliulo, C., Hasan, S., Kosinski, B., Muir, D., Nelson, K., Packo, K., Pollack, J. S., Rezaei, K., Shelton, G., Townsend-Patrick, S., Walsh, M., McDonald, H., Ansari, N., Bye, A., Fu, A. D., Grout, S., Indermill, C., Johnson, R. N., Jumper, J., Linares, S., Lujan, B. J., Munden, A., Persons, M., Rodriguez, R., Rose, J. M., Teske, B., Urias, Y., Young, S., Dreyer, R. F., Daniel, H., Connaughton, M., Handelman, I., Hobbs, S., Hoerner, C., Hudson, D., Kopfer, M., Lee, M., Lemley, C., Logan, J., Ma, C., Mallet, C., Milliron, A., Peters, M., Wohlsein, H., Pearlman, J. A., Andrews, M., Bartlett, M., Carlson, N., Cox, E., Equi, R., Gonzalez, M., Griffin, S., Hogue, F., Kennedy, L., Kryuchkov, L., Lopez, C., Lopez, D., Luevano, B., McKenna, E., Patel, A., Reed, B., Secor, N., Sison, I. R., Tsai, T., Varghis, N., Waller, B., Wendel, R., Yebra, R., Roth, D. B., Deinzer, J., Fine, H., Green, F., Green, S., Keyser, B., Leff, S., Leviton, A., Martir, A., Mosenthine, K., Muscle, S., Okoren, L., Parker, S., Prenner, J., Price, N., Rogers, D., Rosas, L., Schlosser, A., Studenko, L., Tantum, T., Wheatley, H., Trese, M. T., Aaberg, T., Bell, T., Bezaire, D., Bridges, C., Bryant, D., Capone, A., Coleman, M., Consolo, C., Cook, C., DuLong, C., Garretson, B., Grooten, T., Hammersley, J., Hassan, T., Jessick, H., Jones, N., Kinsman, C., Krumlauf, J., Lewis, S., Locke, H., Margherio, A., Markus, D., Marsh, T., Neal, S., Noffke, A., Oh, K., Pence, C., Preston, L., Raphaelian, P., Regan, V. R., Roberts, P., Ruby, A., Sarrafizadeh, R., Scherf, M., Scott, S., Sneed, S., Staples, L., Terry, B., Trese, M. T., Videtich, J., Williams, G., Zajechowski, M., Joseph, D. P., Blinder, K., Boyd, L., Buckley, S., Crow, M., Dinatale, A., Engelbrecht, N., Forke, B., Gabel, D., Grand, G., Grillion-Cerone, J., Holekamp, N., Kelly, C., Nobel, G., Pepple, K., Raeber, M., Rao, P., Ressel, T., Schremp, S., Sgorlon, M., Shears, S., Thomas, M., Timma, C., Vaughn, A., Walters, C., Weeks, R., Wehmeier, J., Wright, T., Berinstein, D. M., Ayyad, A., Barazi, M. K., Bickhart, E., Brady, T., Byank, L., Cronise, A., Denny, V., Dunn, C., Flory, M., Frantz, R., Garfinkel, R. A., Gilbert, W., Lai, M. M., Melamud, A., Newgen, J., Newton, S., Oliver, D., Osman, M., Sanders, R., von Fricken, M., Dugel, P., Arenas, S., Balea, G., Bartoli, D., Bucci, J., Cornelius, J. A., Dickens, S., Doherty, D., Dunlap, H., Goldenberg, D., Jamal, K., Jimenez, N., Kavanagh, N., Kunimoto, D., Martin, J., Miner, J., Mobley, S., Park, D., Quinlan, E., Sipperley, J., Slagle, C., Smith, D., Yafchak, M., Yager, R., Flaxel, C. J., Bailey, S., Francis, P., Howell, C., Hwang, T., Ira, S., Klein, M., Lauer, A., Liesegang, T., Lundquist, A., Nolte, S., Nolte, S. K., Pickell, S., Pope, S., Rossi, J., Schain, M., Steinkamp, P., Toomey, M. D., Vahrenwald, D., West, K., Hubbard, B., Andelman, S., Bergstrom, C., Brower, J., Cribbs, B., Curtis, L., Dobbs, J., DuBois, L., Gaultney, J., Gibbs, D., Jordan, D., Leef, D., Martin, D. F., Myles, R., Olsen, T., Schwent, B., Srivastava, S., Waldron, R., Antoszyk, A. N., Balasubramaniam, U., Brooks, D., Brown, J., Browning, D., Clark, L., Ennis, S., Held, S., Helms, J. V., Herby, J., Karow, A., Leotaud, P., Massimino, C., McClain, D., McOwen, M., Mindel, J., Pereira, C., Pierce, R., Powers, M., Price, A., Rohrer, J., Sanders, J., Avery, R. L., Avery, K., Basefsky, J., Beckner, L., Castellarin, A., Couvillion, S., Giust, J., Giust, M., Nasir, M., Pieramici, D., Rabena, M., Risard, S., See, R., Smith, J., Wan, L., Bakri, S. J., Abu-Yaghi, N., Barkmeier, A., Berg, K., Burrington, J., Edwards, A., Goddard, S., Howard, S., Iezzi, R., Lewison, D., Link, T., McCannel, C. A., Overend, J., Pach, J., Ruszczyk, M., Shultz, R., Stephan, C., Vogen, D., Bradford, R. H., Bergman, V., Burris, R., Butt, A., Daniels, B., Dwiggins, C., Fransen, S., Guerrero, T., Haivala, D., Harris, A., Icks, S., Kingsley, R., Redden, L., Richmond, R., Ross, B., White, K., Youngberg, M., Topping, T. M., Bennett, S., Chong, S., Ciotti, M., Cleary, T., Corey, E., Donovan, D., Frederick, A., Freese, L., Graham, M., Gud, N., Howard, T., Jones, M., Morley, M., Moses, K., Stone, J., Ty, R., Wiegand, T., Williams, L., Winder, B., Retina, T., Awh, C. C., Amonette, M., Arrindell, E., Beck, D., Busbee, B., Dilback, A., Downs, S., Guidry, A., Gutow, G., Hardin, J., Hines, S., Hutchins, E., LaCivita, K., Lester, A., Malott, L., McCain, M., Miracle, J., Moffat, K., Palazzotta, L., Robinson, K., Sonkin, P., Travis, A., TrentWallace, R., Winters, K. J., Wray, J., Harris, A. E., Bunnell, M., Crooks, K., Fitzgerald, R., Javid, C., Kew, C., Kill, E., Kline, P., Kreienkamp, J., Martinez, M., Moore, R., Saavedra, E., Taylor, L., Walsh, M., Wilson, L., Ciulla, T. A., Coyle, E., Harrington, T., Harris, C., Hood, C., Kerr, I., Maturi, R., Moore, D., Morrow, S., Savage, J., Sink, B., Steele, T., Thukral, N., Wilburn, J., Walker, J. P., Banks, J., Ciampaglia, D., Dyshanowitz, D., Frederick, J., Ghuman, A., Grodin, R., Kiesel, C., Knips, E., Mccue, J., Ortiz, M., Peters, C., Raskauskas, P., Schoeman, E., Sharma, A., Wing, G., Youngblood, R., Chandra, S. R., Altaweel, M., Blodi, B., Burke, K., Dietzman, K. A., Gottlieb, J., Knutson, G., Krolnik, D., Nork, T., Olson, S., Peterson, J., Reed, S., Soderling, B., Somers, G., Stevens, T., Wealti, A., Bearelly, S., Branchaud, B., Bryant, J. W., Crowell, S., Fekrat, S., Gammage, M., Harrison, C., Jones, S., McClain, N., McCuen, B., Mruthyunjaya, P., Queen, J., Sarin, N., Skalak, C., Skelly, M., Suner, I., Tomany, R., Welch, L., Park, S. S., Cassidy, A., Chandra, K., Good, I., Imson, K., Kaur, S., Metzler, H., Morse, L., Redenbo, E., Salvador, M., Telander, D., Thomas, M., Wallace, C., Barr, C. C., Battcher, A., Bottorff, M., Chasteen, M., Clark, K., Denning, D., Schoen, D., Schultz, A., Tempel, E., Wheeler, L., Whittington, G. K., Stone, T. W., Blevins, T., Buck, M., Cruz, L., Heath, W., Holcomb, D., Isernhagen, R., Kidd, T., Kitchens, J., Sears, C., Slade, E., Van Arsdall, J., VanHoose, B., Wolfe, J., Wood, W., Zilis, J., Crooks, C., Disney, L., Liu, M., Petty, S., Sall, S., Folk, J. C., Aly, T., Brotherton, A., Critser, D., Hinz, C. J., Karakas, S., Kirschner, V., Lester, C., Montague, C., Russell, S., Stockman, H., Taylor, B., Verdick, R., Walshire, J., Thompson, J. T., Connell, B., Constantine, M., Davis, J. L., Holsapple, G., Hunter, L., Lenane, C., Mitchell, R., Russel, L., Sjaarda, R., Brown, D. M., Benz, M., Burns, L., Carranza, J. G., Fish, R., Goates, D., Hay, S., Jeffers, T., Kegley, E., Kubecka, D., McGilvra, S., Richter, B., Sneed, V., Stoever, C., Tellez, I., Wong, T., Kim, I., Andreoli, C., Barresi, L., Brett, S., Callahan, C., Capaccioli, K., Carli, W., Coppola, M., Emmanuel, N., Evans, C., Fagan, A., Grillo, M., Head, J., Lee, E., Lord, U., Miretsky, E., Palitsch, K., Petrin, T., Reader, L., Reznichenko, S., Robertson, M., Smith, J., Vavvas, D., Wells, J., Cahill, C., Clark, W., Henry, K., Johnson, D., Miller, P., Oliver, L., Spivey, R., Swinford, T., Taylor, M., Lambert, M., Chase, K., Fredrickson, D., Khawly, J., Lazarte, V., Lowd, D., Miller, P., Willis, A., Ferrone, P. J., Almonte, M., Arnott, R., Aviles, I., Carbon, S., Chitjian, M., DAmore, K., Elliott, C., Fastenberg, D., Golub, B., Graham, K., Lavorna, A., Murphy, L., Palomo, A., Puglisi, C., Rhee, D., Romero, J., Rosenblatt, B., Salcedo, G., Schlameuss, M., Shakin, E., Sookhai, V., Kaiser, R., Affel, E., Brown, G., Centinaro, C., Fine, D., Fineman, M., Formoso, M., Garg, S., Grande, L., Herbert, C., Ho, A., Hsu, J., Jay, M., Lavetsky, L., Liebenbaum, E., Maguire, J., Monsonego, J., O'Connor, L., Pierce, L., Regillo, C., Rosario, M., Spirn, M., Vander, J., Walsh, J., Davidorf, F. H., Barnett, A., Chang, S., Christoforidis, J., Elliott, J., Justice, H., Letson, A., McKinney, K., Perry, J., Salerno, J. A., Savage, S., Shelley, S., Singerman, L. J., Coney, J., DuBois, J., DuBois, K., Greanoff, G., Himmelman, D., Ilc, M., Mcnamara, E., Novak, M., Pendergast, S., Rath, S., Smith-Brewer, S., Tanner, V., Weiss, D. E., Zegarra, H., Halperin, L., Aramayo, P., Dhalla, M., Fernandez, B., Fernandez, C., Lopez, J., Lopez, M., Mariano, J., Murphy, K., Sherley, C., Veksler, R., Rahhal, F., Babikian, R., Boyer, D., Hami, S., Kessinger, J., Kurokouchi, J., Mukarram, S., Pachman, S., Protacio, E., Sierra, J., Tabandeh, H., Zamboni, A., Elman, M., Belz, J., Butcher, T., Coffey, T., Firestone, D., Gore, N., Singletary, P., Sotirakos, P., Starr, J., Meredith, T. A., Barnhart, C. J., Cantrell, D., Esquejo-Leon, R., Houghton, O., Kaur, H., Ndure, F., Glatzer, R., Joffe, L., Schindler, R., Martin, D. F., Fine, S. L., Katz, M., Maguire, M. G., Brightwell-Arnold, M., Glaser, R., Hall, J., Harkins, S., Huang, J., Khvatov, A., McWilliams, K., Nolte, S. K., Peskin, E., Pistilli, M., Ryan, S., Schnader, A., Ying, G., Jaffe, G., Afrani-Sakyi, J., Balsley, B., Bennett, L. S., Brooks, A., Brower-Lingsch, A., Bruce, L., Burns, R., Busian, D., Choong, J., Cloaninger, L., DeCroos, F., DuBois, E., El-Dairi, M., Gach, S., Hall, K., Hawks, T., Huang, C., Heydary, C., Ho, A., Kini, S., McCall, M., Muhammad, D., Nicholson, J., Queen, J., Rieves, P., Shields, K., Skalak, C., Specker, A., Stinnett, S., Subramaniam, S., Tenbrink, P., Toth, C., Towe, A., Welch, K., Williams, N., Winter, K., Young, E., Grunwald, J. E., Alexander, J., Daniel, E., Daniel, E., Martin, E., Parker, C., Sepielli, K., Shannon, T., Whearry, C., Redford, M., Martin, D. F., Avery, R. L., Bakri, S. J., Daniel, E., Fine, S. L., Grunwald, J. E., Jaffe, G., Kopfer, M. R., Maguire, M. G., Meredith, T. A., Peskin, E., Redford, M., Williams, D. F., Martin, D. F., Bennett, L. S., Daniel, E., Ferris, F. L., Fine, S. L., Grunwald, J. E., Jaffe, G., Maguire, M. G., Peskin, E., Redford, M., Toth, C., Peskin, E., Brightwell-Arnold, M., DuPont, J., Maguire, M. G., McWilliams, K., Nolte, S. K., Friedman, L. M., Bressler, S. B., DeMets, D. L., Friedlander, M., Johnson, M. W., Lindblad, A., Losordo, D. W., Miller, F. G., Comparison Age-Related Macular 2019; 137 (11): 1306–11

  Abstract

  Recent reports suggest that cilioretinal arteries (CRAs) confer protection against developing advanced age-related macular degeneration (AMD).To further characterize the association between the presence of a CRA and incidence of geographic atrophy (GA) or choroidal neovascularization (CNV).This cohort study constituted an ad hoc secondary analysis of data from the Comparison of Age-Related Macular Degeneration Treatments Trials (CATT) and was performed at 44 clinical centers in the United States among participants in CATT with CNV in the study eye and without advanced AMD in the fellow eye at baseline. The presence of a CRA was determined by 2 graders, masked to clinical data, using color fundus photographs, red-free fundus photographs, and fluorescein angiography. The proportion with CRAs at baseline between the study eye with CNV and fellow eye without CNV was first compared. The association of a CRA with incidence of CNV or GA at 5 years among fellow eyes and with incidence of GA among study (treated) eyes was then assessed. In addition, the association of CRAs with the Age-Related Eye Disease Study severity scale among the fellow eyes at baseline was assessed. Data were collected from February 1, 2008, through April 30, 2015, and analyzed from July 1, 2018, through April 30, 2019.Presence of a CRA.The association between the presence of a CRA and incidence of CNV or GA at 5 years of follow-up.A total of 350 patients (700 eyes) (230 [65.7% women; mean [SD] age, 77 [7.2] years) were included in the analysis. Cilioretinal arteries were present in 67 of 345 (19.4%) fellow eyes without baseline CNV and 73 of 349 (20.9%) study eyes with baseline CNV (P = .60). Cilioretinal arteries in fellow eyes were not associated with incidence of CNV at 5 years (125 of 278 [45.0%] among eyes without CRAs and 30 of 67 [44.8%] among eyes with CRAs; P = .99) or with incidence of GA at 5 years (110 of 278 [39.6%] among eyes without CRAs and 25 of 67 [37.3%] among eyes with CRAs; P = .89). Cilioretinal arteries in study eyes were not associated with incidence of GA at 5 years (105 of 276 [38.0%] study eyes without CRAs and 26 of 73 [35.6%] study eyes with CRAs; P = .72).The analysis did not find a protective association between CRAs and incidence of CNV or GA among CATT participants who had unilateral exudative AMD. Why these findings were different from those of previous publications is unclear but may be partially explained by the different techniques used to detect CRAs or by the baseline advanced disease in CATT participants.ClinicalTrials.gov identifier: NCT00593450.

  View details for DOI 10.1001/jamaophthalmol.2019.3509

  View details for Web of Science ID 000503209300016

  View details for PubMedID 31513262

  View details for PubMedCentralID PMC6743058

• Professor Prithvi Mruthyunjaya: working together to move the field forward and better help our patients ANNALS OF TRANSLATIONAL MEDICINE Qiu, A., Zhou, A., Mruthyunjaya, P. 2019; 7 (22)

  View details for DOI 10.21037/atm.2019.09.148

  View details for Web of Science ID 000500459400099

• Ophthalmic specimens from bedside to bench: An integrated biorepository platform to bridge the gap between the operating room and laboratory Chemudupati, S., Mahajan, V. B., Mruthyunjaya, P. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2019

  View details for Web of Science ID 000488800705218

• Multimodal imaging in non-paraneoplastic autoimmune retinopathy. Indian journal of ophthalmology Kasongole, D., Raval, V., Mruthyunjaya, P., Narayanan, R. 2019; 67 (7): 1171–73

  View details for DOI 10.4103/ijo.IJO_1416_18

  View details for PubMedID 31238443

• RELATIONSHIP OF CLINICAL FEATURES AND BASELINE TUMOR SIZE WITH GENE EXPRESSION PROFILE STATUS IN UVEAL MELANOMA A Multi-institutional Study RETINA-THE JOURNAL OF RETINAL AND VITREOUS DISEASES Berry, D., Seider, M., Stinnett, S., Mruthyunjaya, P., Schefler, A. C., Raufi, N., Harbour, W., Berry, J., Kim, J., Skalet, A., Miller, A., Materin, M., Liu, T., Demirci, H., Ozkurt, Z., Hovland, P., Aaberg, T., Schefler, A., Kim, R., Tann, A., Ocular Oncology Study Consortium 2019; 39 (6): 1154–64

  View details for DOI 10.1097/IAE.0000000000002113

  View details for Web of Science ID 000480753300029

• Analysis of Melanin Structure and Biochemical Composition in Conjunctival Melanocytic Lesions Using Pump-Probe Microscopy. Translational vision science & technology Robles, F. E., Deb, S., Vajzovic, L., Vora, G. K., Mruthyunjaya, P., Warren, W. S. 2019; 8 (3): 33

  Abstract

  Purpose: We analyze melanin structure and biochemical composition in conjunctival melanocytic lesions using pump-probe microscopy to assess the potential for this method to assist in melanoma diagnosis.Methods: Pump-probe microscopy interrogates transient excited-state photodynamic properties of absorbing molecules, which yields highly specific molecular information with subcellular spatial resolution. This method is applied to analyze melanin in 39 unstained, thin biopsy specimens of melanocytic conjunctival lesions. Quantitative features of the biochemical composition and structure of melanin in histopathologic specimens are assessed using a geometric representation of principal component analysis (PCA) and principles of mathematical morphology. Diagnostic power is determined using a feature selection algorithm combined with cross validation.Results: Conjunctival melanomas show higher biochemical heterogeneity and different overall biochemical composition than primary acquired melanosis of the conjunctiva (PAM) without severe atypia. The molecular signatures of PAMs with severe atypia more closely resemble melanomas than other types of PAMs. Pigment organization in the tissue becomes more disorganized as diagnosis of the lesions worsen, but nevi are more inconsistent biochemically and structurally than other lesions. Relatively high sensitivity (SE) and specificity (SP) is achieved for differentiating between various melanocytic lesions, particularly PAMs without severe atypia and melanomas (SE = 89%; SP = 87%).Conclusions: Pump-probe microscopy is a powerful tool that can identify quantitative, phenotypic differences between various types of conjunctival melanocytic lesions.Translational Relevance: This study further validates the use of pump-probe microscopy as a potential diagnostic aid for histopathologic evaluation of conjunctival melanocytic lesions.

  View details for DOI 10.1167/tvst.8.3.33

  View details for PubMedID 31183249

• IDENTIFICATION OF POSTERIOR SEGMENT PATHOLOGY WITH EN FACE RETINAL IMAGING USING MULTICOLOR CONFOCAL SCANNING LASER OPHTHALMOSCOPY RETINA-THE JOURNAL OF RETINAL AND VITREOUS DISEASES Feng, H. L., Sharma, S., Stinnett, S., Asrani, S., Mruthyunjaya, P. 2019; 39 (5): 972–79

  View details for DOI 10.1097/IAE.0000000000002111

  View details for Web of Science ID 000480749600029

• The Effect of Anti-Vascular Endothelial Growth Factor Agents on Intraocular Pressure and Glaucoma A Report by the American Academy of Ophthalmology OPHTHALMOLOGY Hoguet, A., Chen, P. P., Junk, A. K., Mruthyunjaya, P., Nouri-Mahdavi, K., Radhakrishnan, S., Takusagawa, H. L., Chen, T. C. 2019; 126 (4): 611–22

  View details for DOI 10.1016/j.ophtha.2018.11.019

  View details for Web of Science ID 000462025300030

• Comparison of Optical Coherence Tomography With Fundus Photographs, Fluorescein Angiography, and Histopathologic Analysis in Assessing Coats Disease JAMA OPHTHALMOLOGY Ong, S. S., Cummings, T. J., Vajzovic, L., Mruthyunjaya, P., Toth, C. A. 2019; 137 (2): 176–83

  View details for DOI 10.1001/jamaophthalmol.2018.5654

  View details for Web of Science ID 000458631500014

• Widefield imaging of retinal and choroidal tumors. International journal of retina and vitreous Callaway, N. F., Mruthyunjaya, P. n. 2019; 5 (Suppl 1): 49

  Abstract

  Wide-field imaging plays an increasingly important role in ocular oncology clinics. The purpose of this review is to describe the commonly used wide-field imaging devices and review conditions seen in ocular oncology clinic that underwent wide-field imaging as part of the multimodal evaluation.Wide-field or wide-angle imaging is defined as greater than 50° field of view. Modern devices can reach far beyond this reporting fields of view up to 267°, when utilizing montage features, with increasingly impressive resolution. Wide-field imaging modalities include fundus photography, fluorescein angiography (FA), fundus autofluorescence (FAF), indocyanine angiography (ICG), spectral domain optical coherence tomography (SD-OCT), and recently wide-field OCT Angiography (OCTA). These imaging modalities are increasingly prevalent in practice. The wide-field systems include laser, optical, and lens based systems that are contact or non-contact lens systems each with its own benefits and drawbacks. The purpose of this review is to discuss commonly used wide-field imaging modalities for retinal and choroidal tumors and demonstrate the use of various widefield imaging modalities in select ocular oncology cases.Clinical examination remains the gold standard for the evaluation of choroidal and retinal tumors. Wide-field imaging plays an important role in ocular oncology for initial documentation, surgical planning, determining the relationship of the tumor to adjacent ocular structures, following tumor size after treatment, and monitoring for recurrence.

  View details for DOI 10.1186/s40942-019-0196-5

  View details for PubMedID 31890289

  View details for PubMedCentralID PMC6907111

• Updates in imaging in ocular oncology. F1000Research Davila, J. R., Mruthyunjaya, P. 2019; 8

  Abstract

  Innovations in ophthalmic imaging have made a profound impact on the diagnosis and treatment of ophthalmic disease. In ocular oncology, the development of optical coherence tomography with enhanced depth imaging and swept source technologies has made it possible to visualize the anatomical characteristics of retinoblastoma and uveal melanoma with a level of detail previously unobtainable on clinical exam alone. As a result, our understanding of the pathophysiology of vision loss in choroidal melanoma in particular has improved. These modalities have also helped identify fundoscopically "invisible" tumors and risk stratify pre-malignant choroidal lesions, making a strong case for their inclusion in all screening evaluations. Optical coherence tomography angiography, on the other hand, has allowed non-invasive imaging of the retinal and uveal vasculatures, providing insight into vascular changes associated with malignant transformation and vision loss following exposure to radiation. While the impact of new imaging technologies on clinical outcomes and overall survival in ocular oncology has yet to be determined, several reports cited herein offer promising results.

  View details for DOI 10.12688/f1000research.19979.1

  View details for PubMedID 31602297

• Multi-center analysis of intraocular biopsy technique and outcomes for uveal melanoma: Ocular Oncology Study Consortium report 4. Graefe's archive for clinical and experimental ophthalmology = Albrecht von Graefes Archiv fur klinische und experimentelle Ophthalmologie Seider, M. I., Berry, D. E., Schefler, A. C., Materin, M. n., Stinnett, S. n., Mruthyunjaya, P. n. 2019

  Abstract

  To investigate the relationship between surgical approach for intraocular tumor biopsy of uveal melanoma and tumor morphologic features such as size and intraocular location and the effect of these variables on diagnostic yield and biopsy outcome.Consecutive patients from nine Ocular Oncology centers with uveal melanoma (UM) undergoing tumor biopsy immediately preceding I125 plaque brachytherapy with tissue sent for gene expression profiling (GEP) testing were reviewed retrospectively.Three hundred sixty patients were included (50% men, mean age 60.2 years). Overall biopsy yield was 99% and 83% for GEP and cytopathology, respectively. Surgeon choice of biopsy approach (trans-vitreal vs. trans-scleral) was found to associate with both tumor location and tumor thickness. A trans-scleral rather than trans-vitreal approach was used more commonly for anteriorly located tumors (92% vs. 38% of posterior tumors, p < 0.001) and thicker tumors (86% vs. 55% of thin tumors, p < 0.001). When performing trans-vitreal biopsies, ocular oncologists with previous vitreoretinal surgery fellowship training were more likely to use wide-field surgical viewing systems, compared with indirect ophthalmoscopy (82.6% vs. 20.6%, p < 0.001). Surgical complications were rare and occurred more frequently with trans-vitreal biopsies (3.6% vs. 0.46%, p = 0.046).In this multi-center analysis of UM tumor biopsy, surgical yield was high for obtaining tumor tissue for GEP and cytopathology analysis with both trans-scleral and trans-vitreal techniques. Fellowship-trained ocular oncologists' preferred intraocular biopsy techniques associated strongly with tumor location, tumor thickness, and fellowship training of the surgeon. Short-term complication rates were low.

  View details for DOI 10.1007/s00417-019-04531-8

  View details for PubMedID 31807898

• Racial, Ethnic, and Socioeconomic Disparities in Retinoblastoma Enucleation: A Population-Based Study, SEER 18 2000-2014. American journal of ophthalmology Rajeshuni, N. n., Whittemore, A. S., Ludwig, C. A., Mruthyunjaya, P. n., Moshfeghi, D. M. 2019

  Abstract

  To determine the effect of race, ethnicity, and census-tract-level composite socioeconomic status (SES) on retinoblastoma enucleation. This study augments Truong et al., providing multivariate analyses combining sociodemographic and clinical characteristics with more accurate SES measures. We hypothesized children from non-white, Hispanic, and lower socioeconomic backgrounds would have increased adjusted odds of enucleation.Retrospective cohort analysis.Setting: Multicenter population-based study using the Surveillance, Epidemiology, and End Results (SEER) 18 Registries.Children aged 18 and under diagnosed with retinoblastoma between 2000-2014. Subjects were identified using International Classification of Diseases Oncology (ICD-O) site and morphology codes.Enucleation Odds Ratios and 95% Confidence Intervals RESULTS: Analysis of 959 retinoblastoma patients revealed that 70.8% were enucleated. Adjusted analyses showed associations between enucleation and Asian (Odds Ratio (OR) 2.00, Confidence Interval (CI) 1.08-3.71) or Black (2.42, 1.41-4.16) race, Hispanic ethnicity (1.69, 1.16-2.46), and low SES (1.68, 1.09-2.58). Significantly increased enucleation risk was associated with older age at diagnosis (Age 1-2 years 2.55, 1.80-3.61; >2 years 4.88, 2.57-9.25), unilateral disease (5.00, 3.45-7.14), and advanced stage (Regional 4.71, 2.51-8.84; Distant 3.15, 1.63-6.08). No interactions were observed between race, ethnicity, SES, and stage at diagnosis. Enucleation rates decreased over time across all racial, ethnic, and socioeconomic groups.Children from non-white, Hispanic, and lower socioeconomic backgrounds are more likely to receive enucleation. These associations are independent of stage of diagnosis, suggesting larger systemic disparities in retinoblastoma care. The origin of these differences requires further study and attention by clinicians and policy-makers.

  View details for PubMedID 31077666

• The Effect of Anti-Vascular Endothelial Growth Factor Agents on Intraocular Pressure and Glaucoma A Report by the American Academy of Ophthalmology. Ophthalmology Hoguet, A., Chen, P. P., Junk, A. K., Mruthyunjaya, P., Nouri-Mahdavi, K., Radhakrishnan, S., Takusagawa, H. L., Chen, T. C. 2018

  Abstract

  PURPOSE: To assess the effect of intravitreal injections of anti-vascular endothelial growth factor (anti-VEGF) agents on immediate and long-term intraocular pressure (IOP) elevation and glaucoma.METHODS: Literature searches of the PubMed and Cochrane databases, last conducted in April 2018, yielded 253 unique citations. Of these, 41 met the inclusion criteria and were rated according to the strength of evidence. Two articles were rated level I, 17 were rated level II, and 15 were rated level III; an additional 7 were excluded owing to poor study design and lack of relevance to the topic under evaluation.RESULTS: The studies that reported on short-term IOP elevation (i.e., between 0 and 60 minutes) showed that an immediate increase in IOP is seen in all patients when measured between 0 and 30 minutes of intravitreal injection and that the IOP elevation decreases over time. The data on long-term IOP elevation were mixed; 7 studies reported that between 4% and 15% of patients developed sustained elevation of IOP at 9 to 24 months after injection, whereas 6 studies found no long-term change in IOP from 1 to 36 months after injection. Pretreatment with glaucoma medications, anterior chamber tap, vitreous reflux, longer intervals between injections, and longer axial lengths were associated with lower IOP elevations after injection. Data were mixed on the relationship between IOP rise and the type of intravitreal injection, number of intravitreal injections, pre-existing glaucoma, and globe decompression before injection. There were no data on the onset or progression of glaucoma in the studies reviewed in this assessment.CONCLUSIONS: Intravitreal injection of anti-VEGF agents results in an immediate and transient rise in IOP. A long-term increase in IOP may be seen as well, and further studies are needed to determine at-risk populations. Although there is some suggestion in the literature, there is currently insufficient data to determine the impact of intravitreal anti-VEGF injections on glaucoma progression. Even though pretreatment with glaucoma medications, performing anterior chamber paracentesis, or increasing the interval between injections may reduce the impact of transient IOP elevation, the clinical significance and associated risks of these interventions are unknown.

  View details for PubMedID 30472176

• Comparison of Optical Coherence Tomography With Fundus Photographs, Fluorescein Angiography, and Histopathologic Analysis in Assessing Coats Disease. JAMA ophthalmology Ong, S. S., Cummings, T. J., Vajzovic, L., Mruthyunjaya, P., Toth, C. A. 2018

  Abstract

  Importance: Coats disease is a rare pediatric vitreoretinopathy that can cause devastating visual and anatomic outcomes.Objective: To compare optical coherence tomography (OCT) with fundus photographs, fluorescein angiography (FA), and histopathologic findings in Coats disease.Design, Setting, and Participants: This retrospective cohort study was conducted in a single tertiary institution (Duke Eye Center) and identified 28 children with Coats disease through a review of medical records from December 2002 to January 2018. Four eyes were obtained from a biorepository for histopathologic analysis.Main Outcomes and Measures: Macular OCT, fundus photographs, and FA results were reviewed and compared for morphological changes. These were compared with retinal histopathological findings.Results: The mean (SD) age was 9.5 (5.5) years for the 28 children (and 29 eyes) with clinical imaging results, and 24 (86%) were boys. A comparison between imaging modalities revealed OCT features that were not visible in photographs or FA, including exudates in multiple retinal layers (23 [82.1%]), small pockets of subretinal fluid (4 [14.3%]), an outer retinal atrophy overlying fibrotic nodules (7 [25.0%]), and small preretinal hyperreflective OCT dots (25 [89.3%]). Next, a comparison with light micrographs introduced an association of OCT findings with possible pathological features, including hyperreflective linear structures on OCT that appeared consistent with cholesterol crystals, small hyperreflective dots with macrophages, outer retinal tubulations with rosettes, and analogous OCT histopathology features such as intraretinal vessels entering fibrotic nodules and retinal pigment epithelium excrescences under the subretinal fluid. An OCT analysis revealed intraretinal cystoid spaces in 19 eyes, but in 9 of 19 (47.4) this was not associated with cystoid macular leakage; rather, fluorescein leakage was observed from peripheral telangiectatic vessels. Additionally, exudates were intraretinal only (6 [21.4%]) or both intraretinal and subretinal (17 [60.7%]); none were subretinal only. In eyes with follow-up results, new fibrosis developed in 8 of 17 eyes (47.1%). Fibrosis developed in 5 of 5 eyes (100%) with baseline subretinal fluid vs 3 of 12 without (25%; 95% CI, 22%-92%) and in 7 of 9 eyes (77.8%) with subretinal exudates vs 1 of 8 (12.5%) without (95% CI, 16%-89%).Conclusions and Relevance: Optical coherence tomography may show the transient and permanent effects of Coats disease on the retina. These results suggest that exudates and fluid in the macular subretinal space appear later in the disease and may result in fibrosis formation. Further studies are needed to confirm if early treatment could prevent vision-threatening macular fibrosis.

  View details for PubMedID 30476946

• CORRELATION OF GENE EXPRESSION PROFILE STATUS AND AMERICAN JOINT COMMISSION ON CANCER STAGE IN UVEAL MELANOMA. Retina (Philadelphia, Pa.) Berry, D. E., Schefler, A. C., Seider, M. I., Materin, M., Stinnett, S., Mruthyunjaya, P., Ocular Oncology Study Consortium 2018

  Abstract

  PURPOSE: To study the relationship between gene expression profile (GEP) subclass and American Joint Committee on Cancer (AJCC) stage in patients with uveal melanoma (UM).METHODS: A retrospective, multicenter study was undertaken with patients entered from nine major ocular oncology centers from across the United States. Three hundred sixty eligible patients had UM and underwent I-125 plaque brachytherapy with concurrent tumor biopsy with GEP testing between January 1, 2010, and October 28, 2014. Patient demographics and UM features were analyzed by both GEP and AJCC status.RESULTS: Gene expression profile class divided the cohort into three groups: Class 1a (n = 186), Class 1b (n = 77), and Class 2 (n = 113). When classified using AJCC staging criteria, we found the following: Stage I in 91 cases (25.3%), Stage IIA in 143 cases (39.7%), Stage IIB in 89 cases (24.7%), Stage IIIA in 36 cases (10%), and Stage IIIB in 1 case (0.3%). There were no Stage IV cases, as lymph node and metastatic data were not collected as a part of this study. Among Stage I tumors, both high tumor height and high largest basal diameter were associated with a higher frequency of Class 2 status (P < 0.05). As UMs progress to a larger AJCC tumor group (T1-T4), the odds ratio of having a worse prognosis based on GEP class was 1.75 (95% CI, 1.36-2.25; P < 0.001). Similarly, as UMs progress to a higher AJCC stage, the odds ratio of having a worse prognosis based on GEP class was 1.69 (95% CI, 1.36-2.10; P < 0.001).CONCLUSION: This report details the differences in clinical features between GEP subclasses and how they are distributed among the AJCC stages. When the tumors were grouped by AJCC staging criteria, both larger AJCC tumor (T) group and worsening AJCC stage were associated with worsening predicted prognosis, based on GEP subclass.

  View details for PubMedID 30418387

• Conjunctival Dehiscence and Scleral Necrosis following Iodine-125 Plaque Brachytherapy for Uveal Melanoma: A Report of 3 Cases. Ocular oncology and pathology Berry, D. E., Grewal, D. S., Mruthyunjaya, P. 2018; 4 (5): 291-296

  Abstract

  Plaque brachytherapy is currently the most common treatment for uveal melanoma and has many known potential complications. Here we present 3 cases of early conjunctival and scleral necrosis following iodine-125 plaque.This study was conducted as a retrospective case series.We identified 3 cases of early conjunctival and scleral necrosis following iodine-125 plaque. All patients were managed conservatively with resolution of the necrosis.While delayed corneoscleral necrosis following plaque brachytherapy has been previously reported, occurring many months to years after treatment, the 3 cases in this series presented within 2-6 weeks in the postoperative period. While we were unable to identify a specific etiology, we believe this represents a distinct clinical entity of post-brachytherapy cornea-scleral necrosis that is important to recognize. Possible causes include acute radiation toxicity, mechanical trauma, and/or conjunctival microinfection.

  View details for DOI 10.1159/000481858

  View details for PubMedID 30320099

  View details for PubMedCentralID PMC6167656

• CHOROIDAL TUMOR BIOPSY A Review of the Current State and a Glance Into Future Techniques RETINA-THE JOURNAL OF RETINAL AND VITREOUS DISEASES Finn, A. P., Materin, M. A., Mruthyunjaya, P. 2018; 38: S79–S87

  View details for DOI 10.1097/IAE.0000000000001997

  View details for Web of Science ID 000454004600011

• Biopsy of a Choroidal Melanoma Using Transvitreal Pars Plana Vitrectomy. Ophthalmic surgery, lasers & imaging retina Tang, P. H., Shields, R. A., Schefler, A. C., Mruthyunjaya, P. 2018; 49 (8): 645–47

  Abstract

  Determining when a previously benign choroidal nevi becomes malignant can be challenging, as traditional biopsy methods are often invasive and can lead to secondary complications such as endophthalmitis and vitreous hemorrhage. Using a transvitreal approach with the 27-gauge vitrectomy system provides several advantages, including direct visualization, theoretically lower risk of inadvertent seeding, and collection of a larger sample size. In this video, the authors present their technique for transvitreal biopsy of choroidal lesions using the 27-gauge vitreous cutter.

  View details for DOI 10.3928/23258160-20180803-16

  View details for PubMedID 30114313

• Spectral-domain optical coherence tomography findings in Coats' disease Ong, S. S., Vajzovic, L., Stinnett, S., Mruthyunjaya, P., Toth, C. A. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2018

  View details for Web of Science ID 000442932805046

• Macular Features on Spectral-Domain Optical Coherence Tomography Imaging Associated With Visual Acuity in Coats' Disease INVESTIGATIVE OPHTHALMOLOGY & VISUAL SCIENCE Ong, S. S., Mruthyunjaya, P., Stinnett, S., Vajzovic, L., Toth, C. A. 2018; 59 (7): 3161–74

  View details for DOI 10.1167/iovs.18-24109

  View details for Web of Science ID 000437542400015

• Macular Features on Spectral-Domain Optical Coherence Tomography Imaging Associated With Visual Acuity in Coats' Disease. Investigative ophthalmology & visual science Ong, S. S., Mruthyunjaya, P., Stinnett, S., Vajzovic, L., Toth, C. A. 2018; 59 (7): 3161-3174

  Abstract

  To investigate the association between macular features on spectral-domain optical coherence tomography (SD-OCT) and visual acuity (VA) in Coats' disease.Thirty-nine eyes (39 patients) with SD-OCT from January 1, 2008 to December 31, 2016 were reviewed for SD-OCT features. Central subfield (CSF) SD-OCT findings were analyzed relative to VA (logarithm of the minimum angle of resolution) at baseline and final visit (when follow-up ≥ 6 months) and across visits.Mean VA ± standard deviation at baseline (37 eyes) was 0.92 ± 0.82. SD-OCT features associated with worse VA included, for treatment-naïve eyes (n = 21), outer retinal atrophy (ORA) (1.18 ± 0.34 with versus 0.20 ± 0.30 without, P = 0.005), subretinal fluid (SRF) (1.80 ± 0.63 vs. 0.63 ± 0.50, P = 0.008), bright hyperreflectivities (1.23 ± 0.68 vs. 0.52 ± 0.53, P = 0.02), thicker foveal subretinal space (r2 = 0.32, P = 0.01), and CSF (r2 = 0.39, P = 0.007); and for previously treated eyes (n = 16), a compact hyperreflective structure (1.60 ± 0.88 vs. 0.56 ± 0.64, P = 0.02) and ORA (1.34 ± 0.86 vs. 0.30 ± 0.44, P = 0.01). At final follow-up (n = 22), mean VA was 0.81 ± 0.83. Eyes with final VA <20/200 (n = 6, vs. >20/60, n = 11) more commonly had a compact hyperreflective structure and ORA at baseline and final visit (P < 0.05). Mean change in VA from baseline (n = 20) was -0.20 ± 0.59. Mean improvement in VA (range, -0.525 to -1.127) occurred in eyes with baseline SRF (P = 0.02) and bright hyperreflectivities (P = 0.03). Changes in thickness that correlated with change in VA included those for the foveal subretinal space (r2 = 0.52, P < 0.001) and CSF (r2 = 0.26, P = 0.045).A compact hyperreflective structure (fibrosis) and ORA were associated with poor final VA while SRF, bright hyperreflectivities (exudation), and foveal subretinal thickness were associated with VA improvement post treatment.

  View details for DOI 10.1167/iovs.18-24109

  View details for PubMedID 30025132

  View details for PubMedCentralID PMC6021031

• A Case of Progressive Dimming Vision JAMA OPHTHALMOLOGY Thompson, A. C., Chen, X., Mruthyunjaya, P. 2018; 136 (4): 434–35

  View details for PubMedID 29270619

• Diagnostic and Therapeutic Challenges RETINA-THE JOURNAL OF RETINAL AND VITREOUS DISEASES Iu, L. P., Fan, M. C., Wong, I. Y., Mruthyunjaya, P. 2018; 38 (4): 849-853

  View details for DOI 10.1097/IAE.0000000000001751

  View details for Web of Science ID 000440623400032

  View details for PubMedID 28661968

• RELATIONSHIP OF CLINICAL FEATURES AND BASELINE TUMOR SIZE WITH GENE EXPRESSION PROFILE STATUS IN UVEAL MELANOMA: A Multi-institutional Study. Retina (Philadelphia, Pa.) Berry, D., Seider, M., Stinnett, S., Mruthyunjaya, P., Schefler, A. C., Ocular Oncology Study Consortium 2018

  Abstract

  PURPOSE: To study the relationship between gene expression profile subclass and clinical features in a multicenter cohort of patients with uveal melanoma.METHODS: A retrospective, multicenter study was undertaken with patients entered from nine major ocular oncology centers from across the United States. Eligible patients had uveal melanoma and underwent I-125 plaque brachytherapy with concurrent tumor biopsy with gene expression profile testing between January 1, 2010, and October 28, 2014. Data were collected regarding patient demographics, baseline tumor clinical features, and gene expression profile results. Statistical analyses were performed using the Fisher's exact test, Wilcoxon rank-sum test, Kruskal-Wallis test, and proportional-odds cumulative logit modeling.RESULTS: Inclusion criteria were met for 379 patients. Gene expression profile class divided the cohort into two main groups, Class 1 (n = 263) and Class 2 (n = 113). Class 1 tumors were further subdivided into Class 1a (n = 186) and Class 1b (n = 77). The differences between Class 1 and Class 2 tumors were similar to previous studies, except the finding of Class 2 tumors being more likely to have associated exudative retinal detachment (P < 0.001). There was no statistically significant difference between Class 1 and Class 2 tumors based on the presence of lipofuscin, drusen, or subretinal fluid. Class 1a tumor patients, compared with Class 1b, were significantly older (P = 0.034). Class 2 tumors, when compared with Class 1b, were associated with increasing patient age (P < 0.001), larger tumor height (P = 0.010), ciliary body involvement (P = 0.001), exudative retinal detachment (P = 0.024), and anterior tumor location (P < 0.001). When the tumors were grouped into Collaborative Ocular Melanoma Study size categories, increasing tumor size category was significantly associated with Class 2 status: 6% of small tumors, 32% of medium tumors, and 53% of large tumors were Class 2.CONCLUSION: In a multi-institutional setting, we found that the only significant difference in clinical features between Class 1a and Class 1b tumors was that patients with Class 1a tumors were older at the time of diagnosis. We also found that Class 1a and Class 1b have clinical features distinct from Class 2 tumors. The distribution of the gene expression profile subclasses among the size groups was similar to reported time-to-metastasis data among the same size groupings. Our clinical findings support the current molecular classification-based survival data previously reported in uveal melanoma.

  View details for PubMedID 29578940

• IDENTIFICATION OF POSTERIOR SEGMENT PATHOLOGY WITH EN FACE RETINAL IMAGING USING MULTICOLOR CONFOCAL SCANNING LASER OPHTHALMOSCOPY. Retina (Philadelphia, Pa.) Feng, H. L., Sharma, S., Stinnett, S., Asrani, S., Mruthyunjaya, P. 2018

  Abstract

  PURPOSE: To assess posterior segment findings on multicolor confocal scanning laser ophthalmoscopy by correlation with spectral domain optical coherence tomography (SD-OCT) and to quantify agreement between these imaging modalities.METHODS: Retrospective review of 159 eyes of 96 consecutive patients who underwent concurrent imaging with multicolor confocal scanning laser ophthalmoscopy and SD-OCT. Positive percent agreement and negative percent agreement were calculated for each finding identified on infrared, green, blue, and multicolor reflectance images using SD-OCT as a comparator.RESULTS: Infrared reflectance best detected outer retinal and choroidal findings such as choroidal lesions, retinal pigment epithelium atrophy, peripapillary atrophy, and drusen (positive percent agreement 100, 92, 92, and 67%, respectively). Inner retinal changes including epiretinal membrane, lamellar macular hole, and inner retinal alterations were best detected on blue reflectance (positive percent agreement 94, 50, and 100%, respectively). Composite multicolor reflectance most effectively detected conditions with retinal elevation, including pigment epithelial detachment, intraretinal fluid, and subretinal fluid (positive percent agreement 65, 49, and 54%, respectively). Multicolor confocal scanning laser ophthalmoscopy detected intraretinal and subretinal hemorrhages, which were not detected on SD-OCT (negative percent agreement 87 and 97%, respectively).CONCLUSION: Multicolor confocal scanning laser ophthalmoscopy is capable of identifying posterior segment pathology at various anatomical depths and may be a useful adjunct to SD-OCT for detecting or monitoring certain retinal conditions.

  View details for PubMedID 29474307

• Efficacy and Safety of Low-Dose Iodine Plaque Brachytherapy for Juxtapapillary Choroidal Melanoma AMERICAN JOURNAL OF OPHTHALMOLOGY Oellers, P., Mowery, Y. M., Perez, B. A., Stinnett, S., Mettu, P., Vajzovic, L., Light, K., Steffey, B. A., Cai, J., Dutton, J. J., Buckley, E. G., Halperin, E. C., Marks, L. B., Kirsch, D. G., Mruthyunjaya, P. 2018; 186: 32–40

  Abstract

  To evaluate low- vs high-dose plaque brachytherapy for juxtapapillary choroidal melanoma.Retrospective interventional case series.Setting: Single institution.Forty-seven patients with juxtapapillary choroidal melanoma.Iodine-125 plaque brachytherapy. Eyes were divided into apex low-dose (LD) and high-dose (HD) groups (≤ or > median apex dose 84.35 Gy). Main outcome measures were time to distant failure, local failure, death, enucleation, radiation retinopathy, optic neuropathy, and best-corrected visual acuity (BCVA).Freedom from distant failure rates were 96% and 95% in apex LD and HD groups at 5 years and 77% and 95% at 10 years, respectively (P = .84). Freedom from local failure rates were 90% in the apex LD group vs 89% in the HD group at 5 and 10 years (P = .96). Apex LD and HD groups did not differ for time to death or enucleation. Five- and 10-year freedom from radiation retinopathy and optic neuropathy rates were higher in the apex LD than HD group. Loss of ≥3 BCVA lines, final BCVA 20/40 or better, and final BCVA 20/200 or worse were more favorable in the 5 mm LD compared to HD group. Visual acuity outcomes did not differ between apex LD and HD groups.Low-dose iodine-125 plaque brachytherapy (67.5-81 Gy at tumor apex) provides safe and effective tumor control for juxtapapillary choroidal melanoma and may be associated with reduced radiation toxicity. Larger trials are needed to determine the optimal therapeutic dose for juxtapapillary choroidal melanoma.

  View details for PubMedID 29199010

• MOLECULAR PROGNOSTICS FOR UVEAL MELANOMA RETINA-THE JOURNAL OF RETINAL AND VITREOUS DISEASES Seider, M. I., Mruthyunjaya, P. 2018; 38 (2): 211–19

  Abstract

  To review laboratory methods, currently available commercial tests, caveats and clinical tips regarding prognostic analysis of uveal melanoma tissue.A review of the literature was performed focused on the genetic abnormalities found in uveal melanoma cells, their correlation to the development of metastases, the validity of various laboratory approaches in their detection, and the existing commercially available tests for uveal melanoma prognostication.Numerous laboratory methods exist for analyzing genetic material obtained from uveal melanoma cells. Older tests have been gradually replaced with contemporary methods that are simpler with greater accuracy. Two commercially available assays exist which have not been directly compared-a gene expression profiling test has been validated directly through a large, prospective multicenter study and a DNA-based test which uses laboratory methods supported by extensive historical data.There are myriad laboratory methods for prognostic analysis of uveal melanoma tissue. These tests were historically only available to those with access to an outfitted laboratory. Newer commercially available assays have increased the accessibility of prognostic biopsy for uveal melanoma. The various caveats that exist when considering and performing prognostic biopsy of uveal melanoma are discussed.

  View details for Web of Science ID 000428735400006

  View details for PubMedID 28665870

• Conjunctival Dehiscence and Scleral Necrosis following Iodine-125 Plaque Brachytherapy for Uveal Melanoma: A Report of 3 Cases OCULAR ONCOLOGY AND PATHOLOGY Berry, D. E., Grewal, D. S., Mruthyunjaya, P. 2018; 4 (5): 291–96

  View details for DOI 10.1159/000481858

  View details for Web of Science ID 000444101800004

• CHOROIDAL TUMOR BIOPSY: A Review of the Current State and a Glance Into Future Techniques. Retina (Philadelphia, Pa.) Finn, A. P., Materin, M. A., Mruthyunjaya, P. 2017

  Abstract

  PURPOSE: To review the indications for and the methods of obtaining biopsies in eyes with uveal melanoma. In addition, this review provides recommendations for avoiding biopsy-related complications and discusses the future directions of biopsy techniques for uveal melanoma.METHODS: This review is based on a presentation by the authors (PM and MM) at the 2017 Duke Advanced Vitreoretinal Surgery Course and an extensive literature review using PubMed.RESULTS: Transscleral and transvitreal fine-needle aspiration biopsy, and transvitreal vitrectomy-assisted biopsy techniques are described. The use of 25- and 27-gauge needles and vitreous cutters through a transvitreal approach are most commonly used. Complications are uncommon but may include vitreous hemorrhage, retinal detachment, and rarely, extraocular extension. Proper technique and precautions will minimize the occurrence of these rare complications.CONCLUSION: Biopsy of uveal melanoma either using a needle or vitrectomy-assisted procedures is safe and these techniques continue to improve with new vitreoretinal surgical advances.

  View details for PubMedID 29280938

• Multifocal iris melanoma in a 2-year-old managed with I-125 plaque brachytherapy JOURNAL OF AAPOS Lee, A. R., Grewal, D. S., Cummings, T. J., Enyedi, L. B., Larrier, N. A., Mruthyunjaya, P. 2017; 21 (5): 410–11

  Abstract

  We report a 23-month-old patient presenting with multifocal iris melanoma who underwent plaque brachytherapy with full corneal coverage. The lesion demonstrated several high-risk clinical and histopathologic features associated with iris melanoma in adults, including growth and angle seeding. The patient has been subsequently followed for 3.5 years with no evidence of recurrence. This report demonstrates the importance of serial examination of suspected melanocytic iris lesions in very young children and the effective treatment option of globe-sparing radiation therapy.

  View details for PubMedID 28844752

• Characterization of Artifacts Associated With Multicolor Confocal Scanning Laser Ophthalmoscopy OPHTHALMIC SURGERY LASERS & IMAGING RETINA Feng, H. L., Sharma, S., Stinnett, S., Asrani, S., Mruthyunjaya, P. 2017; 48 (10): 810–15

  Abstract

  To characterize the appearance of three types of artifacts observed on multicolor confocal scanning laser ophthalmoscopy (cSLO).Retrospective review of 159 eyes of 96 consecutive patients from the Duke Eye Center who underwent multicolor cSLO with spectral-domain optical coherence tomography (SD-OCT). Infrared (IR), green, blue, and multicolor reflectance images were evaluated for artifacts with corresponding SD-OCT scans available for reference.Multicolor cSLO artifacts were detected in 23.3% (37 of 159) of eyes and comprised three main patterns: spot, wisp, and net. Only three instances of these artifacts were detected on IR reflectance versus 34, 37, and 35 instances on green, blue, and multicolor reflectance, respectively. Artifacts were observed in 0% of eyes with clear lenses, 27.7% of eyes with cataracts, and in 20.8% of eyes with posterior chamber intraocular lenses.Awareness of spot, wisp, and net artifacts when interpreting multicolor cSLO images may facilitate the identification of true retinal pathology. [Ophthalmic Surg Lasers Imaging Retina. 2017;48:810-815.].

  View details for DOI 10.3928/23258160-20170928-05

  View details for Web of Science ID 000416073000005

  View details for PubMedID 29020424

• Anterior Chamber Angle Invasion of Iridociliary Melanoma. Ophthalmology Walter, S. D., Cummings, T. J., Mruthyunjaya, P. 2017; 124 (6): 842-?

  View details for DOI 10.1016/j.ophtha.2016.12.003

  View details for PubMedID 28528829

• Ocular Oncology Study Consortium Report 3: Baseline clinical features and relationship to GEP Class Schefler, A. C., Berry, D., Seider, M., Stinnett, S., Mruthyunjaya, P. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2017

  View details for Web of Science ID 000432170306229

• Therapies for Macular Edema Associated with Branch Retinal Vein Occlusion: A Report by the American Academy of Ophthalmology. Ophthalmology Ehlers, J. P., Kim, S. J., Yeh, S., Thorne, J. E., Mruthyunjaya, P., Schoenberger, S. D., Bakri, S. J. 2017

  Abstract

  To evaluate the available evidence on the ocular safety and efficacy of current therapeutic alternatives for the management of macular edema (ME) secondary to branch retinal vein occlusion (BRVO).Literature searches were last conducted on January 31, 2017, in PubMed with no date restrictions and limited to articles published in English, and in the Cochrane Database without language limitations. The searches yielded 321 citations, of which 109 were reviewed in full text and 27 were deemed appropriate for inclusion in this assessment. The panel methodologist assigned ratings to the selected studies according to the level of evidence.Level I evidence was identified in 10 articles that addressed anti-vascular endothelial growth factor (VEGF) pharmacotherapies for ME, including intravitreal bevacizumab (5), aflibercept (2), and ranibizumab (4). Level I evidence was identified in 6 studies that examined intravitreal corticosteroids, including triamcinolone (4) and the dexamethasone implant (2). Level I evidence also was available for the role of macular grid laser photocoagulation (7) and scatter peripheral laser surgery (1). The inclusion of level II and level III studies was limited given the preponderance of level I studies. The number of studies on combination therapy is limited.Current level I evidence suggests that intravitreal pharmacotherapy with anti-VEGF agents is effective and safe for ME secondary to BRVO. Prolonged delay in treatment is associated with less improvement in visual acuity (VA). Level I evidence also indicates that intravitreal corticosteroids are effective and safe for the management of ME associated with BRVO; however, corticosteroids are associated with increased potential ocular side effects (e.g., elevated intraocular pressure, cataracts). Laser photocoagulation remains a safe and effective therapy, but VA results lag behind the results for anti-VEGF therapies.

  View details for DOI 10.1016/j.ophtha.2017.03.060

  View details for PubMedID 28551163

• Association between Tumor Regression Rate and Gene Expression Profile after Iodine 125 Plaque Radiotherapy for Uveal Melanoma. Ophthalmology Mruthyunjaya, P., Seider, M. I., Stinnett, S., Schefler, A. 2017

  Abstract

  Gene expression profile (GEP) testing segregates uveal melanoma (UM) into 2 main prognostic classes. It is unknown if a greater tumor regression response after iodine 125 (I(125)) brachytherapy correlates with class 2 GEP status. The purpose of this study was to determine whether there is a significant relationship between the rate of UM height regression and GEP classification testing after I(125) plaque brachytherapy.Multicenter, retrospective cohort study.Adult UM patients treated with I(125) plaque brachytherapy who had concurrent tumor biopsy at the time of surgery with a GEP test result from January 1, 2010 through June 30, 2014.Baseline clinical data and GEP class assignments were obtained. The ultrasonographic tumor height was recorded at baseline and at 3, 6, 9, and 12 months and at the most recent final follow-up visits. Subanalysis of paired cases based on pretreatment ultrasound height was performed. Statistical analysis was performed using Wilcoxon rank-sum tests, the Fisher exact test, and Kaplan-Meier analysis.Percentage change in tumor height from baseline.A total of 353 patients were included in the study. Median follow-up was 2.1 years (range, 0.5-5.3 years). Gene expression profile status was class 1 in 247 tumors (70%) and class 2 in 106 tumors (30%). Increased patient age, larger tumor dimensions, and greater tumor thickness were associated with class 2 GEP status (P = 0.006, P < 0.001, and P < 0.001, respectively). The percentage reduction in tumor height from baseline was significantly greater in class 1 than class 2 tumors at 3 months (17.5% vs. 11.8%; P = 0.007) and 6 months (26.8% vs. 17.1%; P = 0.007), respectively, but there was no significant difference in reduction between class 1 and 2 tumors at 9 months (P = 0.26) and 12 months (P = 0.57) after treatment. Class 1A and 1B tumors showed similar reduction compared with class 2 tumors (P < 0.05).Class 1 UM tumors tend to regress more rapidly than class 2 tumors in the first 6 months after plaque radiotherapy. Class 1A and 1B tumors regress at similar rates after plaque radiotherapy.

  View details for DOI 10.1016/j.ophtha.2017.04.013

  View details for PubMedID 28549517

• Outcomes of 27-Gauge Vitrectomy-Assisted Choroidal and Subretinal Biopsy. Ophthalmic surgery, lasers & imaging retina Grewal, D. S., Cummings, T. J., Mruthyunjaya, P. 2017; 48 (5): 406-415

  Abstract

  To report the initial experience of 27-gauge vitrectomy-assisted choroidal and subretinal biopsy PATIENTS AND METHODS: Retrospective, interventional case series. Eighteen eyes of 18 patients undergoing 27-gauge vitrectomy-assisted choroidal (n = 16) or subretinal biopsy (n = 2). Clinical and lesion characteristics, cytopathology, histology, gene expression profiling (GEP), visual acuity (VA), complications including vitreous hemorrhage (VH), development of rhegmatogenous retinal detachment (RD), and need for additional surgeries were analyzed.Indications were choroidal melanoma (n = 10), indeterminate choroidal (n = 5), and subretinal lesions (n = 3). Mean lesion height was 3.33 mm ± 1.55 mm (range: 0.80 mm to 6.75 mm) and largest diameter was 8.63 mm ± 4.14 mm (range: 3 mm to 15.5 mm). Mean number of intralesional biopsy passes required was 1.76 ± 0.83 (range: one to four). During a mean follow-up of 7.4 months ± 2.7 months (range: 4 months to 14 months), VA was unchanged (0.5 logMAR ± 0.6 logMAR vs. 0.7 logMAR ± 0.84 logMAR; P = .07). Pathologic diagnosis was obtained in 16 of 18 eyes (88.9%), and GEP data were collected for all 11 choroidal melanomas. Post-biopsy VH occurred in 13 of 18 eyes (72.2%) and was severe enough to require a concurrent limited vitrectomy in six eyes (33.3%). These eyes had a greater lesion height compared to eyes not requiring a vitrectomy (4.08 mm ± 1.68 mm vs. 2.76 mm ± 1.43 mm; P = .04). A rhegmatogenous RD requiring repeat surgery developed in two of 18 eyes (11.1%).The authors concluded that 27-gauge vitrectomy-assisted choroidal and subretinal biopsy established a diagnosis in 88.9% of eyes in lesions 0.8 mm or larger. [Ophthalmic Surg Lasers Imaging Retina. 2017;48:406-415.].

  View details for DOI 10.3928/23258160-20170428-07

  View details for PubMedID 28499052

• Comparison of Visual Outcomes in Coats' Disease: A 20-Year Experience. Ophthalmology Ong, S. S., Buckley, E. G., McCuen, B. W., Jaffe, G. J., Postel, E. A., Mahmoud, T. H., Stinnett, S. S., Toth, C. A., Vajzovic, L., Mruthyunjaya, P. 2017

  Abstract

  To report differences in visual acuities among patients with Coats' disease who sought treatment at a tertiary care university-based practice.Single-center retrospective cohort study.Patients with Coats' disease diagnosed clinically, angiographically, or both from 1995 through 2015.Patients were divided into 2 groups based on date of presentation: decade 1 (1995-2005) and decade 2 (2006-2015).Visual acuity (VA).Thirty-nine eyes of 39 patients were included with 19 eyes presenting in decade 1 and 20 eyes presenting in decade 2. Three patients demonstrated bilateral disease, but only the worse eye was included for analysis. Forty-seven percent of eyes in decade 1 demonstrated advanced stages of disease (stage 3B or worse) compared with 20% of eyes in decade 2. There was a trend for the mean initial presenting VA (±standard deviation) for decade 1 eyes to be worse (2.05±1.29 logarithm of the minimum angle of resolution [logMAR]) than for decade 2 eyes (1.45±0.99 logMAR; P = 0.1). From initial to final follow-up visit, mean VA also worsened for decade 1 eyes (P = 0.03), but remained stable for decade 2 eyes (P = 1.0). At the end of follow-up, there was a trend for mean VA for decade 1 eyes (2.28±1.17 logMAR) to be worse than for decade 2 eyes (1.60±1.15 logMAR; P = 0.07). Eight eyes were observed initially in decade 1 compared with 1 eye in decade 2, and only 1 of the observed eyes (in decade 2) developed painful glaucoma requiring enucleation. Decade 2 eyes had a higher average number of procedures per eye (6.5±4.9) compared with decade 1 eyes (1.4±1.7; P < 0.001).The earlier presentation of disease in decade 2 suggests improvements in disease detection over time. Furthermore, there was a trend for eyes to have better final VA in this decade. This is due to a combination of factors, including earlier presentation of disease, fewer eyes being observed without treatment, and eyes, when treated, receiving a higher number of procedures.

  View details for DOI 10.1016/j.ophtha.2017.03.051

  View details for PubMedID 28461016

• Pigmented Iridociliary Lesion and Increased Intraocular Pressure. JAMA ophthalmology Schwartz, T. M., Walter, S. D., Mruthyunjaya, P. 2017

  View details for DOI 10.1001/jamaophthalmol.2016.5128

  View details for PubMedID 28448661

• Intraoperative 4-Dimensional Microscope-Integrated Optical Coherence Tomography-Guided 27-Gauge Transvitreal Choroidal Biopsy for Choroidal Melanoma RETINA-THE JOURNAL OF RETINAL AND VITREOUS DISEASES Grewal, D. S., Bhullar, P. K., Pasricha, N. D., Carrasco-Zevallos, O. M., Viehland, C., Keller, B., Shen, L., Izatt, J. A., Kuo, A. N., Toth, C. A., Mruthyunjaya, P. 2017; 37 (4): 796-799

  View details for Web of Science ID 000399378000030

• Ocular Surface Epithelial Atypia Mimicking Squamous Neoplasia in Association With Ulcerative Colitis. Cornea Ong, S. S., Walter, S. D., Chen, X., Vora, G. K., Daluvoy, M., Proia, A. D., Mruthyunjaya, P. 2017; 36 (4): 502-505

  Abstract

  Inflammatory bowel disease may be associated with extraintestinal manifestations. We report a case of severe reactive epithelial atypia resembling ocular surface squamous neoplasia (OSSN) in a patient with ulcerative colitis (UC).Case report.A 32-year-old woman presented with sequential, progressive keratoconjunctival lesions in the left and right eyes, and both lesions were excised. Anterior segment optical coherence tomography demonstrated features similar to OSSN, whereas histological examination revealed severe reactive epithelial atypia mimicking severe dysplasia. Shortly after treatment of the second eye, the patient was diagnosed with UC. Residual disease improved dramatically in response to systemic corticosteroids.Severe ocular surface epithelial atypia resembling OSSN may be seen in association with UC.

  View details for DOI 10.1097/ICO.0000000000001144

  View details for PubMedID 28129293

• Diagnosis and Treatment of Acute Retinal Necrosis: A Report by the American Academy of Ophthalmology. Ophthalmology Schoenberger, S. D., Kim, S. J., Thorne, J. E., Mruthyunjaya, P., Yeh, S., Bakri, S. J., Ehlers, J. P. 2017; 124 (3): 382-392

  Abstract

  To evaluate the available evidence in peer-reviewed publications about the diagnosis and treatment of acute retinal necrosis (ARN).Literature searches of the PubMed and Cochrane Library databases were last conducted on July 27, 2016. The searches identified 216 unique citations, and 49 articles of possible clinical relevance were reviewed in full text. Of these 49 articles, 27 were deemed sufficiently relevant or of interest, and they were rated according to strength of evidence. An additional 6 articles were identified from the reference lists of these articles and included. All 33 studies were retrospective.Polymerase chain reaction (PCR) testing of aqueous or vitreous humor was positive for herpes simplex virus (HSV) or varicella zoster virus (VZV) in 79% to 100% of cases of suspected ARN. Aqueous and vitreous specimens are both sensitive and specific. There is level II and III evidence supporting the use of intravenous and oral antiviral therapy for the treatment of ARN. Data suggest that equivalent plasma drug levels of acyclovir can be achieved after administration of oral valacyclovir or intravenous acyclovir. There is level II and III evidence suggesting that the combination of intravitreal foscarnet and systemic antiviral therapy may have greater therapeutic efficacy than systemic therapy alone. The effectiveness of prophylactic laser or early pars plana vitrectomy (PPV) in preventing retinal detachment (RD) remains unclear.Polymerase chain reaction testing of ocular fluid is useful in supporting a clinical diagnosis of ARN, but treatment should not be delayed while awaiting PCR results. Initial oral or intravenous antiviral therapy is effective in treating ARN. The adjunctive use of intravitreal foscarnet may be more effective than systemic therapy alone. The role of prophylactic laser retinopexy or early PPV is unknown at this time.

  View details for DOI 10.1016/j.ophtha.2016.11.007

  View details for PubMedID 28094044

• Association of Pediatric Choroidal Neovascular Membranes at the Temporal Edge of Optic Nerve and Retinochoroidal Coloboma AMERICAN JOURNAL OF OPHTHALMOLOGY Grewal, D. S., Du Tran-Viet, D., Vajzovic, L., Mruthyunjaya, P., Toth, C. A. 2017; 174: 104-112

  Abstract

  To describe the characteristics of pediatric choroidal neovascular membranes (CNV) associated with retinochoroidal and optic nerve coloboma using optical coherence tomography (OCT) and their response to treatment.Retrospective case series.Retrospective review of children <16 years with CNV and retinochoroidal and optic-nerve coloboma from 1995-2015 who underwent OCT imaging using either hand-held (Bioptigen, Morrisville, NC) or table-top OCT (Spectralis, Heidelberg, Carlsbad, CA) RESULTS: Eight eyes of 8 patients (3 males, 5 females) with a mean age of 4.1±3.9 years (range 6-months to 10-years) at diagnosis were included. Mean follow-up was 21.4±12.1 months (range 7-38 months). An optic-nerve coloboma was present in 2 eyes and combined optic nerve and retinochoroidal coloboma in 6 eyes. In all eyes, CNV was located at temporal margin of the coloboma closest to macula. Fluorescein angiogram characteristics included staining without leakage suggesting inactivity (n=6), and leakage (n=2). OCT characteristics included subretinal fluid (n=5), intraretinal fluid and cysts (n=1) and subretinal hyperreflective material (n=7). Two eyes received intravitreal bevacizumab (range 3-6) injections, and one of which also underwent focal peripapillary laser. Both eyes showed improvement in subretinal or intraretinal fluid on OCT. Vision at presentation among those quantified, ranged from 20/200 to 20/40 and at final follow-up from 20/400 to 20/30. Genetic or systemic abnormalities were seen in 6 patients.Association of pediatric CNV occurrence at the temporal margin of retinochoroidal and optic nerve colobomas closest to fovea has not been established before and careful OCT and angiographic assessment of this region is warranted. The CNV lesions exhibit a varied degree of response to treatment.

  View details for DOI 10.1016/j.ajo.2016.10.010

  View details for Web of Science ID 000393148800012

• Advances in the management of conjunctival melanoma SURVEY OF OPHTHALMOLOGY Vora, G. K., Demirci, H., Marr, B., Mruthyunjaya, P. 2017; 62 (1): 26-42

  Abstract

  Malignant melanoma of the conjunctiva is a rare but serious condition. Over the last several years, there have been important advances in the classification, diagnosis, and treatment of this condition. Recent cytogenetic and immunohistochemical studies are increasing understanding of its tumorigenesis. Diagnosis, although still made via histopathology, has been aided with imaging techniques such as ultrasound biomicroscopy and anterior segment optical coherence tomography. Primary treatment consists of surgical excision. But adjuvant treatments with cryotherapy, topical chemotherapy, and radiation therapy have shown increased success. Sentinel lymph node biopsy has shown early promise of detecting micro-metastasis. Long term follow-up of patients with conjunctival melanoma with systemic surveillance is necessary to detect recurrences and metastases.

  View details for DOI 10.1016/j.survophthal.2016.06.001

  View details for Web of Science ID 000389617200002

  View details for PubMedID 27321895

  View details for PubMedCentralID PMC5353981

• Everolimus to treat aggressive retinal astrocytic hamartoma in tuberous sclerosis complex. Journal of AAPOS : the official publication of the American Association for Pediatric Ophthalmology and Strabismus Nallasamy, N. n., Seider, M. I., Gururangan, S. n., Mruthyunjaya, P. n. 2017; 21 (4): 328–31

  Abstract

  Retinal astrocytic hamartomas (RAH) are the most frequent ocular manifestation of tuberous sclerosis complex and are usually indolent, requiring only observation. We report an aggressive RAH subtype in a child unresponsive to anti-VEGF and laser therapy. Treatment with systemic everolimus was well-tolerated and significantly reduced ocular (and nonocular) tumor size and fluid exudation.

  View details for PubMedID 28733147

• Pediatric conjunctival melanoma arising from a compound nevus. Journal of AAPOS : the official publication of the American Association for Pediatric Ophthalmology and Strabismus Liu, K. C., Mruthyunjaya, P. n., Proia, A. D., Vora, G. K. 2017; 21 (5): 416–18

  Abstract

  We present a rare case of conjunctival melanoma in a 9-year-old girl who presented with a conjunctival lesion of the left eye, growth of which was documented by patient photographs. Examination showed a raised pigmented lesion at the temporal limbus, with fine surrounding vessels. Enhanced depth imaging-optical coherence tomography showed no invasion into the sclera. The patient underwent excisional biopsy, and histopathology revealed conjunctival melanoma arising from a nevus with malignant cells that stained positively with markers HMB-45 and Ki-67. Systemic workup was negative for metastatic disease. Conjunctival nevi are the most common melanocytic conjunctival lesions in children and generally demonstrate physiologic growth during adolescence. Thus, there may be a greater risk of misdiagnosis of conjunctival melanoma in a child.

  View details for PubMedID 28860029

• Neuro-oculo-cutaneous cavernous hemangiomas: a CCM1 mutation-associated phakomatosis. Journal of AAPOS : the official publication of the American Association for Pediatric Ophthalmology and Strabismus Labowsky, M. T., Walter, S. D., McDonald, M. T., Mruthyunjaya, P. n. 2017; 21 (5): 426–29.e1

  Abstract

  Evaluation for intracranial lesions in a patient with retinal cavernous hemangiomas is vital for early recognition of this heritable and potentially life-threatening disease. We report a case of a highly penetrant but variably expressed form of cerebral cavernous malformation syndrome with cerebral, cutaneous, and retinal cavernomas in a family found to harbor a nonsense mutation of the CCM1 gene.

  View details for PubMedID 28867399

• Association of Pediatric Choroidal Neovascular Membranes at the Temporal Edge of Optic Nerve and Retinochoroidal Coloboma. American journal of ophthalmology Grewal, D. S., Tran Viet, D., Vajzovic, L., Mruthyunjaya, P., Toth, C. A. 2016

  Abstract

  To describe the characteristics of pediatric choroidal neovascular membranes (CNV) associated with retinochoroidal and optic nerve coloboma using optical coherence tomography (OCT) and their response to treatment.Retrospective case series.Retrospective review of children <16 years with CNV and retinochoroidal and optic-nerve coloboma from 1995-2015 who underwent OCT imaging using either hand-held (Bioptigen, Morrisville, NC) or table-top OCT (Spectralis, Heidelberg, Carlsbad, CA) RESULTS: Eight eyes of 8 patients (3 males, 5 females) with a mean age of 4.1±3.9 years (range 6-months to 10-years) at diagnosis were included. Mean follow-up was 21.4±12.1 months (range 7-38 months). An optic-nerve coloboma was present in 2 eyes and combined optic nerve and retinochoroidal coloboma in 6 eyes. In all eyes, CNV was located at temporal margin of the coloboma closest to macula. Fluorescein angiogram characteristics included staining without leakage suggesting inactivity (n=6), and leakage (n=2). OCT characteristics included subretinal fluid (n=5), intraretinal fluid and cysts (n=1) and subretinal hyperreflective material (n=7). Two eyes received intravitreal bevacizumab (range 3-6) injections, and one of which also underwent focal peripapillary laser. Both eyes showed improvement in subretinal or intraretinal fluid on OCT. Vision at presentation among those quantified, ranged from 20/200 to 20/40 and at final follow-up from 20/400 to 20/30. Genetic or systemic abnormalities were seen in 6 patients.Association of pediatric CNV occurrence at the temporal margin of retinochoroidal and optic nerve colobomas closest to fovea has not been established before and careful OCT and angiographic assessment of this region is warranted. The CNV lesions exhibit a varied degree of response to treatment.

  View details for DOI 10.1016/j.ajo.2016.10.010

  View details for PubMedID 27793604

• Wide field of view swept-source optical coherence tomography for peripheral retinal disease BRITISH JOURNAL OF OPHTHALMOLOGY McNabb, R. P., Grewal, D. S., Mehta, R., Schuman, S. G., Izatt, J. A., Mahmoud, T. H., Jaffe, G. J., Mruthyunjaya, P., Kuo, A. N. 2016; 100 (10): 1377-1382

  Abstract

  To assess peripheral retinal lesions and the posterior pole in single widefield optical coherence tomography (OCT) volumes.A wide field of view (FOV) swept-source OCT (WFOV SSOCT) system was developed using a commercial swept-source laser and a custom sample arm consisting of two indirect ophthalmic lenses. Twenty-seven subjects with peripheral lesions (choroidal melanomas, choroidal naevi, sclerochoroidal calcification, retinitis pigmentosa, diabetic retinopathy, retinoschisis and uveitis) were imaged with the WFOV SSOCT. Volumes were taken in primary gaze. Using the optic nerve to fovea distance as a reference measurement, comparisons were made between the lateral FOV of the WFOV SSOCT, current generation spectral-domain OCT (SDOCT) and widefield scanning laser ophthalmoscopy (SLO) of the same eyes.Peripheral pathologies were captured with WFOV SSOCT in 26 of the 27 subjects. The one not captured was in the far nasal periphery and was not seen in the primary gaze volume. Posterior pole associated pathologies were captured in all subjects. Current generation SDOCT had a mean lateral FOV of 2.08±0.21 optic nerve to fovea distance units, WFOV SSOCT had an FOV of 4.62±0.62 units and SLO had an FOV of 9.35±1.02 units.WFOV OCT can be used to examine both peripheral retinal pathology and the posterior pole within a single volume acquisition. SLO had the greatest FOV, but does not provide depth information. Future studies using widefield OCT systems will help further delineate the role of WFOV OCT to quantitatively assess and monitor peripheral retinal disease in three dimensions.

  View details for DOI 10.1136/bjophthalmol-2015-307480

  View details for Web of Science ID 000384679400013

  View details for PubMedID 26755643

  View details for PubMedCentralID PMC5088499

• Portable Optical Coherence Tomography Detection or Confirmation of Ophthalmoscopically Invisible or Indeterminate Active Retinoblastoma. Ophthalmic surgery, lasers & imaging retina Seider, M. I., Grewal, D. S., Mruthyunjaya, P. 2016; 47 (10): 965-968

  Abstract

  Portable, hand-held optical coherence tomography (OCT) revealed three clinically relevant yet not ophthalmoscopically detected or confirmed manifestations of retinoblastoma in a single patient with familial bilateral disease. Specifically, OCT showed new retinal tumors, new vitreous seeds, and tumor recurrence before they could be detected or confirmed by ophthalmoscopy. [Ophthalmic Surg Lasers Imaging Retina. 2016;47:965-968.].

  View details for DOI 10.3928/23258160-20161004-12

  View details for PubMedID 27759865

• Intraoperative 4-Dimensional Microscope-Integrated Optical Coherence Tomography-Guided 27-Gauge Transvitreal Choroidal Biopsy for Choroidal Melanoma. Retina (Philadelphia, Pa.) Grewal, D. S., Bhullar, P. K., Pasricha, N. D., Carrasco-Zevallos, O. M., Viehland, C., Keller, B., Shen, L., Izatt, J. A., Kuo, A. N., Toth, C. A., Mruthyunjaya, P. 2016: -?

  View details for PubMedID 27673716

• Primary adenocarcinoma of pigmented ciliary epithelium in a phthisical eye SURVEY OF OPHTHALMOLOGY Kumar, J. B., Proia, A. D., Mruthyunjaya, P., Sharma, S. 2016; 61 (4): 502-505

  Abstract

  We report a case of adenocarcinoma of the pigmented ciliary epithelium arising in a phthisical eye. A 92-year-old man who initially presented with severe ocular pain had calcification extending from the posterior pole to ciliary body on B-scan ultrasonography to a degree not previously reported. We highlight the importance of screening for intraocular neoplasms in adults with a long-standing phthisical eye.

  View details for DOI 10.1016/j.survophthal.2015.11.001

  View details for Web of Science ID 000378444500009

  View details for PubMedID 26597037

• Impact of Microscope-Integrated OCT on Ophthalmology Resident Performance of Anterior Segment Surgical Maneuvers in Model Eyes INVESTIGATIVE OPHTHALMOLOGY & VISUAL SCIENCE Todorich, B., Shieh, C., Desouza, P. J., Carrasco-Zevallos, O. M., Cunefare, D. L., Stinnett, S. S., Izatt, J. A., Farsiu, S., Mruthyunjaya, P., Kuo, A. N., Toth, C. A. 2016; 57 (9): OCT146-OCT153

  Abstract

  The integration of swept-source optical coherence tomography (SS-OCT) into the operating microscope enables real-time, tissue-level three-dimensional (3D) imaging to aid in ophthalmic microsurgery. In this prospective randomized controlled study, we evaluated the impact of SS microscope-integrated OCT (MI-OCT) on ophthalmology residents' performance of ophthalmic microsurgical maneuvers.Fourteen ophthalmology residents from a single institution were stratified by year of training and randomized to perform four anterior segment surgical maneuvers on porcine eyes with (MI-OCT+) or without (MI-OCT-) direct intraoperative OCT guidance. Subsequently, both groups repeated the same maneuvers without MI-OCT feedback to test whether initial MI-OCT experience affected subsequent surgical performance. Finally, the MI-OCT- group was crossed over and allowed to repeat the same maneuvers with direct MI-OCT guidance. Each resident completed a survey at the completion of the study.With direct MI-OCT feedback, residents demonstrated enhanced performance in depth-based anterior segment maneuvers (corneal suture passes at 50% and 90% depth and corneal laceration repair) compared with the residents operating without MI-OCT. Microscope-integrated OCT+ residents continued to outperform the controls when both groups subsequently operated without MI-OCT. For clear corneal wound geometry, there was no statistically significant effect of MI-OCT as applied in this study. Overall, the resident surgeons rated their subjective experience of using MI-OCT very favorably.Microscope-integrated OCT feedback enhances performance of ophthalmology residents in select anterior segment surgical maneuvers. Microscope-integrated OCT represents a valuable tool in the surgical education of ophthalmology residents.

  View details for DOI 10.1167/iovs.15-18818

  View details for Web of Science ID 000383985400008

  View details for PubMedID 27409466

  View details for PubMedCentralID PMC4968783

• Scleral Buckling with Chandelier Illumination. Journal of ophthalmic & vision research Seider, M. I., Nomides, R. E., Hahn, P., Mruthyunjaya, P., Mahmoud, T. H. 2016; 11 (3): 304-309

  Abstract

  Scleral buckling is a highly successful technique for the repair of rhegmatogenous retinal detachment that requires intra-operative examination of the retina and treatment of retinal breaks via indirect ophthalmoscopy. Data suggest that scleral buckling likely results in improved outcomes for many patients but is declining in popularity, perhaps because of significant advances in vitrectomy instrumentation and visualization systems. Emerging data suggest that chandelier-assisted scleral buckling is safe and has many potential advantages over traditional buckling techniques. By combining traditional scleral buckling with contemporary vitreoretinal visualization techniques, chandelier-assistance may increase the popularity of scleral buckling to treat primary rhegmatogenous retinal detachment for surgeons of the next generation, maintaining buckling as an option for appropriate patients in the future.

  View details for DOI 10.4103/2008-322X.188402

  View details for PubMedID 27621789

  View details for PubMedCentralID PMC5000534

• MULTICOLOR IMAGING OF INNER RETINAL ALTERATIONS AFTER INTERNAL LIMITING MEMBRANE PEELING. Retinal cases & brief reports Feng, H. L., Sharma, S., Asrani, S., Mruthyunjaya, P. 2016: -?

  Abstract

  To characterize the appearance of inner retinal alterations after internal limiting membrane (ILM) peeling using multicolor confocal scanning laser ophthalmoscopy (cSLO).Retrospective review of two eyes that underwent pars plana vitrectomy with internal limiting membrane peeling and postoperative multicolor cSLO with spectral-domain optical coherence tomography. Infrared, green, blue, standard multicolor, and blue-green enhanced multicolor reflectance images were evaluated alongside spectral-domain optical coherence tomography for inner retinal alterations.Two eyes of 2 patients, aged 70 and 65 years, were identified. Preoperative diagnoses were epiretinal membrane with lamellar macular hole for Case 1 and full-thickness macular hole for Case 2. Time from surgery to initial multicolor cSLO imaging was 9 years in Case 1 and 3 weeks in Case 2. Inner retinal alterations were best visualized on blue reflectance, moderately visualized on green and blue-green enhanced multicolor, and less evident on infrared and standard multicolor. In Case 2, serial multicolor cSLO imaging demonstrated the emergence of inner retinal alterations between 3 weeks and 5 weeks postoperatively.Multicolor cSLO is a novel imaging modality capable of detecting inner retinal alterations in patients with a history of internal limiting membrane peeling, and may be clinically useful for monitoring anatomical changes associated with internal limiting membrane peeling.

  View details for PubMedID 27164506

• SMALL-GAUGE VALVED VERSUS NONVALVED CANNULA PARS PLANA VITRECTOMY FOR RETINAL DETACHMENT REPAIR RETINA-THE JOURNAL OF RETINAL AND VITREOUS DISEASES Oellers, P., Stinnett, S., Mruthyunjaya, P., Hahn, P. 2016; 36 (4): 744-749

  Abstract

  To compare functional and anatomical outcomes and complication rates between valved versus traditional nonvalved small-gauge cannula vitrectomy for retinal detachment repair.Retrospective case series of 163 eyes undergoing small-gauge valved versus nonvalved vitrectomy with intraoperative perfluoro-n-octane for retinal detachment repair at a single academic institution.There were 104 eyes in the valved cannula group and 59 eyes in the nonvalved cannula group. The valved group had lower baseline Grade C proliferative vitreoretinopathy (35 vs. 53%, P = 0.031) and combined rhegmatogenous retinal detachment/tractional retinal detachment (3 vs. 12%, P = 0.037), but both groups had otherwise comparable preoperative characteristics. Final postoperative best-corrected visual acuity was 1.01 logarithm of the minimum angle of resolution (Snellen 20/205) and 1.27 (Snellen 20/372) (P = 0.131) in valved and nonvalved cannula eyes, respectively. Single surgery success was equivalent between the valved and nonvalved groups (88 vs. 86%; P = 1.00). Final anatomical success was higher in the valved versus nonvalved group (98 vs. 90%; P = 0.027). Complication rates were not statistically different, including Postoperative Day 1 intraocular pressure, Postoperative Day 1 anterior chamber fibrin, retained subretinal/intraocular perfluoro-n-octane, and epiretinal membrane peeling.Valved cannulas, with their improved fluidics, are an important addition to pars plana vitrectomy with similar functional and anatomical success without increased complication rates compared with traditional nonvalved cannulas.

  View details for DOI 10.1097/IAE.0000000000000762

  View details for Web of Science ID 000373884700012

  View details for PubMedID 26398696

• Angiographic Cystoid Macular Edema and Outcomes in the Comparison of Age-Related Macular Degeneration Treatments Trials OPHTHALMOLOGY Shah, N., Maguire, M. G., Martin, D. F., Shaffer, J., Ying, G., Grunwald, J. E., Toth, C. A., Jaffe, G. J., Daniel, E., Comparison Age-Related Macular Deg 2016; 123 (4): 858–64

  Abstract

  To describe morphologic and visual outcomes in eyes with angiographic cystoid macular edema (CME) treated with ranibizumab or bevacizumab for neovascular age-related macular degeneration (nAMD).Prospective cohort study within a randomized clinical trial.A total of 1185 CATT study subjects.Baseline fluorescein angiography (FA) images of all CATT study eyes were evaluated for CME. Grading of other characteristics on optical coherence tomography (OCT) and photographic images at baseline and during 2-year follow-up was completed by readers at the CATT Reading Centers. Three groups were created on the basis of baseline CME and intraretinal fluid (IRF) status: (1) CME, (2) IRF without CME, (3) neither CME nor IRF.Visual acuity (VA) and total central retinal thickness (CRT) on OCT at baseline, year 1, and year 2.Among 1131 participants with images of sufficient quality for determining CME and IRF at baseline, 92 (8.1%) had CME, 766 (67.7%) had IRF without CME, and 273 (24.1%) had neither. At baseline, eyes with CME had worse mean VA (letters) than eyes with IRF without CME and eyes with neither CME nor IRF (52 vs. 60 vs. 66 letters, P < 0.001); higher mean total CRT (μm) on OCT (514 vs. 472 vs. 404, P < 0.001); and greater hemorrhage, retinal angiomatous proliferation (RAP) lesions, and classic choroidal neovascularization (CNV). All groups showed improvement in VA at follow-up; however, the CME group started and ended with the worst VA among the 3 groups. Central retinal thickness, although higher at baseline for the CME group, was similar at 1 and 2 years follow-up for all groups. More eyes with CME (65.3%) developed scarring during 2 years of follow-up compared with eyes with IRF without CME (43.8%) and eyes with neither CME nor IRF (32.5%; P < 0.001).In CATT, eyes with CME had worse baseline and follow-up VA, although all groups showed similar rates of improvement in VA during 2 years of follow-up. Cystoid macular edema seems to be a marker for poorer visual outcomes in nAMD because of underlying baseline retinal dysfunction and subsequent scarring.

  View details for DOI 10.1016/j.ophtha.2015.11.030

  View details for Web of Science ID 000372718300030

  View details for PubMedID 26778329

  View details for PubMedCentralID PMC4808340

• Macular Morphology and Visual Acuity in the Second Year of the Comparison of Age-Related Macular Degeneration Treatments Trials OPHTHALMOLOGY Sharma, S., Toth, C. A., Daniel, E., Grunwald, J. E., Maguire, M. G., Ying, G., Huang, J., Martin, D. F., Jaffe, G. J., Comparison Age-Related Macular Deg 2016; 123 (4): 865–75

  Abstract

  To describe the association between morphologic features on fundus photography (FP), fluorescein angiography (FA), and optical coherence tomography (OCT) and visual acuity (VA) in the second year of the Comparison of Age-related Macular Degeneration Treatments Trials (CATT).Prospective cohort study within a randomized clinical trial.Participants in the CATT.Study eye eligibility required angiographic and OCT evidence of choroidal neovascularization (CNV) secondary to age-related macular degeneration (AMD) and VA between 20/25 and 20/320. Treatment was assigned randomly to ranibizumab or bevacizumab with 3 different dosing regimens over a 2-year period.Fluid type, location, and thickness; retina and subretinal tissue complex thickness on OCT; size and lesion composition on FP and FA; and VA.Among 1185 CATT participants, 993 (84%) had fluid on OCT at baseline and completed 2 years of follow-up. At 2 years, intraretinal fluid (IRF), subretinal fluid (SRF), sub-retinal pigment epithelium (RPE) fluid, and subretinal tissue complex thickness decreased in all treatment groups. Ranibizumab monthly was best able to resolve each type of fluid. Eyes with SRF in the foveal center on OCT had better mean VA than eyes with no SRF (72.8 vs. 66.6 letters; P = 0.006). Eyes with IRF in the foveal center had worse mean VA than eyes without IRF (59.9 vs. 70.9 letters; P < 0.0001). Eyes with retinal thickness <120 μm had worse VA compared with eyes with retinal thickness 120 to 212 and >212 μm (59.4 vs. 71.3 vs. 70.3 letters; P < 0.0001). At 2 years, the mean VA (letters) of eyes varied substantially by the type of subfoveal pathology on FP and FA: 70.6 for no pathology; 74.1 for fluid only; 73.3 for CNV or pigment epithelial (RPE) detachment; 68.4 for nongeographic atrophy; and 62.9 for geographic atrophy, hemorrhage, RPE tear, or scar (P < 0.0001).The associations between VA and morphologic features identified through year 1 were maintained or strengthened during year 2. Eyes with foveal IRF, abnormally thin retina, greater thickness of the subretinal tissue complex on OCT, and subfoveal geographic atrophy or scar on FP/FA had the worst VA. Subretinal fluid was associated with better VA.

  View details for DOI 10.1016/j.ophtha.2015.12.002

  View details for Web of Science ID 000372718300031

  View details for PubMedID 26783095

  View details for PubMedCentralID PMC4998967

• Outcomes in Eyes with Retinal Angiomatous Proliferation in the Comparison of Age-Related Macular Degeneration Treatments Trials (CATT) OPHTHALMOLOGY Daniel, E., Shaffer, J., Ying, G., Grunwald, J. E., Martin, D. F., Jaffe, G. J., Maguire, M. G. 2016; 123 (3): 609-616

  Abstract

  To compare baseline characteristics, visual acuity (VA), and morphologic outcomes between eyes with retinal angiomatous proliferation (RAP) and all other eyes among patients with neovascular age-related macular degeneration (NVAMD) treated with anti-vascular endothelial growth factor (VEGF) drugs.Prospective cohort study within the Comparison of Age-Related Macular Degeneration Treatments Trials (CATT).Patients with NVAMD.Reading center staff evaluated digital color fundus photographs, fluorescein angiography (FA) images, and optical coherence tomography (OCT) scans of eyes with NVAMD treated with either ranibizumab or bevacizumab over a 2-year period. Retinal angiomatous proliferation was identified by the intense intra-retinal leakage of fluorescein in combination with other associated features.Visual acuity; fluorescein leakage; scar; geographic atrophy (GA) on FA; retinal thickness, fluid, and subretinal hyperreflective material (SHRM) on OCT; and the number of intravitreal anti-VEGF injections at 1 and 2 years.Retinal angiomatous proliferation was present in 126 of 1183 (10.7%) study eyes at baseline. Mean VA improvement from baseline was greater (10.6 vs. 6.9 letters; P = 0.01) at 1 year, but similar at 2 years (7.8 vs. 6.2 letters; P = 0.34). At 1 year, eyes with RAP were more likely to have no fluid (46% vs. 26%; P < 0.001) on OCT, no leakage on FA (61% vs. 50%; P = 0.03), and greater reduction in foveal thickness (-240 μm vs. -161 μm; P < 0.001). They were more likely to demonstrate GA (24% vs. 15%; P = 0.01) and less likely to have scarring (17% vs. 36%; P < 0.001) or SHRM (36% vs. 48%; P = 0.01). These results were similar at 2 years. The mean change in lesion size at 1 year differed (-0.27 DA vs. 0.27 DA; P = 0.02), but was similar at 2 years (0.49 DA vs. 0.79 DA; P = 0.26). Among eyes treated PRN, eyes with RAP received a lower mean number of injections in year 1 (6.1 vs. 7.4; P = 0.003) and year 2 (5.4 vs. 6.6; P = 0.025).At both 1 and 2 years after initiation of anti-VEGF treatment in CATT, eyes with RAP were less likely to have fluid, FA leakage, scar, and SHRM and more likely to have GA than eyes without RAP. Mean improvement in VA was similar at 2 years.

  View details for DOI 10.1016/j.ophtha.2015.10.034

  View details for Web of Science ID 000370626300036

  View details for PubMedID 26681392

  View details for PubMedCentralID PMC4766028

• A Comparative Study of Rebound Tonometry With Tonopen and Goldmann Applanation Tonometry Following Vitreoretinal Surgery AMERICAN JOURNAL OF OPHTHALMOLOGY Grewal, D. S., Stinnett, S. S., Folgar, F. A., Schneider, E. W., Vajzovic, L., Asrani, S., Freedman, S. F., Mruthyunjaya, P., Hahn, P. 2016; 161: 22-28

  Abstract

  To investigate agreement in intraocular pressure (IOP) measurements among Icare rebound tonometry, Tonopen tonometry, and Goldmann applanation tonometry following vitreoretinal surgery.Reliability analysis of tonometers.Fifty-eyes of 50 adults undergoing vitreoretinal surgery were enrolled. IOP was measured on first postoperative day using Icare (Tiolat, Helsinki, Finland), followed by Tonopen (Reichert, Depew, New York, USA) and Goldmann (Haag-Streit USA, Mason, Ohio, USA) in randomized order. Intraclass correlation coefficients (ICC) and Bland-Altman plots were calculated for all subcategories.Icare successfully measured IOP in all eyes, while Goldmann was unmeasurable in 6 eyes (12%) and Tonopen in 1 eye (2%). Mean IOP by Icare, Tonopen, and Goldmann was 15.9 ± 8.9, 16.9 ± 6.2, and 16.0 ± 7.3 mm Hg, respectively (P = .76). Type of intraocular tamponade, status of lens, status of cornea, gauge of instrumentation, and history of prior vitrectomy did not result in significant differences among the 3 tonometers. ICC was excellent (>0.75) in all subgroups, except at IOP <10 and ≥ 23 mm Hg (based on Icare). In eyes with IOP <10 mm Hg, Icare underestimated IOP (mm Hg; P = .01) compared to Goldmann (2.0 ± 2.1) and Tonopen (3.5 ± 2.4), whereas at IOP ≥ 23 mm Hg Icare was overestimated (P = .01) compared to Goldmann (3.77 ± 3.49) and Tonopen (4.97 ± 3.33). Overall, differences in IOP were ≤ 3 mm Hg in 58% of eyes for Icare-Tonopen, 72% for Tonopen-Goldmann, and 62% for Icare-Goldmann.IOP measurements using Icare rebound tonometry, Tonopen, and Goldmann tonometry are in excellent agreement following vitreoretinal surgery. However, Icare overestimates at IOP ≥ 23 and underestimates at IOP <10 mm Hg.

  View details for DOI 10.1016/j.ajo.2015.09.022

  View details for Web of Science ID 000367632300004

  View details for PubMedID 26408266

• Low-dose brachytherapy strategies to treat uveal melanoma: is less more? Melanoma management Oellers, P. n., Mruthyunjaya, P. n. 2016; 3 (1): 13–22

  Abstract

  The Collaborative Ocular Melanoma Study (COMS) has established equivalency of globe salvaging brachytherapy compared with enucleation in terms of survival for medium-sized choroidal melanoma. The radiation dose protocol followed by the COMS was 85 Gray to a prescription point of the tumor apex or 5 mm inner sclera; whichever was greater. While the COMS realized appropriate local and distant tumor control rates, ocular morbidity due to radiation complications remains a significant clinical challenge. Recent studies challenge the COMS radiation dose paradigm by demonstrating similar tumor control by utilizing lower radiation doses that are associated with reduced radiation toxicity. Improved operative techniques including intraoperative ultrasound can aid to obtain adequate radiation delivery to the tumor by ensuring optimal plaque position. Adjuvant transpupillary thermotherapy, intravitreal anti-VEGF and posterior sub-Tenon steroids may further enhance outcome by providing additional tumor control and/or facilitating visual recovery.

  View details for PubMedID 30190869

  View details for PubMedCentralID PMC6094673

• Incidence, Risk Factors, and Timing of Elevated Intraocular Pressure After Intravitreal Triamcinolone Acetonide Injection for Macular Edema Secondary to Retinal Vein Occlusion SCORE Study Report 15 JAMA OPHTHALMOLOGY Aref, A. A., Scott, I. U., Oden, N. L., Ip, M. S., Blodi, B. A., VanVeldhuisen, P. C. 2015; 133 (9): 1022-1029

  Abstract

  The Standard of Care vs Corticosteroid for Retinal Vein Occlusion (SCORE) Study showed that intravitreal triamcinolone acetonide (IVTA) is effective at reducing macular edema and improving visual acuity in participants with retinal vein occlusion. Secondary analysis of the incidence, risk factors, and timing of intraocular pressure (IOP) elevation occurring after IVTA provides guidance for clinical decision making and management of patients treated with IVTA.To investigate the incidence, risk factors, and time course of IOP elevation in participants in the SCORE Study.Secondary analysis conducted from August through December 2014 of a prospective, randomized clinical trial featuring an evaluable population conducted at 75 clinical sites. Six hundred eighty-two patients with macular edema secondary to retinal vein occlusion were enrolled in the study. The SCORE Study enrollment period ran from November 4, 2004, to February 29, 2008, with participant follow-up ending February 28, 2009.Study participants were randomized to standard of care, 1 mg of IVTA, or 4 mg of IVTA therapy and followed up for a mean (SD) of 24.7 (10.3) months.Intraocular pressure elevation greater than 10 mm Hg from baseline.Kaplan-Meier incidences of IOP elevation greater than 10 mm Hg from baseline at 36 months were 0.02 (95% CI, 0.01-0.06), 0.09 (95% CI, 0.05-0.14), and 0.45 (95% CI, 0.38-0.53) in the standard of care, 1-mg IVTA, and 4-mg IVTA groups, respectively. The rates of IOP-related events were higher for the 4-mg IVTA group compared with the other groups (P ≤ .001 for main outcome measure). Younger age, 4-mg IVTA vs 1-mg IVTA treatment, and higher baseline IOP were found to confer greater risk for IOP-related events (P < .05 for all). The median number of days from time of first injection to IOP elevation greater than 10 mm Hg from baseline was 34.0 and 52.5 days in participants treated with 1-mg and 4-mg IVTA, respectively.Intravitreal triamcinolone acetonide injection therapy, in particular the 4-mg dose, is associated with an increased risk for IOP elevation. The risk factors for an IOP-related event include higher treatment dose, younger age, and higher baseline IOP. Intraocular pressure-related events may take several months from the time of first IVTA injection to occur. Clinicians should be mindful of these risk factors when assessing the risks and benefits of IVTA therapy and also of the need for long-term follow-up of participants at risk for this complication.clinicaltrials.gov Identifier: NCT00105027.

  View details for DOI 10.1001/jamaophthalmol.2015.1823

  View details for Web of Science ID 000361377100010

  View details for PubMedID 26086920

• Subretinal Hyperreflective Material in the Comparison of Age-Related Macular Degeneration Treatments Trials OPHTHALMOLOGY Willoughby, A. S., Ying, G., Toth, C. A., Maguire, M. G., Burns, R. E., Grunwald, J. E., Daniel, E., Jaffe, G. J. 2015; 122 (9): 1846-?

  Abstract

  To evaluate the association of subretinal hyperreflective material (SHRM) with visual acuity (VA), geographic atrophy (GA), and scar in the Comparison of Age-Related Macular Degeneration Treatments Trials (CATT).Prospective cohort study within a randomized clinical trial.The 1185 CATT participants.Masked readers graded scar and GA on fundus photography and fluorescein angiography and graded SHRM on time-domain and spectral-domain (SD) optical coherence tomography (OCT) throughout 104 weeks. Measurements of SHRM height and width in the fovea, within the center 1 mm(2), or outside the center 1mm(2) were obtained on SD OCT images at 56 (n = 76) and 104 (n = 66) weeks.Presence of SHRM, as well as location and size, and associations with VA, scar, and GA.Among CATT participants, the percentage with SHRM at enrollment was 77%, decreasing to 68% at 4 weeks after treatment and to 54% at 104 weeks. At 104 weeks, scar was present more often in eyes with persistent SHRM than in eyes with SHRM that resolved (64% vs. 31%; P < 0.0001). Among eyes with detailed evaluation of SHRM at weeks 56 (n = 76) and 104 (n = 66), mean VA letter score was 73.5 (standard error [SE], 2.8), 73.1 (SE, 3.4), 65.3 (SE, 3.5), and 63.9 (SE, 3.7) when SHRM was absent, present outside the central 1 mm(2), present within the central 1 mm(2) but not the foveal center, or present at the foveal center (P = 0.02), respectively. When SHRM was present, the median maximum height under the fovea, within the central 1 mm(2) including the fovea and anywhere within the scan, was 86 μm, 120 μm, and 122 μm, respectively. Visual acuity was decreased with greater SHRM height and width (P < 0.05).In eyes with neovascular age-related macular degeneration (AMD), SHRM is common and often persists after anti-vascular endothelial growth factor treatment. At 2 years, eyes with scar were more likely to have SHRM than other eyes. Greater SHRM dimensions were associated with worse VA. In eyes with neovascular AMD, SHRM is an important morphologic biomarker.

  View details for DOI 10.1016/j.ophtha.2015.05.042

  View details for Web of Science ID 000360116900025

  View details for PubMedID 26143666

  View details for PubMedCentralID PMC4549177

• Impact of Microscope Integrated OCT on ophthalmology resident performance of anterior segment maneuvers in model eyes Bozho-Todorich, Shieh, C., DeSouza, P., Carrasco-Zevallos, O., Cunefare, D., Izatt, J. A., Farsiu, S., Mruthyunjaya, P., Kuo, A. N., Toth, C. A. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2015

  View details for Web of Science ID 000362891102287

• En face imaging of retinal pathology using multicolor confocal scanning laser ophthalmoscopy Feng, H., Sharma, S., Asrani, S. G., Stinnett, S., Mruthyunjaya, P. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2015

  View details for Web of Science ID 000362882201150

• Ultra wide-field swept-source optical coherence tomography for peripheral eye disease McNabb, R. P., Grewal, D., Schuman, S., Mruthyunjaya, P., Izatt, J. A., Kuo, A. N. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2015

  View details for Web of Science ID 000362882206374

• Retained Intraocular Perfluoro-n-octane After Valved Cannula Pars Plana Vitrectomy for Retinal Detachment OPHTHALMIC SURGERY LASERS & IMAGING RETINA Oellers, P., Schneider, E. W., Fekrat, S., Mahmoud, T. H., Mruthyunjaya, P., Hahn, P. 2015; 46 (4): 451-456

  Abstract

  To investigate cases of retained intraocular perfluoro-n-octane (PFO) after pars plana vitrectomy (PPV) for retinal detachment (RD).Retrospective, noncomparative case series of six eyes with retained intraocular PFO after RD repair. Clinical data were supplemented with an experimental silicone eye model.A cluster of six cases of retained intraocular PFO after PPV for RD repair were noted shortly after transitioning to valved cannulas. PFO was noted in the anterior chamber (AC) and/or vitreous and removed with AC paracentesis, AC wash-out, and/or PPV. A silicone eye model demonstrated that PFO levels are maintained anterior to cannula insertion with valved cannulas only.The authors hypothesize that anterior PFO fill using valved cannulas can lead to sequestration within the AC, zonules, ciliary sulcus, ciliary teeth, and/or capsular bag. They suggest vigilance in not overfilling PFO, particularly when transitioning to use of valved cannulas, to minimize the risk of intraocular retention.

  View details for DOI 10.3928/23258160-20150422-08

  View details for Web of Science ID 000359292300008

  View details for PubMedID 25970866

• Outcomes of Eyes with Lesions Composed of > 50% Blood in the Comparison of Age-Related Macular Degeneration Treatments Trials (CATT) OPHTHALMOLOGY Altaweel, M. M., Daniel, E., Martin, D. F., Mittra, R. A., Grunwald, J. E., Lai, M. M., Melamud, A., Morse, L. S., Huang, J., Ferris, F. L., Fine, S. L., Maguire, M. G. 2015; 122 (2): 391-?

  Abstract

  To compare baseline characteristics, treatment frequency, visual acuity (VA), and morphologic outcomes of eyes with >50% of the lesion composed of blood (B50 group) versus all other eyes (Other group) enrolled in the Comparison of Age-Related Macular Degeneration Treatments Trials (CATT).Prospective cohort study within a multicenter randomized clinical trial.CATT patients with neovascular age-related macular degeneration (AMD).Treatment for the study eye was assigned randomly to either ranibizumab or bevacizumab and to 3 different dosing regimens over a 2-year period. Reading center graders evaluated baseline and follow-up morphology in color fundus photographs, fluorescein angiography (FA), and optical coherence tomography (OCT). Masked examiners tested VA.Morphologic features and VA at 1 and 2 years.The B50 group consisted of 84 of 1185 (7.1%) patients enrolled in CATT. Baseline lesion characteristics differed between groups. In the B50 group, choroidal neovascularization size was smaller (0.73 vs 1.83 disc areas [DA]; P < 0.001), total lesion size was greater (4.55 vs 2.31 DA; P <0.001), total retinal thickness was greater (524 vs 455 μm; P = 0.02), and mean VA was worse (56.0 vs 60.9 letters; P = 0.002). Increases in mean VA were similar in the B50 and Other groups at 1 year (+9.3 vs +7.2 letters; P = 0.22) and at 2 years (9.0 vs 6.1 letters; P = 0.17). Eyes treated PRN received a similar number of injections in the 2 groups (12.2 vs 13.4; P = 0.27). Mean lesion size in the B50 group decreased by 1.2 DA at both 1 and 2 years (primarily owing to resolution of hemorrhage) and increased in the Other group by 0.33 DA at 1 year and 0.91 DA at 2 years (P < 0.001). Leakage on FA and fluid on OCT were similar between groups at 1 and 2 years.In CATT, the B50 group had a visual prognosis similar to the Other group. Lesion size decreased markedly through 2 years. Eyes like those enrolled in CATT with neovascular AMD lesions composed of >50% blood can be managed similarly to those with less or no blood.

  View details for DOI 10.1016/j.ophtha.2014.08.020

  View details for Web of Science ID 000348290000032

  View details for PubMedID 25307130

• Conjunctival Pseudotumor Caused by Herpes Simplex Virus Infection JAMA OPHTHALMOLOGY Vora, G. K., Marr, B., Cummings, T. J., Mruthyunjaya, P. 2015; 133 (1): 105-107

  View details for DOI 10.1001/jamaophthalmol.2014.3316

  View details for Web of Science ID 000347972500021

  View details for PubMedID 25232655

• Conjunctival Melanoma JAMA OPHTHALMOLOGY Yiu, G., Cummings, T. J., Mruthyunjaya, P. 2014; 132 (12): 1432-1432

  View details for Web of Science ID 000346176400009

  View details for PubMedID 25340828

• Comparison of Optical Coherence Tomography Assessments in the Comparison of Age-Related Macular Degeneration Treatments Trials OPHTHALMOLOGY Folgar, F. A., Jaffe, G. J., Ying, G., Maguire, M. G., Toth, C. A. 2014; 121 (10): 1956-?

  Abstract

  To determine agreement between spectral-domain (SD) and time-domain (TD) optical coherence tomography (OCT) image assessments by certified readers in eyes treated for neovascular age-related macular degeneration (AMD).Cross-sectional study within the Comparison of AMD Treatments Trials (CATT).During year 2 of CATT, 1213 pairs of SD OCT and TD OCT scans were compared from a subset of 384 eyes.Masked readers independently graded OCT scans for presence of intraretinal fluid (IRF), subretinal fluid (SRF), and sub-retinal pigment epithelium (RPE) fluid and performed manual measurements of retinal, SRF, and subretinal tissue complex thicknesses at the foveal center.Presence of fluid was evaluated with percent agreement, κ coefficients with 95% confidence intervals (CIs), and McNemar tests. Thickness measurements were evaluated with mean difference (Δ) ±95% limits of agreement and intraclass correlation coefficients (ICCs) with 95% CIs.Between SD OCT and TD OCT, agreement on presence of any fluid was 82% (κ = 0.46; 95% CI, 0.40-0.52), with 5% more SD OCT scans demonstrating fluid (P<0.001). Agreement on presence of SRF was 87% and sub-RPE fluid was 80%, with more SD OCT scans demonstrating fluid (both P < 0.001). Agreement on IRF was 73% (κ = 0.47; 95% CI, 0.42-0.52), with 6% more TD OCT scans demonstrating fluid (P < 0.001). Between SD OCT and TD OCT, mean thickness of the retina was Δ = 5±67 μm, SRF was Δ = 1.5±35 μm, and subretinal tissue complex was Δ = 5±86 μm. Thickness measurements were reproducible for retina (ICC = 0.84; 95% CI, 0.83-0.86), SRF (ICC = 0.88; 95% CI, 0.86-0.89), and subretinal tissue complex (ICC = 0.91; 95% CI, 0.89-0.92), with ≤25-μm difference in these measurements in 71%, 94%, and 61% of paired scans, respectively.Agreement on fluid presence and manual thickness measurements between paired scans from each OCT modality was moderate, providing a reasonable basis to compare CATT results with future SD OCT-based trials. Fluid was detected 5% more frequently with SD OCT, which may increase frequency of fluid-based treatment. Lower-resolution and artifactual interpretation of dark areas as cystoid edema may explain the greater frequency of IRF detected with TD OCT.

  View details for DOI 10.1016/j.ophtha.2014.04.020

  View details for Web of Science ID 000342697300025

  View details for PubMedID 24835760

  View details for PubMedCentralID PMC4515372

• Choroidal Metastatasis From a Neuroendocrine Tumor Masquerading as Choroidal Melanoma OPHTHALMIC SURGERY LASERS & IMAGING RETINA Yiu, G., Cummings, T. J., Mruthyunjaya, P. 2014; 45 (5): 456-458

  Abstract

  A mushroom-shaped choroidal mass is classically suggestive of melanoma, due to the ability of these tumors to erupt through Bruch's membrane. In contrast, choroidal metastases rarely adopt this growth pattern. The authors present an unusual case of a patient with a large choroidal metastasis from a pancreatic neuroendocrine tumor that shows a collar-button configuration. The diagnosis was confirmed by histology and immunohistochemistry following enucleation. The authors review the typical appearance of choroidal metastases from neuroendocrine tumors and discuss mechanisms by which uveal tumors may extend through Bruch's membrane.

  View details for DOI 10.3928/23258160-20140725-01

  View details for Web of Science ID 000347297300016

  View details for PubMedID 25153655

• Uveal Melanoma Treated With Iodine-125 Episcleral Plaque According to the COMS Trial Is Associated With Worsened Visual Acuity Change and Increased Risk of Chronic Toxicity Compared to Lower Prescription Doses Perez, B. A., Mettu, P., Vajzovic, L., Alkaissi, A., Steffey, B. A., Cai, J., Stinnett, S., Mruthyunjaya, P., Kirsch, D. G. ELSEVIER SCIENCE INC. 2014: S306

  View details for DOI 10.1016/j.ijrobp.2014.05.1023

  View details for Web of Science ID 000342331401127

• VITAMIN D DEFICIENCY IN NEOVASCULAR VERSUS NONNEOVASCULAR AGE-RELATED MACULAR DEGENERATION RETINA-THE JOURNAL OF RETINAL AND VITREOUS DISEASES Itty, S., Day, S., Lyles, K. W., Stinnett, S. S., Vajzovic, L. M., Mruthyunjaya, P. 2014; 34 (9): 1779-1786

  Abstract

  To compare 25-hydroxyvitamin D (25OHD) levels in patients with neovascular age-related macular degeneration (NVAMD) with patients with nonneovascular age-related macular degeneration and control patients.Medical records of all patients diagnosed with age-related macular degeneration and tested for serum 25OHD level at a single medical center were reviewed. Control patients were selected from patients diagnosed with pseudophakia but without age-related macular degeneration. The lowest 25OHD level available for each patient was recorded.Two hundred sixteen patients with nonneovascular age-related macular degeneration, 146 with NVAMD, and 100 non-age-related macular degeneration control patients were included. The levels of 25OHD (mean ± SD) were significantly lower in NVAMD patients (26.1 ± 14.4 ng/mL) versus nonneovascular age-related macular degeneration (31.5 ± 18.2 ng/mL, P = 0.003) and control (29.4 ± 10.1 ng/mL, P = 0.049) patients. The prevalence of vitamin D insufficiency (<30 ng/mL 25OHD), deficiency (<20 ng/mL), and severe deficiency (<10 ng/mL) were highest in the NVAMD group. The highest quintile of 25OHD was associated with a 0.35 (95% confidence interval, 0.18-0.68) odds ratio for NVAMD.This is the largest study to compare 25OHD levels in patients with the different clinical forms of age-related macular degeneration. Mean 25OHD levels were lower and vitamin D deficiency was more prevalent in NVAMD patients. These associations suggest that further research is necessary regarding vitamin D deficiency as a potentially modifiable risk factor for the development of NVAMD.

  View details for Web of Science ID 000341630400013

  View details for PubMedID 24946100

• Sporadic Visual Acuity Loss in the Comparison of Age-Related Macular Degeneration Treatments Trials (CATT) AMERICAN JOURNAL OF OPHTHALMOLOGY Kim, B. J., Ying, G., Huang, J., Levy, N. E., Maguire, M. G. 2014; 158 (1): 128-135

  Abstract

  To evaluate transient, large visual acuity (VA) decreases, termed sporadic vision loss, during anti-vascular endothelial growth factor treatment for neovascular age-related macular degeneration (AMD).Cohort within a randomized clinical trial.setting: Comparison of Age-Related Macular Degeneration Treatments Trials (CATT). study population: Total of 1185 CATT patients. main outcome measures: Incidence of sporadic vision loss and odds ratio (OR) for association with patient and ocular factors. Sporadic vision loss was a decline of ≥15 letters from the previous visit, followed by a return at the next visit to no more than 5 letters worse than the visit before the VA loss.There were 143 sporadic vision loss events in 122 of 1185 patients (10.3%). Mean VA at 2 years for those with and without sporadic vision loss was 58.5 (∼20/63) and 68.4 (∼20/40) letters, respectively (P < .001). Among patients treated pro re nata, no injection was given for 27.6% (27/98) of sporadic vision loss events. Multivariate analysis demonstrated that baseline predictors for sporadic vision loss included worse baseline VA (OR 2.92, 95% confidence interval [CI]:1.65-5.17 for ≤20/200 compared with ≥20/40), scar (OR 2.21, 95% CI:1.22-4.01), intraretinal foveal fluid on optical coherence tomography (OR 1.80, 95% CI:1.11-2.91), and medical history of anxiety (OR 1.90, 95% CI:1.12-3.24) and syncope (OR 2.75, 95% CI:1.45-5.22). Refraction decreased the likelihood of sporadic vision loss (OR 0.62, 95%CI: 0.42-0.91).Approximately 10% of CATT patients had sporadic vision loss. Baseline predictors included AMD-related factors and factors independent of AMD. These data are relevant for clinicians in practice and those involved in clinical trials.

  View details for DOI 10.1016/j.ajo.2014.04.004

  View details for Web of Science ID 000338097300018

  View details for PubMedID 24727261

• Uveal Melanoma Treated With Iodine-125 Episcleral Plaque: An Analysis of Dose on Disease Control and Visual Outcomes INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS Perez, B. A., Mettu, P., Vajzovic, L., Rivera, D., Alkaissi, A., Steffey, B. A., Cai, J., Stinnett, S., Dutton, J. J., Buckley, E. G., Halperin, E., Marks, L. B., Mruthyunjaya, P., Kirsch, D. G. 2014; 89 (1): 127-136

  Abstract

  To investigate, in the treatment of uveal melanomas, how tumor control, radiation toxicity, and visual outcomes are affected by the radiation dose at the tumor apex.A retrospective review was performed to evaluate patients treated for uveal melanoma with (125)I plaques between 1988 and 2010. Radiation dose is reported as dose to tumor apex and dose to 5 mm. Primary endpoints included time to local failure, distant failure, and death. Secondary endpoints included eye preservation, visual acuity, and radiation-related complications. Univariate and multivariate analyses were performed to determine associations between radiation dose and the endpoint variables.One hundred ninety patients with sufficient data to evaluate the endpoints were included. The 5-year local control rate was 91%. The 5-year distant metastases rate was 10%. The 5-year overall survival rate was 84%. There were no differences in outcome (local control, distant metastases, overall survival) when dose was stratified by apex dose quartile (<69 Gy, 69-81 Gy, 81-89 Gy, >89 Gy). However, increasing apex dose and dose to 5-mm depth were correlated with greater visual acuity loss (P=.02, P=.0006), worse final visual acuity (P=.02, P<.0001), and radiation complications (P<.0001, P=.0009). In addition, enucleation rates were worse with increasing quartiles of dose to 5 mm (P=.0001).Doses at least as low as 69 Gy prescribed to the tumor apex achieve rates of local control, distant metastasis-free survival, and overall survival that are similar to radiation doses of 85 Gy to the tumor apex, but with improved visual outcomes.

  View details for DOI 10.1016/j.ijrobp.2014.01.026

  View details for Web of Science ID 000334590500019

  View details for PubMedID 24613808

  View details for PubMedCentralID PMC3988201

• VEGFA and VEGFR2 Gene Polymorphisms and Response to Anti-Vascular Endothelial Growth Factor Therapy Comparison of Age-Related Macular Degeneration Treatments Trials (CATT) JAMA OPHTHALMOLOGY Hagstrom, S. A., Ying, G., Pauer, G. J., Sturgill-Short, G. M., Huang, J., Maguire, M. G., Martin, D. F. 2014; 132 (5): 521-527

  Abstract

  Individual variation in response and duration of anti-vascular endothelial growth factor (VEGF) therapy is seen among patients with neovascular age-related macular degeneration. Identification of genetic markers that affect clinical response may result in optimization of anti-VEGF therapy.To evaluate the pharmacogenetic relationship between genotypes of single-nucleotide polymorphisms (SNPs) in the VEGF signaling pathway and response to treatment with ranibizumab or bevacizumab for neovascular age-related macular degeneration.In total, 835 of 1149 patients (72.7%) participating in the Comparison of Age-Related Macular Degeneration Treatments Trials (CATT) at 43 CATT clinical centers.Each patient was genotyped for 7 SNPs in VEGFA (rs699946, rs699947, rs833069, rs833070, rs1413711, rs2010963, and rs2146323) and 1 SNP in VEGFR2 (rs2071559) using TaqMan SNP genotyping assays.Genotypic frequencies were compared with clinical measures of response to therapy at 1 year, including the mean visual acuity, mean change in visual acuity, at least a 15-letter increase, retinal thickness, mean change in total foveal thickness, presence of fluid on optical coherence tomography, presence of leakage on fluorescein angiography, mean change in lesion size, and mean number of injections administered. Differences in response by genotype were evaluated with tests of linear trend calculated from logistic regression models for categorical outcomes and linear regression models for continuous outcomes. The method of controlling the false discovery rate was used to adjust for multiple comparisons.For each of the measures of visual acuity evaluated, no association was observed with any of the genotypes or with the number of risk alleles. Four VEGFA SNPs demonstrated an association with retinal thickness: rs699947 (P = .03), rs833070 (P = .04), rs1413711 (P = .045), and rs2146323 (P = .006). However, adjusted P values for these associations were all statistically nonsignificant (range, P = .24 to P = .45). Among the participants in 2 as-needed groups, no association was found in the number of injections among the different genotypes or for the total number of risk alleles. The effect of risk alleles on each clinical measure did not differ by treatment group, drug, or dosing regimen (P > .01 for all).This study provides evidence that no pharmacogenetic associations exist between the studied VEGFA and VEGFR2 SNPs and response to anti-VEGF therapy.clinicaltrials.gov Identifier: NCT00593450.

  View details for DOI 10.1001/jamaophthalmol.2014.109

  View details for Web of Science ID 000337892500002

  View details for PubMedID 24652518

• Spectral Domain Optical Coherence Tomography Imaging of Ocular Surface Lesions Vora, G., Mruthyunjaya, P., Gupta, P. K., Kuo, A. N. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2014

  View details for Web of Science ID 000433205502033

• Optimizing Laser Parameters for Pump-Probe Microscopy of Conjunctival Melanocytic Lesions Vajzovic, L., Vora, G., Deb, S., Wilson, J. W., Robles, F. E., Cummings, T. J., Mruthyunjaya, P., Warren, W. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2014

  View details for Web of Science ID 000433205504229

• Characterization of the Choroid-Scleral Junction and Suprachoroidal Layer in Healthy Individuals on Enhanced-Depth Imaging Optical Coherence Tomography JAMA OPHTHALMOLOGY Yiu, G., Pecen, P., Sarin, N., Chiu, S. J., Farsiu, S., Mruthyunjaya, P., Toth, C. A. 2014; 132 (2): 174-181

  Abstract

  Accurate measurements of choroidal thickness (CT) using enhanced-depth imaging optical coherence tomography (EDI-OCT) require a well-defined choroid-scleral junction (CSJ), which may appear in some eyes as a hyporeflective band corresponding to the suprachoroidal layer (SCL).To identify factors associated with the presence and thickness of the SCL in healthy participants and determine how different CSJ boundary definitions impact CT measurements.Secondary analysis of EDI-OCT images obtained prospectively from 74 eyes of 74 controls (mean age, 68.6 years) from the Age-Related Eye Disease Study 2 Ancillary SDOCT Study.The CSJ appearances were categorized as either having no visible SCL or a hyporeflective band corresponding to the SCL. Ocular parameters associated with the presence and thickness of the SCL were identified. Subfoveal CT was measured using 3 different posterior boundaries: (1) the posterior vessel border (vascular CT [VCT]), (2) inner border of the SCL (stromal CT [StCT]), and (3) inner border of the sclera (total CT [TCT]). Manual segmentation using custom software was used to compare VCT, StCT, and TCT across the macula. RESULTS The SCL was visible in 33 eyes (44.6%). Factors associated with SCL presence and thickness included hyperopic refractive error (R2 = 0.123; P = .045) and increased TCT (R2 = 0.215; P = .004), but not age, visual acuity, intraocular pressure, retinal foveal thickness, VCT, or StCT. In eyes where the SCL was not visible, mean [SD] subfoveal VCT was 222.3 [101.5] μm and StCT and TCT were 240.0 [99.0] μm, with a difference of 17.7 [16.0] μm (P < .001). In eyes where the SCL was visible, mean [SD] subfoveal VCT, StCT, and TCT were 221.9 [83.1] μm, 257.7 [97.3] μm, and 294.1 [104.8] μm, respectively, with the greatest difference of 72.2 [30.4] μm between VCT and TCT (P < .001). All 3 CT measurements were significantly different along all points up to 3.0 mm nasal and temporal to the fovea.A hyporeflective SCL is visible at the CSJ on EDI-OCT in nearly half of healthy individuals, and its presence correlates with hyperopia. Different posterior boundary definitions may result in significant differences in CT measurements and should be explicitly identified in future choroidal studies and segmentation algorithms.

  View details for DOI 10.1001/jamaophthalmol.2013.7288

  View details for Web of Science ID 000331367600009

  View details for PubMedID 24336985

• Reduced fluorescein angiography and fundus photography use in the management of neovascular macular degeneration and macular edema during the past decade. Investigative ophthalmology & visual science Schneider, E. W., Mruthyunjaya, P., Talwar, N., Harris Nwanyanwu, K., Nan, B., Stein, J. D. 2014; 55 (1): 542-549

  Abstract

  We assessed recent trends in the use of diagnostic testing for neovascular age-related macular degeneration (NVAMD) and macular edema (ME).Claims data from a managed-care network were analyzed on patients with NVAMD (n = 22,954) or ME (n = 31,810) to assess the use of fluorescein angiography (FA), fundus photography (FP), and optical coherence tomography (OCT) from 2001 to 2009. Repeated-measures logistic regression was performed to compare patients' odds of undergoing these procedures in 2001, 2005, and 2009. In addition, the proportions of patients with an incident NVAMD or ME diagnosis in 2003 or 2008 who underwent FA, FP, and OCT were compared.From 2001 to 2009, among patients with NVAMD, the odds of undergoing OCT increased 23-fold, whereas the odds of receiving FA and FP decreased by 68% and 79%, respectively. Similar trends were observed for ME. From 2003 to 2008, the proportion of patients undergoing OCT within 1 year of initial diagnosis increased by 315% for NVAMD and by 143% for ME; the proportion undergoing OCT without FA within 1 year increased by 463% for NVAMD and by 216% for ME.Use of OCT increased dramatically during the past decade, whereas use of FA and FP declined considerably, suggesting that OCT may be replacing more traditional diagnostic testing in patients with NVAMD or ME. Future studies should evaluate whether this increased reliance on OCT instead of FA and FP affects patient outcomes.

  View details for DOI 10.1167/iovs.13-13034

  View details for PubMedID 24346174

  View details for PubMedCentralID PMC3907135

• Reduced Fluorescein Angiography and Fundus Photography Use in the Management of Neovascular Macular Degeneration and Macular Edema During the Past Decade INVESTIGATIVE OPHTHALMOLOGY & VISUAL SCIENCE Schneider, E. W., Mruthyunjaya, P., Talwar, N., Nwanyanwu, K. H., Nan, B., Stein, J. D. 2014; 55 (1): 542-549

  Abstract

  We assessed recent trends in the use of diagnostic testing for neovascular age-related macular degeneration (NVAMD) and macular edema (ME).Claims data from a managed-care network were analyzed on patients with NVAMD (n = 22,954) or ME (n = 31,810) to assess the use of fluorescein angiography (FA), fundus photography (FP), and optical coherence tomography (OCT) from 2001 to 2009. Repeated-measures logistic regression was performed to compare patients' odds of undergoing these procedures in 2001, 2005, and 2009. In addition, the proportions of patients with an incident NVAMD or ME diagnosis in 2003 or 2008 who underwent FA, FP, and OCT were compared.From 2001 to 2009, among patients with NVAMD, the odds of undergoing OCT increased 23-fold, whereas the odds of receiving FA and FP decreased by 68% and 79%, respectively. Similar trends were observed for ME. From 2003 to 2008, the proportion of patients undergoing OCT within 1 year of initial diagnosis increased by 315% for NVAMD and by 143% for ME; the proportion undergoing OCT without FA within 1 year increased by 463% for NVAMD and by 216% for ME.Use of OCT increased dramatically during the past decade, whereas use of FA and FP declined considerably, suggesting that OCT may be replacing more traditional diagnostic testing in patients with NVAMD or ME. Future studies should evaluate whether this increased reliance on OCT instead of FA and FP affects patient outcomes.

  View details for DOI 10.1167/iovs.13-13034

  View details for Web of Science ID 000331877200063

  View details for PubMedCentralID PMC3907135

• Imaging Microscopic Pigment Chemistry in Conjunctival Melanocytic Lesions Using Pump-Probe Laser Microscopy INVESTIGATIVE OPHTHALMOLOGY & VISUAL SCIENCE Wilson, J. W., Vajzovic, L., Robles, F. E., Cummings, T. J., Mruthyunjaya, P., Warren, W. S. 2013; 54 (10): 6867-6876

  Abstract

  To report the application of a novel imaging technique, pump-probe microscopy, to analyze patterns of pigment chemistry of conjunctival melanocytic lesion biopsies.Histopathologic specimens of eight previously excised conjunctival melanocytic lesions were analyzed with pump-probe microscopy. The technique uses a laser scanning microscope with a two-color pulsed laser source to distinguish hemoglobin, eumelanin, and pheomelanin pigment based on differences in transient excited state and ground state photodynamics. The pump-probe signatures of conjunctival melanins were compared with cutaneous melanins. The distributions of hemoglobin, eumelanin, and pheomelanin were analyzed, and pump-probe images were correlated with adjacent hematoxylin and eosin (H&E)-stained sections.The pump-probe signatures of conjunctival melanins are similar, but not identical to cutaneous melanins. In addition, there are qualitative and quantitative differences in the structure and pigment chemistry of conjunctival benign nevi, primary acquired melanosis of the conjunctiva (PAM), and conjunctival melanomas. The pump-probe images correlated well with histopathologic features observed in the adjacent H&E-stained sections, and provided a label-free means of discerning conjunctival anatomic features and pathologic benign or malignant tissue.Pump-probe laser microscopy shows promise as an adjuvant diagnostic tool in evaluation of ocular melanocytic lesions based on morphologic correlation with the histopathology results and pigment chemistry. This initial study suggests systematic differences in pigmentation patterns among conjunctival benign nevi, primary acquired melanosis, and melanomas. In addition, pump-probe microscopy has the potential for use as a noninvasive "in vivo" optical biopsy technique to aid clinical and surgical management of conjunctival melanocytic lesions.

  View details for DOI 10.1167/iovs.13-12432

  View details for Web of Science ID 000326567700047

  View details for PubMedID 24065811

  View details for PubMedCentralID PMC3805089

• Combination therapy for macular edema secondary to retinal vein occlusion OPHTHALMIC SURGERY LASERS & IMAGING RETINA Schneider, E. W., Mruthyunjaya, P., Hariprasad, S. M. 2013; 44 (5): 434-438

  View details for DOI 10.3928/23258160-20130909-02

  View details for Web of Science ID 000330192400001

  View details for PubMedID 24044704

• Macular Morphology and Visual Acuity in the Comparison of Age-related Macular Degeneration Treatments Trials OPHTHALMOLOGY Jaffe, G. J., Martin, D. F., Toth, C. A., Daniel, E., Maguire, M. G., Ying, G., Grunwald, J. E., Huang, J., Comparison Age-related Macular 2013; 120 (9): 1860–70

  Abstract

  To describe the effects of treatment for 1 year with ranibizumab or bevacizumab on macular morphology and the association of macular morphology with visual acuity (VA) in eyes with neovascular age-related macular degeneration (AMD).Prospective cohort study within a randomized clinical trial.Participants in the Comparison of Age-related Macular Degeneration Treatments Trials.Participants were assigned randomly to treatment with ranibizumab or bevacizumab on a monthly or as-needed schedule. Optical coherence tomography (OCT), fluorescein angiography (FA), color fundus photography (FP), and VA testing were performed periodically throughout 52 weeks. Masked readers graded images. General linear models were applied to evaluate effects of time and treatment on outcomes.Fluid type and location and thickness by OCT, size, and lesion composition on FP, FA, and VA.Intraretinal fluid (IRF), subretinal fluid (SRF), subretinal pigment epithelium fluid, and retinal, subretinal, and subretinal tissue complex thickness decreased in all treatment groups. A higher proportion of eyes treated monthly with ranibizumab had fluid resolution at 4 weeks, and the difference persisted through 52 weeks. At 52 weeks, there was little association between the presence of fluid of any type (without regard to fluid location) and the mean VA. However, at all time points, eyes with residual IRF, especially foveal IRF, had worse mean VA (9 letters) than those without IRF. Eyes with abnormally thin (<120 μm) or thick (>212 μm) retinas had worse VA than those with normal thickness (120-212 μm). At week 52, eyes with larger neovascular lesions or with foveal scar had worse VA than eyes without these features.Anti-vascular endothelial growth factor (VEGF) therapy reduced lesion activity and improved VA in all treatment groups. At all time points, eyes with residual IRF had worse VA than those without. Eyes with abnormally thin or thick retinas, residual large lesions, and scar also had worse VA. Monthly ranibizumab dosing yielded more eyes with no fluid and an abnormally thin retina, although the long-term significance is unknown. These results have important treatment implications in eyes undergoing anti-VEGF therapy for neovascular AMD.Proprietary or commercial disclosure may be found after the references.

  View details for DOI 10.1016/j.ophtha.2013.01.073

  View details for Web of Science ID 000324045800041

  View details for PubMedID 23642377

  View details for PubMedCentralID PMC3737287

• PRECLINICAL EVALUATION AND INTRAOPERATIVE HUMAN RETINAL IMAGING WITH A HIGH-RESOLUTION MICROSCOPE-INTEGRATED SPECTRAL DOMAIN OPTICAL COHERENCE TOMOGRAPHY DEVICE RETINA-THE JOURNAL OF RETINAL AND VITREOUS DISEASES Hahn, P., Migacz, J., O'Connell, R., Day, S., Lee, A., Lin, P., Vann, R., Kuo, A., Fekrat, S., Mruthyunjaya, P., Postel, E. A., Izatt, J. A., Toth, C. A. 2013; 33 (7): 1328-1337

  Abstract

  The authors have recently developed a high-resolution microscope-integrated spectral domain optical coherence tomography (MIOCT) device designed to enable OCT acquisition simultaneous with surgical maneuvers. The purpose of this report is to describe translation of this device from preclinical testing into human intraoperative imaging.Before human imaging, surgical conditions were fully simulated for extensive preclinical MIOCT evaluation in a custom model eye system. Microscope-integrated spectral domain OCT images were then acquired in normal human volunteers and during vitreoretinal surgery in patients who consented to participate in a prospective institutional review board-approved study. Microscope-integrated spectral domain OCT images were obtained before and at pauses in surgical maneuvers and were compared based on predetermined diagnostic criteria to images obtained with a high-resolution spectral domain research handheld OCT system (HHOCT; Bioptigen, Inc) at the same time point. Cohorts of five consecutive patients were imaged. Successful end points were predefined, including ≥80% correlation in identification of pathology between MIOCT and HHOCT in ≥80% of the patients.Microscope-integrated spectral domain OCT was favorably evaluated by study surgeons and scrub nurses, all of whom responded that they would consider participating in human intraoperative imaging trials. The preclinical evaluation identified significant improvements that were made before MIOCT use during human surgery. The MIOCT transition into clinical human research was smooth. Microscope-integrated spectral domain OCT imaging in normal human volunteers demonstrated high resolution comparable to tabletop scanners. In the operating room, after an initial learning curve, surgeons successfully acquired human macular MIOCT images before and after surgical maneuvers. Microscope-integrated spectral domain OCT imaging confirmed preoperative diagnoses, such as full-thickness macular hole and vitreomacular traction, and demonstrated postsurgical changes in retinal morphology. Two cohorts of five patients were imaged. In the second cohort, the predefined end points were exceeded with ≥80% correlation between microscope-mounted OCT and HHOCT imaging in 100% of the patients.This report describes high-resolution MIOCT imaging using the prototype device in human eyes during vitreoretinal surgery, with successful achievement of predefined end points for imaging. Further refinements and investigations will be directed toward fully integrating MIOCT with vitreoretinal and other ocular surgery to image surgical maneuvers in real time.

  View details for Web of Science ID 000330470700005

  View details for PubMedID 23538579

• Progression of Diabetic Retinopathy in the Hypertension Intervention Nurse Telemedicine Study JAMA OPHTHALMOLOGY Muir, K. W., Grubber, J., Mruthyunjaya, P., McCant, F., Bosworth, H. B. 2013; 131 (7): 957-958

  View details for DOI 10.1001/jamaophthalmol.2013.81

  View details for Web of Science ID 000323553600023

  View details for PubMedID 23702951

• Trends in Utilization of Ancillary Testing for Patients with Exudative Macular Degeneration and Macular Edema from 2001 to 2009 Schneider, E., Mruthyunjaya, P., Talwar, N., Nwanyanwu, K., Nan, B., Stein, J. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2013

  View details for Web of Science ID 000436232900320

• Pump-Probe Laser Imaging of Pigment in Conjunctival Melanocytic Lesions Mruthyunjaya, P., Vajzovic, L., Wilson, J., Robles, F., Cummings, T., Warren, W. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2013

  View details for Web of Science ID 000436232703263

• Pharmacogenetics for Genes Associated with Age-related Macular Degeneration in the Comparison of AMD Treatments Trials (CATT) OPHTHALMOLOGY Hagstrom, S. A., Ying, G., Pauer, G. J., Sturgill-Short, G. M., Huang, J., Callanan, D. G., Kim, I. K., Klein, M. L., Maguire, M. G., Martin, D. F. 2013; 120 (3): 593-599

  Abstract

  To evaluate the pharmacogenetic relationship between genotypes of single nucleotide polymorphisms (SNPs) known to be associated with age-related macular degeneration (AMD) and response to treatment with ranibizumab (Lucentis; Genentech, South San Francisco, CA) or bevacizumab (Avastin; Genentech) for neovascular AMD.Clinical trial.Eight hundred thirty-four (73%) of 1149 patients participating in the Comparison of AMD Treatments Trials (CATT) were recruited through 43 CATT clinical centers.Each patient was genotyped for SNPs rs1061170 (CFH), rs10490924 (ARMS2), rs11200638 (HTRA1), and rs2230199 (C3), using TaqMan SNP genotyping assays (Applied Biosystems, Foster City, CA).Genotypic frequencies were compared with clinical measures of response to therapy at one year, including mean visual acuity (VA), mean change in VA, 15-letter or more increase in VA, retinal thickness, mean change in total foveal thickness, presence of fluid on OCT, presence of leakage on fluorescein angiography (FA), mean change in lesion size, and mean number of injections administered. Differences in response by genotype were evaluated with tests of linear trend calculated from logistic regression models for categorical outcomes and linear regression models for continuous outcomes. To adjust for multiple comparisons, P≤0.01 was considered statistically significant.No statistically significant differences in response by genotype were identified for any of the clinical measures studied. Specifically, there were no high-risk alleles that predicted final VA or change in VA, the degree of anatomic response (fluid on OCT or FA, retinal thickness, change in total foveal thickness, change in lesion size), or the number of injections. Furthermore, a stepwise analysis failed to show a significant epistatic interaction among the variants analyzed; that is, response did not vary by the number of risk alleles present. The lack of association was similar whether patients were treated with ranibizumab or bevacizumab or whether they received monthly or pro re nata dosing.Although specific alleles for CFH, ARMS2, HTRA1, and C3 may predict the development of AMD, they did not predict response to anti-vascular endothelial growth factor therapy.

  View details for DOI 10.1016/j.ophtha.2012.11.037

  View details for PubMedID 23337555

• SD-OCT and autofluorescence characteristics of autoimmune retinopathy BRITISH JOURNAL OF OPHTHALMOLOGY Pepple, K. L., Cusick, M., Jaffe, G. J., Mruthyunjaya, P. 2013; 97 (2): 139-144

  Abstract

  To report abnormal fundus hyperautofluorescence (hyper-AF) and loss of outer retinal layers by spectral domain optical coherence tomography in patients with autoimmune retinopathy (AIR).Retrospective, observational case series of 14 eyes of 7 patients diagnosed with an AIR for whom colour fundus photographs, fundus AF images and spectral domain optical coherence tomograms (SD-OCT) were obtained at presentation.Seven patients were identified ranging in age from 24 to 73 years. Six had a history of cancer and were diagnosed with cancer associated retinopathy or melanoma associated retinopathy. Among the seven patients, six (86%) had abnormalities by AF or SD-OCT including loss of outer retinal layers in association with hyper-AF. One patient with melanoma associated retinopathy did not have any imaging abnormalities. In one patient with cancer associated retinopathy followed over 8 months, progressive loss of retinal architecture was associated with the formation of a hyper-AF ring.Patients with AIR can present with structural abnormalities that are detectable by fundus AF and SD-OCT. The areas of hyper-AF correspond to loss of outer-retinal structures such as the inner segment/outer segment junction, the external limiting membrane and outer nuclear layer. These imaging modalities may be useful in establishing the diagnosis of this rare disease, monitoring disease progression and evaluating response to therapy.

  View details for DOI 10.1136/bjophthalmol-2012-302524

  View details for Web of Science ID 000313877700007

  View details for PubMedID 23221966

• Imaging pigment chemistry in melanocytic conjunctival lesions with pump-probe microscopy Conference on Ophthalmic Technologies XXIII as a part of the SPIE Photonics West BiOS Meeting Wilson, J. W., Vajzovic, L., Robles, F. E., Cummings, T. J., Mruthyunjaya, P., Warren, W. S. SPIE-INT SOC OPTICAL ENGINEERING. 2013

  View details for DOI 10.1117/12.2003137

  View details for Web of Science ID 000325430800013

• Baseline Predictors for One-Year Visual Outcomes with Ranibizumab or Bevacizumab for Neovascular Age-related Macular Degeneration OPHTHALMOLOGY Ying, G., Huang, J., Maguire, M. G., Jaffe, G. J., Grunwald, J. E., Toth, C., Daniel, E., Klein, M., Pieramici, D., Wells, J., Martin, D. F., Comparison Age-Related Macular 2013; 120 (1): 122–29

  Abstract

  To determine the baseline predictors of visual acuity (VA) outcomes 1 year after treatment with ranibizumab or bevacizumab for neovascular age-related macular degeneration (AMD).Cohort study within the Comparison of Age-related Macular Degeneration Treatments Trials (CATT).A total of 1105 participants with neovascular AMD, baseline VA 20/25 to 20/320, and VA measured at 1 year.Participants were randomly assigned to ranibizumab or bevacizumab on a monthly or as-needed schedule. Masked readers evaluated fundus morphology and features on optical coherence tomography (OCT). Visual acuity was measured using electronic VA testing. Independent predictors were identified using regression techniques.The VA score, VA score change from baseline, and ≥3-line gain at 1 year.At 1 year, the mean VA score was 68 letters, mean improvement from baseline was 7 letters, and 28% of participants gained ≥3 lines. Older age, larger area of choroidal neovascularization (CNV), and elevation of retinal pigment epithelium (RPE) were associated with worse VA (all P<0.005), less gain in VA (all P<0.02), and a lower proportion gaining ≥3 lines (all P<0.04). Better baseline VA was associated with better VA at 1 year, less gain in VA, and a lower proportion gaining ≥3 lines (all P<0.0001). Predominantly or minimally classic lesions were associated with worse VA than occult lesions (66 vs. 69 letters; P=0.0003). Retinal angiomatous proliferans (RAP) lesions were associated with more gain in VA (10 vs. 7 letters; P=0.03) and a higher proportion gaining ≥3 lines (odds ratio, 1.9; 95% confidence interval, 1.2-3.1). Geographic atrophy (GA) was associated with worse VA (64 vs. 68 letters; P=0.02). Eyes with total foveal thickness in the second quartile (325-425 μm) had the best VA (P=0.01) and were most likely to gain ≥3 lines (P=0.004). Predictors did not vary by treatment group.For all treatment groups, older age, better baseline VA, larger CNV area, predominantly or minimally classic lesion, absence of RAP lesion, presence of GA, greater total fovea thickness, and RPE elevation on optical coherence tomography were independently associated with less improvement in VA at 1 year.The author(s) have no proprietary or commercial interest in any materials discussed in this article.

  View details for DOI 10.1016/j.ophtha.2012.07.042

  View details for Web of Science ID 000313011700019

  View details for PubMedID 23047002

  View details for PubMedCentralID PMC3536921

• Evaluating the Relationship Between Prescription Dose and Overall Survival Among Patients Treated With I-125 Brachytherapy for Posterior Uveal Melanoma Perez, B., Vajzovic, L., Mettu, P., Rivera, D., Alkaissi, A., Steffey, B. A., Stinnett, S., Marks, L. B., Mruthyunjaya, P., Kirsch, D. G. ELSEVIER SCIENCE INC. 2012: S197

  View details for DOI 10.1016/j.ijrobp.2012.07.511

  View details for Web of Science ID 000310542900493

• Diagnostic yield of vitreous biopsy in presumed sarcoidosis-related posterior segment inflammation GRAEFES ARCHIVE FOR CLINICAL AND EXPERIMENTAL OPHTHALMOLOGY Scott, A. W., Mruthyunjaya, P., McCallum, R. M., Jaffe, G. J. 2012; 250 (9): 1379-1385

  Abstract

  Diagnostic vitrectomy is frequently used to help establish a diagnosis in challenging uveitis cases. The usefulness of this procedure in patients with suspected sarcoidosis with posterior segment involvement, in whom a diagnosis cannot be determined by conventional methods, has not been well-described. We hypothesized that diagnostic vitrectomy would help establish a diagnosis of presumed sarcoidosis-related posterior segment inflammation in these challenging cases, and evaluated the diagnostic yield of vitreous biopsy in these eyes.Retrospective interventional case series.Diagnostic vitrectomy was performed on eyes with intermediate, posterior, or panuveitis in which an etiology could not be characterized by history, clinical examination, ancillary testing, and/or laboratory testing. Retrospective chart review was conducted on consecutive eyes that underwent diagnostic, or diagnostic and therapeutic vitrectomy by a single surgeon between January 1989 and June 2006.Diagnostic and therapeutic vitrectomy was performed on 150 eyes. The final diagnosis was established by positive vitreous fluid analysis in 63 eyes (42 %). Eight of these vitreous specimens (5.3 %) yielded cytopathology consistent with presumed sarcoidosis-related posterior segment inflammation.Sarcoidosis can cause characteristic inflammatory changes in the vitreous. In the appropriate clinical setting, cytopathologic assessment of these inflammatory changes observed in vitreous specimens can support the diagnosis of presumed sarcoidosis-related posterior segment inflammation, and help direct clinical management.

  View details for DOI 10.1007/s00417-012-1993-9

  View details for Web of Science ID 000307993900018

  View details for PubMedID 22434211

• Collaborative Ocular Oncology Group Report Number 1: Prospective Validation of a Multi-Gene Prognostic Assay in Uveal Melanoma OPHTHALMOLOGY Onken, M. D., Worley, L. A., Char, D. H., Augsburger, J. J., Correa, Z. M., Nudleman, E., Aaberg, T. M., Altaweel, M. M., Bardenstein, D. S., Finger, P. T., Gallie, B. L., Harocopos, G. J., Hovland, P. G., McGowan, H. D., Milman, T., Mruthyunjaya, P., Simpson, E. R., Smith, M. E., Wilson, D. J., Wirostko, W. J., Harbour, J. W. 2012; 119 (8): 1596-1603

  Abstract

  This study evaluates the prognostic performance of a 15 gene expression profiling (GEP) assay that assigns primary posterior uveal melanomas to prognostic subgroups: class 1 (low metastatic risk) and class 2 (high metastatic risk).Prospective, multicenter study.A total of 459 patients with posterior uveal melanoma were enrolled from 12 independent centers.Tumors were classified by GEP as class 1 or class 2. The first 260 samples were also analyzed for chromosome 3 status using a single nucleotide polymorphism assay. Net reclassification improvement analysis was performed to compare the prognostic accuracy of GEP with the 7th edition clinical Tumor-Node-Metastasis (TNM) classification and chromosome 3 status.Patients were managed for their primary tumor and monitored for metastasis.The GEP assay successfully classified 446 of 459 cases (97.2%). The GEP was class 1 in 276 cases (61.9%) and class 2 in 170 cases (38.1%). Median follow-up was 17.4 months (mean, 18.0 months). Metastasis was detected in 3 class 1 cases (1.1%) and 44 class 2 cases (25.9%) (log-rank test, P<10(-14)). Although there was an association between GEP class 2 and monosomy 3 (Fisher exact test, P<0.0001), 54 of 260 tumors (20.8%) were discordant for GEP and chromosome 3 status, among which GEP demonstrated superior prognostic accuracy (log-rank test, P = 0.0001). By using multivariate Cox modeling, GEP class had a stronger independent association with metastasis than any other prognostic factor (P<0.0001). Chromosome 3 status did not contribute additional prognostic information that was independent of GEP (P = 0.2). At 3 years follow-up, the net reclassification improvement of GEP over TNM classification was 0.43 (P = 0.001) and 0.38 (P = 0.004) over chromosome 3 status.The GEP assay had a high technical success rate and was the most accurate prognostic marker among all of the factors analyzed. The GEP provided a highly significant improvement in prognostic accuracy over clinical TNM classification and chromosome 3 status. Chromosome 3 status did not provide prognostic information that was independent of GEP.

  View details for DOI 10.1016/j.ophtha.2012.02.017

  View details for Web of Science ID 000307080100016

  View details for PubMedID 22521086

  View details for PubMedCentralID PMC3404209

• Association of Vitamin D Deficiency and Age-Related Macular Degeneration in Medicare Beneficiaries ARCHIVES OF OPHTHALMOLOGY Day, S., Acquah, K., Platt, A., Lee, P. P., Mruthyunjaya, P., Sloan, F. A. 2012; 130 (8): 1070-1071

  View details for Web of Science ID 000307455800022

  View details for PubMedID 22893083

  View details for PubMedCentralID PMC3616629

• Ranibizumab and bevacizumab for treatment of neovascular age-related macular degeneration: two-year results. Ophthalmology Martin, D. F., Maguire, M. G., Fine, S. L., Ying, G., Jaffe, G. J., Grunwald, J. E., Toth, C., Redford, M., Ferris, F. L. 2012; 119 (7): 1388-1398

  Abstract

  To describe effects of ranibizumab and bevacizumab when administered monthly or as needed for 2 years and to describe the impact of switching to as-needed treatment after 1 year of monthly treatment.Multicenter, randomized clinical trial.Patients (n = 1107) who were followed up during year 2 among 1185 patients with neovascular age-related macular degeneration who were enrolled in the clinical trial.At enrollment, patients were assigned to 4 treatment groups defined by drug (ranibizumab or bevacizumab) and dosing regimen (monthly or as needed). At 1 year, patients initially assigned to monthly treatment were reassigned randomly to monthly or as-needed treatment, without changing the drug assignment.Mean change in visual acuity.Among patients following the same regimen for 2 years, mean gain in visual acuity was similar for both drugs (bevacizumab-ranibizumab difference, -1.4 letters; 95% confidence interval [CI], -3.7 to 0.8; P = 0.21). Mean gain was greater for monthly than for as-needed treatment (difference, -2.4 letters; 95% CI, -4.8 to -0.1; P = 0.046). The proportion without fluid ranged from 13.9% in the bevacizumab-as-needed group to 45.5% in the ranibizumab monthly group (drug, P = 0.0003; regimen, P < 0.0001). Switching from monthly to as-needed treatment resulted in greater mean decrease in vision during year 2 (-2.2 letters; P = 0.03) and a lower proportion without fluid (-19%; P < 0.0001). Rates of death and arteriothrombotic events were similar for both drugs (P > 0.60). The proportion of patients with 1 or more systemic serious adverse events was higher with bevacizumab than ranibizumab (39.9% vs. 31.7%; adjusted risk ratio, 1.30; 95% CI, 1.07-1.57; P = 0.009). Most of the excess events have not been associated previously with systemic therapy targeting vascular endothelial growth factor (VEGF).Ranibizumab and bevacizumab had similar effects on visual acuity over a 2-year period. Treatment as needed resulted in less gain in visual acuity, whether instituted at enrollment or after 1 year of monthly treatment. There were no differences between drugs in rates of death or arteriothrombotic events. The interpretation of the persistence of higher rates of serious adverse events with bevacizumab is uncertain because of the lack of specificity to conditions associated with inhibition of VEGF.

  View details for DOI 10.1016/j.ophtha.2012.03.053

  View details for PubMedID 22555112

  View details for PubMedCentralID PMC3389193

• Image Inversion Spectral-Domain Optical Coherence Tomography Optimizes Choroidal Thickness and Detail through Improved Contrast INVESTIGATIVE OPHTHALMOLOGY & VISUAL SCIENCE Lin, P., Mettu, P. S., Pomerleau, D. L., Chiu, S. J., Maldonado, R., Stinnett, S., Toth, C. A., Farsiu, S., Mruthyunjaya, P. 2012; 53 (4): 1874-1882

  Abstract

  This study was conducted to determine whether there were significant differences in choroidal thickness, contrast, outer choroidal vessel (OCV), and choroidal-scleral junction (CSJ) visualization in inverted versus upright spectral-domain optical coherence tomography (SD-OCT).Images were captured on Bioptigen SD-OCT, Zeiss Cirrus HD-OCT, and Heidelberg Spectralis in 42 eyes of 21 healthy subjects. Average choroidal thickness across a fovea-centered 4-mm segment was determined with MATLAB. Quantitative measures of choroidal contrast were measured and CSJ assessed by applying a score of 0 to 3. OCV was determined by counting choroidal vessels ≥ 200 μm.Mean choroidal thickness was greater in inverted versus upright images captured by Bioptigen (P ≤ 0.003) and Spectralis (P ≤ 0.015). Choroidal thickness varied significantly between the three machines (P < 0.05). Contrast was higher in inverted versus upright images captured by Bioptigen (P ≤ 0.02) and Spectralis (P < 0.001), but not in Cirrus (P > 0.10, both observers). CSJ score was highest in the following: Spectralis inverted = Spectralis EDI > Cirrus upright > Bioptigen inverted. Mean OCV was highest in Spectralis inverted mode.The most favorable modes to visualize CSJ and OCV are the Spectralis EDI, Spectralis inverted, Cirrus upright, and Bioptigen inverted. These modes demonstrate the highest outer choroidal contrast and choroidal thickness measurements. Choroidal thickness cannot be compared between machines due to conversion factor differences. Future studies and construction of automated segmentation and detection software should take these benefits and pitfalls into account.

  View details for DOI 10.1167/iovs.11-9290

  View details for Web of Science ID 000303669400023

  View details for PubMedID 22410550

• Unanticipated Vision Loss After Pars Plana Vitrectomy SURVEY OF OPHTHALMOLOGY Jain, N., McCuen, B. W., Mruthyunjaya, P. 2012; 57 (2): 91-104

  Abstract

  Although advances in vitreoretinal surgical techniques and technology have helped to minimize the risks associated with surgical manipulation of the retina, retinal pigment epithelium, and optic nerve, unanticipated or unexplained visual loss still occurs. We review causes of vision loss encountered after pars plana vitrectomy, including retinal toxicities, vascular events, and optic neuropathies, and we suggest strategies to limit or prevent them.

  View details for DOI 10.1016/j.survophthal.2011.09.001

  View details for Web of Science ID 000301034500001

  View details for PubMedID 22337337

• Retinal manifestations of oncologic and hematologic conditions. International ophthalmology clinics Lin, P., Mruthyunjaya, P. 2012; 52 (1): 67-91

  View details for DOI 10.1097/IIO.0b013e31823bbd14

  View details for PubMedID 22124239

• Medicare Costs for Neovascular Age-Related Macular Degeneration, 1994-2007 AMERICAN JOURNAL OF OPHTHALMOLOGY Day, S., Acquah, K., Lee, P. P., Mruthyunjaya, P., Sloan, F. A. 2011; 152 (6): 1014-1020

  Abstract

  To assess changes in Medicare payments for neovascular age-related macular degeneration (AMD) since introduction of anti-vascular endothelial growth factor (VEGF) therapies.Retrospective, longitudinal cohort study.Using the Medicare 5% sample, beneficiaries with new diagnoses of neovascular AMD in 1994 (N = 2497), 2000 (N = 3927), and 2006 (N = 6041) were identified using International Classification of Diseases (ICD-9-CM). The total first-year health care and eye care costs were calculated for each beneficiary. Propensity score matching was used to match individuals in the 2000 and 2006 cohorts with the 1994 cohort on age, sex, race, Charlson Comorbidity Index, and low vision/blindness.The number of beneficiaries newly diagnosed with neovascular AMD more than doubled between the 1994 and 2006 cohorts. Overall yearly Part B payments per beneficiary increased significantly from $3567 for the 1994 to $5991 for the 2006 cohort (P < .01) in constant 2008 dollars. Payments for eye care alone doubled from $1504 for the 1994 cohort to $3263 for the 2006 cohort (P < .01). Most of the increase in payments for eye care in 2006 reflected payments for anti-VEGF injections, which were $1609 over 1 year. Mean annual numbers of visits and imaging studies also increased significantly between the 1994 and 2006 cohort. Results were similar in the matched sample.The introduction of anti-VEGF intravitreal injections has offered remarkable clinical benefits for patients with neovascular AMD, but these benefits have come at the cost of an increased financial burden of providing care for these patients.

  View details for DOI 10.1016/j.ajo.2011.05.008

  View details for Web of Science ID 000297714900016

  View details for PubMedID 21843875

  View details for PubMedCentralID PMC3219793

• Ocular Complications After Anti-Vascular Endothelial Growth Factor Therapy in Medicare Patients With Age-Related Macular Degeneration AMERICAN JOURNAL OF OPHTHALMOLOGY Day, S., Acquah, K., Mruthyunjaya, P., Grossman, D. S., Lee, P. P., Sloan, F. A. 2011; 152 (2): 266-272

  Abstract

  To determine longitudinal rates of ocular complications after anti-vascular endothelial growth factor (VEGF) treatment for neovascular age-related macular degeneration (AMD) in a nationally representative longitudinal sample.Retrospective, longitudinal case-control study.Using the Medicare 5% claims database, diagnoses of neovascular AMD and anti-VEGF injections of ranibizumab, bevacizumab, or pegaptanib were identified from International Classification of Diseases and Current Procedural Terminology procedure codes. Six thousand one hundred fifty-four individuals undergoing anti-VEGF treatment for neovascular AMD (total of 40 903 injections) were compared with 6154 matched controls with neovascular AMD who did not undergo anti-VEGF treatment. Propensity score matching was used to match individuals receiving anti-VEGF injections with controls. Rates of postinjection adverse outcomes (endophthalmitis, rhegmatogenous retinal detachment, retinal tear, uveitis, and vitreous hemorrhage) were analyzed by cumulative incidence and Cox proportional hazards model to control for demographic factors and ocular comorbidities.At the 2-year follow-up, the rates of endophthalmitis per injection (0.09%; P<.01), uveitis (0.11%; P<.01), and vitreous hemorrhage per injection (0.23%; P < .01) were significantly higher in the anti-VEGF treatment group. With Cox proportional hazards modeling, the anti-VEGF treatment group had a 102% higher risk of severe ocular complications overall and a 4% increased risk per injection, both of which were statistically significant (P<.01).Rates of endophthalmitis, uveitis, and vitreous hemorrhage were higher in the group treated with anti-VEGF injection than in the control group, although these nevertheless were rare in both groups. The overall risk of severe ocular complications was significantly higher in the anti-VEGF treatment group.

  View details for DOI 10.1016/j.ajo.2011.01.053

  View details for Web of Science ID 000293317900018

  View details for PubMedID 21664593

  View details for PubMedCentralID PMC3143287

• Melanoma-associated retinopathy: a presenting sign of metastatic disease. Journal of the American Academy of Dermatology Handler, M. Z., Mruthyunjaya, P., Nelson, K. 2011; 65 (1): e9-11

  View details for DOI 10.1016/j.jaad.2010.09.015

  View details for PubMedID 21679809

• Optimizing Diagnosis and Management of Nocardia Keratitis, Scleritis, and Endophthalmitis: 11-Year Microbial and Clinical Overview OPHTHALMOLOGY DeCroos, F. C., Garg, P., Reddy, A. K., Sharma, A., Krishnaiah, S., Mungale, M., Mruthyunjaya, P. 2011; 118 (6): 1193-1200

  Abstract

  To identify clinical factors and microbiological assays that facilitate a rapid diagnosis of Nocardia keratitis, scleritis, and endophthalmitis, and to determine optimal medical and surgical management strategies.Retrospective, consecutive case series.A total of 111 cases of keratitis, 11 cases of scleritis, and 16 cases of endophthalmitis, all culture-proven Nocardia infections, were identified between January 1999 and January 2010.The keratitis cases underwent intensive medical management, and the scleritis and endophthalmitis cases required concurrent surgical intervention for disease control. Corneal and scleral scrapings, as well as undiluted vitreous sample, were submitted for microbiologic evaluation (direct smear and culture).Historical points, clinical findings, and microbiologic assays that facilitated a prompt Nocardia diagnosis were identified, and management choices were examined for correlation with final acuity.Ocular exposure to soil or plant matter was a common historical point in cases of Nocardia keratitis (48%) and scleritis (45%), respectively. Nocardia keratitis often (38.7%) presented with "wreath"-shaped anterior stromal infiltrate or infiltrate interspersed with elevated, pinhead-sized, chalky lesions. Most patients with scleritis (63.4%) presented with nodular lesions demonstrating pointed abscesses. Nocardia endophthalmitis typically (75%) presented with endoexudates or nodular exudates surrounding the pupillary border. Gram stain and 1% acid-fast stain enabled prompt diagnosis of Nocardia in 64% and 63% of keratitis cases and 45% and 63% of scleritis cases, respectively. Direct smear was usually not revealing in cases of Nocardia endophthalmitis. Isolates from Nocardia keratitis, scleritis, and endophthalmitis demonstrated 97%, 100%, and 90% susceptibility to amikacin, respectively. Nocardia keratitis resolved with medical therapy alone in 82% of cases. Younger age and better initial acuity correlated with improved final acuity in keratitis cases. Outcomes were poor after Nocardia scleritis and endophthalmitis.Early appropriate treatment often results in visual recovery in eyes with Nocardia keratitis. Despite aggressive and prompt surgical intervention, the prognosis for Nocardia scleritis and endophthalmitis is more guarded. Nocardia isolated from ocular infections demonstrate high levels of susceptibility to amikacin.The author(s) have no proprietary or commercial interest in any materials discussed in this article.

  View details for DOI 10.1016/j.ophtha.2010.10.037

  View details for Web of Science ID 000291152700029

  View details for PubMedID 21276615

• Ranibizumab and bevacizumab for neovascular age-related macular degeneration. New England journal of medicine Martin, D. F., Maguire, M. G., Ying, G., Grunwald, J. E., Fine, S. L., Jaffe, G. J. 2011; 364 (20): 1897-1908

  Abstract

  Clinical trials have established the efficacy of ranibizumab for the treatment of neovascular age-related macular degeneration (AMD). In addition, bevacizumab is used off-label to treat AMD, despite the absence of similar supporting data.In a multicenter, single-blind, noninferiority trial, we randomly assigned 1208 patients with neovascular AMD to receive intravitreal injections of ranibizumab or bevacizumab on either a monthly schedule or as needed with monthly evaluation. The primary outcome was the mean change in visual acuity at 1 year, with a noninferiority limit of 5 letters on the eye chart.Bevacizumab administered monthly was equivalent to ranibizumab administered monthly, with 8.0 and 8.5 letters gained, respectively. Bevacizumab administered as needed was equivalent to ranibizumab as needed, with 5.9 and 6.8 letters gained, respectively. Ranibizumab as needed was equivalent to monthly ranibizumab, although the comparison between bevacizumab as needed and monthly bevacizumab was inconclusive. The mean decrease in central retinal thickness was greater in the ranibizumab-monthly group (196 μm) than in the other groups (152 to 168 μm, P=0.03 by analysis of variance). Rates of death, myocardial infarction, and stroke were similar for patients receiving either bevacizumab or ranibizumab (P>0.20). The proportion of patients with serious systemic adverse events (primarily hospitalizations) was higher with bevacizumab than with ranibizumab (24.1% vs. 19.0%; risk ratio, 1.29; 95% confidence interval, 1.01 to 1.66), with excess events broadly distributed in disease categories not identified in previous studies as areas of concern.At 1 year, bevacizumab and ranibizumab had equivalent effects on visual acuity when administered according to the same schedule. Ranibizumab given as needed with monthly evaluation had effects on vision that were equivalent to those of ranibizumab administered monthly. Differences in rates of serious adverse events require further study. (Funded by the National Eye Institute; ClinicalTrials.gov number, NCT00593450.).

  View details for DOI 10.1056/NEJMoa1102673

  View details for PubMedID 21526923

  View details for PubMedCentralID PMC3157322

• Retinal Pigment Epithelial Detachments in Age-Related Macular Degeneration: Classification and Therapeutic Options SEMINARS IN OPHTHALMOLOGY Pepple, K., Mruthyunjaya, P. 2011; 26 (3): 198-208

  Abstract

  Retinal pigment epithelial detachment (PED) is an important predictor of vision loss in patients with age-related macular degeneration (AMD). Here we review the historical PEDs subtypes, include recent insights into PED pathogenesis provided by modern imaging modalities, and summarize the current options for treatment.

  View details for DOI 10.3109/08820538.2011.570850

  View details for Web of Science ID 000293502200016

  View details for PubMedID 21609233

• Bacterial Contamination of Needles Used for Intravitreal Injections:A Prospective, Multicenter Study OCULAR IMMUNOLOGY AND INFLAMMATION Stewart, J. M., Srivastava, S. K., Fung, A. E., Mahmoud, T. H., Telander, D. G., Hariprasad, S. M., Ober, M. D., Mruthyunjaya, P. 2011; 19 (1): 32-38

  Abstract

  To determine the incidence of bacterial contamination of needles used for intravitreal injections.Patients undergoing intravitreal injections were enrolled prospectively. No pre-injection antibiotics were administered. Following povidone-iodine irrigation, conjunctival cultures were taken and the injection was performed. The needle was cultured. A dry control needle was exposed to the surgical field and cultured.No patients developed endophthalmitis. Eighteen injection needles (18%) yielded positive bacterial growth. The most commonly encountered organisms were Propionibacterium acnes (n = 8) and Staphylococcus epidermidis (n = 6). Four control needles showed positive growth, in 2 cases with the same organism as a matching positive used needle. The difference between contamination rates of used and control needles was significant (p = .002, McNemar's test).Bacterial contaminants are present on a substantial proportion of needles. Since the needle contacts both the ocular surface and the vitreous, it is possible that inoculation of the vitreous cavity occurs in such cases.

  View details for DOI 10.3109/09273948.2010.520405

  View details for Web of Science ID 000288355300006

  View details for PubMedID 21034310

• Evaluation of Contrast Agents for Enhanced Visualization in Optical Coherence Tomography INVESTIGATIVE OPHTHALMOLOGY & VISUAL SCIENCE Ehlers, J. P., Gupta, P. K., Farsiu, S., Maldonado, R., Kim, T., Toth, C. A., Mruthyunjaya, P. 2010; 51 (12): 6614-6619

  Abstract

  To identify and evaluate the use of contrast agents in optical coherence tomography (OCT) for ophthalmic applications.Three agents-prednisolone acetate (PA), triamcinolone acetonide (TA), and lipid-based artificial tears (LBAT)-were tested in cadaveric porcine eyes imaged with hand-held spectral-domain OCT (SD-OCT). Anterior segment imaging was performed in triplicate with each agent at three sites: corneal epithelial surface, corneal wound interface, and anterior chamber. OCT characteristics of the three agents at each ocular site were analyzed. Quantitative intensity (i.e., brightness) analysis was performed with image analysis software. Institutional review board approval was obtained for imaging in human subjects undergoing cataract surgery. PA was applied to the corneal surface, and SD-OCT imaging was performed of the corneal surface and wound interface immediately after cataract surgery.All agents provided increased reflectivity. PA and LBAT showed a smooth bright reflectivity profile, whereas TA had a granular profile. Improved visualization of tissue interfaces was noted. Maximum and mean intensity of reflectance were higher for all agents compared with controls (P < 0.05). PA showed topical and wound interface contrast enhancement in human subjects after cataract surgery.Significant OCT contrast enhancement was achieved with improved visualization of tissue interfaces. Each agent had a unique reflectivity profile. Future applications of OCT contrast agents might include evaluation of wound stability, intraocular fluidics, and ocular surface disease.

  View details for DOI 10.1167/iovs.10-6195

  View details for Web of Science ID 000284837500068

  View details for PubMedID 21051711

• One-Year Outcomes After Retinal Detachment Surgery Among Medicare Beneficiaries AMERICAN JOURNAL OF OPHTHALMOLOGY Day, S., Grossman, D. S., Mruthyunjaya, P., Sloan, F. A., Lee, P. P. 2010; 150 (3): 338-345

  Abstract

  To determine longitudinal rates of second retinal detachment operation and postoperative adverse outcomes after retinal detachment surgery in a nationally representative sample of older Americans.Retrospective, longitudinal cohort analysis.A total of 9216 Medicare beneficiaries were identified from the Medicare 5% sample who were diagnosed with rhegmatogenous retinal detachment and underwent primary pars plana vitrectomy (PPV), scleral buckle, pneumatic retinopexy, or laser photocoagulation or cryotherapy alone. Rhegmatogenous retinal detachment, PPV, scleral buckle, pneumatic retinopexy, or laser photocoagulation/cryotherapy was ascertained from International Classification of Diseases and Current Procedural Terminology procedure codes. Rates of second retinal detachment operation and postoperative adverse outcomes were analyzed by cumulative incidence and logistic regression to control for prior adverse outcome measures and demographic factors.At 1-year follow-up, the rate of receipt of a second retinal detachment operation for beneficiaries who had undergone primary pneumatic retinopexy was much higher (40.6%, P < .0001) relative to the scleral buckle (19.2%) group. After controlling for demographic variables and ocular comorbidities, pneumatic retinopexy individuals were nearly 3 times more likely to receive a second retinal detachment surgery than scleral buckle individuals. No significant differences exist in risk of second retinal detachment surgery for the PPV compared to the scleral buckle group. Individuals receiving PPV were 2 times more likely to suffer adverse outcomes than were those undergoing scleral buckle. Results were robust in sensitivity analysis.Rates of second operation were much higher after pneumatic retinopexy than PPV or scleral buckle, and rates of adverse outcomes were higher in PPV, even after controlling for risk factors and demographic variables.

  View details for DOI 10.1016/j.ajo.2010.04.009

  View details for Web of Science ID 000281781800007

  View details for PubMedID 20591398

  View details for PubMedCentralID PMC2926163

• Postoperative cilioretinal artery occlusion in Sturge Weber-associated glaucoma JOURNAL OF AAPOS Chang, L., Mruthyunjaya, P., Rodriguez-Rosa, R. E., Freedman, S. F. 2010; 14 (4): 358-360

  Abstract

  Surgical management of Sturge Weber-associated glaucoma is challenging. Choroidal effusion and expulsive choroidal hemorrhage are commonly cited potential risks. We report a case of a cilioretinal artery occlusion associated with glaucoma drainage device surgery in a child with refractory Sturge Weber-associated glaucoma.

  View details for DOI 10.1016/j.jaapos.2010.04.014

  View details for Web of Science ID 000281524600014

  View details for PubMedID 20621528

• Outcomes of Early versus Delayed Vitreoretinal Surgery for Retained Lens Fragments Following Complicated Cataract Surgery Mruthyunjaya, P., Cusick, M., Ehlers, J. P., Postel, E. A. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2010

  View details for Web of Science ID 000442387305215

• Transpositional Autokeratoplasty in a Patient with Unilateral Choroidal Melanoma and Contralateral Exposure Keratopathy. Ophthalmic surgery, lasers & imaging : the official journal of the International Society for Imaging in the Eye Mehta, H., Hungerford, J. L., Gartry, D. S., Herbert, H. M., Mruthyunjaya, P. 2010: 1-3

  Abstract

  Penetrating keratoplasty was required to improve corneal clarity in the left eye, which had suffered chronic exposure keratopathy following a cerebellopontine angle tumor with facial nerve involvement. The right eye had a large choroidal melanoma, which had failed brachytherapy, but the cornea was transparent and healthy. The right eye corneal button was sutured to the left eye host and a donor corneal button was sutured to the right eye rim. The right eye was subsequently enucleated. Two years later, the patient had 6/12 visual acuity with a clear graft and no tumor seeding in the host eye. Although limited opportunities arise to employ transpositional autokeratoplasty, where appropriate, it offers an alternative to conventional allokeratoplasty with a lower risk of immune rejection.

  View details for DOI 10.3928/15428877-20100215-41

  View details for PubMedID 20337330

• SCORE Study Report 7: Incidence of Intravitreal Silicone Oil Droplets Associated With Staked-on vs Luer Cone Syringe Design AMERICAN JOURNAL OF OPHTHALMOLOGY Scott, I. U., Oden, N. L., VanVeldhuisen, P. C., Ip, M. S., Blodi, B. A., Antoszyk, A. N. 2009; 148 (5): 725-732

  Abstract

  To evaluate the incidence of intravitreal silicone oil (SO) droplets associated with intravitreal injections using a staked-on vs luer cone syringe design in the SCORE (Standard Care vs COrticosteroid in REtinal Vein Occlusion) Study.Prospective, randomized, phase III clinical trial.The incidence of intravitreal SO was compared among participants exposed to the staked-on syringe design, the luer cone syringe design, or both of the syringe designs in the SCORE Study, which evaluated intravitreal triamcinolone acetonide injection(s) for vision loss secondary to macular edema associated with central or branch retinal vein occlusion. Injections were given at baseline and 4-month intervals, based on treatment assignment and study-defined retreatment criteria. Because intravitreal SO was observed following injections in some participants, investigators were instructed, on September 22, 2006, to look for intravitreal SO at all study visits. On November 1, 2007, the luer cone syringe design replaced the staked-on syringe design.A total of 464 participants received a total of 1,205 injections between November 4, 2004 and February 28, 2009. Intravitreal SO was noted in 141 of 319 participants (44%) exposed only to staked-on syringes, 11 of 87 (13%) exposed to both syringe designs, and 0 of 58 exposed only to luer cone syringes (P < .0001). Among participants with first injections after September 22, 2006, intravitreal SO was noted in 65 of 114 (57%) injected only with staked-on syringes compared with 0 of 58 injected only with luer cone syringes. Differential follow-up is unlikely to explain these results.In the SCORE Study, luer cone syringe design is associated with a lower frequency of intravitreal SO droplet occurrence compared with the staked-on syringe design, likely attributable to increased residual space in the needle hub with the luer cone design.

  View details for DOI 10.1016/j.ajo.2009.06.004

  View details for Web of Science ID 000271669300014

  View details for PubMedID 19674727

• A Randomized Trial Comparing the Efficacy and Safety of Intravitreal Triamcinolone With Observation to Treat Vision Loss Associated With Macular Edema Secondary to Central Retinal Vein Occlusion The Standard Care vs Corticosteroid for Retinal Vein Occlusion (SCORE) Study Report 5 ARCHIVES OF OPHTHALMOLOGY Ip, M. S., Scott, I. U., VanVeldhuisen, P. C., Oden, N. L., Blodi, B. A., Fisher, M., Singerman, L. J., Tolentino, M., Chan, C. K., Gonzalez, V. H. 2009; 127 (9): 1101-1114

  Abstract

  To compare the efficacy and safety of 1-mg and 4-mg doses of preservative-free intravitreal triamcinolone with observation for eyes with vision loss associated with macular edema secondary to perfused central retinal vein occlusion (CRVO).Multicenter, randomized, clinical trial of 271 participants.Gain in visual acuity letter score of 15 or more from baseline to month 12.Seven percent, 27%, and 26% of participants achieved the primary outcome in the observation, 1-mg, and 4-mg groups, respectively. The odds of achieving the primary outcome were 5.0 times greater in the 1-mg group than the observation group (odds ratio [OR], 5.0; 95% confidence interval [CI], 1.8-14.1; P = .001) and 5.0 times greater in 4-mg group than the observation group (OR, 5.0; 95% CI, 1.8-14.4; P = .001); there was no difference identified between the 1-mg and 4-mg groups (OR, 1.0; 95% CI, 0.5-2.1; P = .97). The rates of elevated intraocular pressure and cataract were similar for the observation and 1-mg groups, but higher in the 4-mg group.Intravitreal triamcinolone is superior to observation for treating vision loss associated with macular edema secondary to CRVO in patients who have characteristics similar to those in the SCORE-CRVO trial. The 1-mg dose has a safety profile superior to that of the 4-mg dose. Application to Clinical Practice Intravitreal triamcinolone in a 1-mg dose, following the retreatment criteria applied in the SCORE Study, should be considered for up to 1 year, and possibly 2 years, for patients with characteristics similar to those in the SCORE-CRVO trial. Trial Registration clinicaltrials.gov Identifier: NCT00105027.

  View details for Web of Science ID 000269765500001

  View details for PubMedID 19752419

• A Randomized Trial Comparing the Efficacy and Safety of Intravitreal Triamcinolone With Standard Care to Treat Vision Loss Associated With Macular Edema Secondary to Branch Retinal Vein Occlusion The Standard Care vs Corticosteroid for Retinal Vein Occlusion (SCORE) Study Report 6 ARCHIVES OF OPHTHALMOLOGY Scott, I. U., Ip, M. S., VanVeldhuisen, P. C., Oden, N. L., Blodi, B. A., Fisher, M., Chan, C. K., Gonzalez, V. H., Singerman, L. J., Tolentino, M. 2009; 127 (9): 1115-1128

  Abstract

  To compare the efficacy and safety of 1-mg and 4-mg doses of preservative-free intravitreal triamcinolone with standard care (grid photocoagulation in eyes without dense macular hemorrhage and deferral of photocoagulation until hemorrhage clears in eyes with dense macular hemorrhage) for eyes with vision loss associated with macular edema secondary to branch retinal vein occlusion (BRVO).Multicenter, randomized clinical trial of 411 participants. Main Outcome Measure Gain in visual acuity letter score of 15 or more from baseline to month 12.Twenty-nine percent, 26%, and 27% of participants achieved the primary outcome in the standard care, 1-mg, and 4-mg groups, respectively. None of the pairwise comparisons between the 3 groups was statistically significant at month 12. The rates of elevated intraocular pressure and cataract were similar for the standard care and 1-mg groups, but higher in the 4-mg group.There was no difference identified in visual acuity at 12 months for the standard care group compared with the triamcinolone groups; however, rates of adverse events (particularly elevated intraocular pressure and cataract) were highest in the 4-mg group. Application to Clinical Practice Grid photocoagulation as applied in the SCORE Study remains the standard care for patients with vision loss associated with macular edema secondary to BRVO who have characteristics similar to participants in the SCORE-BRVO trial. Grid photocoagulation should remain the benchmark against which other treatments are compared in clinical trials for eyes with vision loss associated with macular edema secondary to BRVO. Trial Registration clinicaltrials.gov Identifier: NCT00105027.

  View details for Web of Science ID 000269765500002

  View details for PubMedID 19752420

• Unusual case of diffuse choroidal melanoma masquerading as atypical central serous chorioretinopathy. Retinal cases & brief reports Scott, A. W., Fekrat, S., Mruthyunjaya, P., Cummings, T. J., Cooney, M. J. 2008; 2 (4): 280-285

  Abstract

  To describe an unusual case of diffuse circumpapillary choroidal melanoma masquerading as atypical central serous chorioretinopathy, and to describe fluorescein angiographic and optical coherence tomography characteristics of this diffuse choroidal melanoma.Interventional case report.A 46-year-old human immunodeficiency virus-positive man presented with an 11-month history of decreased vision and the absence of an elevated choroidal lesion. The patient failed to return for follow-up.Thirteen months after his initial presentation, circumpapillary diffuse choroidal melanoma was diagnosed. The patient underwent enucleation. No extrascleral extension was present.Imaging characteristics on fluorescein angiography or optical coherence tomography may be of diagnostic value to aid the ophthalmologist in earlier detection of diffuse choroidal melanomas.

  View details for DOI 10.1097/ICB.0b013e318156d799

  View details for PubMedID 25390591

• Identification of patients with diabetic macular edema from claims data - A validation study ARCHIVES OF OPHTHALMOLOGY Bearelly, S., Mruthyunjaya, P., Tzeng, J. P., Suner, I. J., Shea, A. M., Lee, J. T., Kowalski, J. W., Curtis, L. H., Schulman, K. A., Lee, P. P. 2008; 126 (7): 986-989

  Abstract

  To assess the validity of an algorithm for identifying patients with diabetic macular edema (DME) using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnosis codes in administrative billing data from a convenience sample of physician offices.A convenience sample of 12 general ophthalmologists and 10 retina specialists applied prespecified algorithms based on ICD-9-CM diagnosis codes to the billing claims of their practices and selected the associated medical records. Four ophthalmologists abstracted data from the medical records, which were then compared with the coded diagnoses. Main outcome measures were sensitivity, specificity, and the kappa statistic for the DME algorithm (a combination of codes 250.xx and 362.53), treating medical record documentation of DME as the standard criterion.The DME algorithm had a sensitivity of 0.88 and a specificity of 0.96 for identifying DME. Excellent agreement was noted between the algorithm and the medical records (kappa = 0.84). The algorithm performed less well in identifying patients with a diagnosis of clinically significant DME (sensitivity, 0.86; specificity, 0.84; kappa = 0.64).The results of this pilot study suggest that patients with DME can be identified accurately in claims data using ICD-9-CM diagnosis codes. Application of this algorithm could improve investigations of disease prevalence and disease burden and provide an efficient means of assessing care and interventions.

  View details for Web of Science ID 000257511300016

  View details for PubMedID 18625948

• Choroidal Metastasis of Follicular Thyroid Adenocarcinoma Diagnosed by 25-Gauge Transretinal Biopsy ANNALS OF OPHTHALMOLOGY Scott, A. W., Cummings, T. J., Kirkpatrick, J. P., Mruthyunjaya, P. 2008; 40 (2): 110-112

  Abstract

  We report a case of a patient with previously treated follicular thyroid carcinoma who presented with a symptomatic amelanotic choroidal mass with low internal reflectivity and a metastatic lytic skull lesion. A 25-gauge vitrector was used to perform transretinal choroidal biopsy (TRCB), confirming the diagnosis of metastatic follicular thyroid carcinoma.

  View details for Web of Science ID 000260909700011

  View details for PubMedID 19013920

• Malignant transformation of iris melanocytoma to iris ring melanoma BRITISH JOURNAL OF OPHTHALMOLOGY Sagoo, M. S., Mruthyunjaya, P., Cree, I., Luthert, P. J., Hungerford, J. L. 2007; 91 (11): 1571-1572

  View details for DOI 10.1136/bjo.2006.105858

  View details for Web of Science ID 000250229300047

  View details for PubMedID 17947283

  View details for PubMedCentralID PMC2095458

• Efficacy of low-release-rate fluocinolone acetonide intravitreal implants to treat experimental uveitis ARCHIVES OF OPHTHALMOLOGY Mruthyunjaya, P., Khalatbari, D., Yang, P., Stinnett, S., Tano, R., Ashton, P., Guo, H., Nazzaro, M., Jaffe, G. J. 2006; 124 (7): 1012-1018

  Abstract

  To determine the efficacy of 0.5-mg and 0.1-mg sustained-release fluocinolone acetonide intravitreal implants to inhibit ocular inflammation in a rabbit model of severe uveitis.The in vitro pharmacokinetic profile of both the 0.5-mg and 0.1-mg sustained-release fluocinolone intravitreal implants was determined during a 10-day period. A sustained-release fluocinolone acetonide intravitreal implant with a release rate of either 0.5 microg/d (n = 16) or 0.1 microg/d (n = 16) was implanted into the vitreous cavity of the right eye in albino rabbits after a subcutaneous injection of tuberculin antigen. Control animals (n = 14) received empty devices. Uveitis was induced with an intravitreal tuberculin antigen injection. A masked observer graded anterior chamber flare, anterior chamber cells, vitreous opacity, and inflammation on histologic sections.In vitro, the drug was released from both devices in a linear manner. In vivo, treated eyes were significantly less inflamed than untreated eyes (P< or =.02). Inflammation was suppressed to a greater degree with the 0.5-microg/d implant compared with the 0.1-microg/d implant.Sustained-release fluocinolone intravitreal implants suppress ocular inflammation in a rabbit model of severe uveitis.The efficacy demonstrated with the 0.1-microg/d implant provides the rationale for future human studies with lower-release-rate implants than are currently used in noninfectious uveitis clinical trials.

  View details for Web of Science ID 000239123200010

  View details for PubMedID 16832025

• Central retinal vein occlusion in patients treated with long-term warfarin sodium (Coumadin) for anticoagulation RETINA-THE JOURNAL OF RETINAL AND VITREOUS DISEASES Mruthyunjaya, P., Wirostko, W. J., Chandrashekhar, R., Stinnett, S., Lai, J. C., Deramo, V., Tang, J., Dev, S., Postel, E. A., Connor, T. B., Fekrat, S. 2006; 26 (3): 285-291

  Abstract

  To describe the clinical features of persons who developed central retinal vein occlusion (CVO) while being treated with Coumadin for chronic anticoagulation.In a retrospective, comparative, noninterventional case series of patients diagnosed with CVO while being treated with Coumadin as a systemic anticoagulant, visual and anatomical outcomes were compared with those for a cohort of patients diagnosed with CVO who were not treated with any systemic anticoagulation.Fourteen eyes of 14 patients treated with Coumadin were identified. At presentation, the median international normalization ratio (INR) was 2.20 (range, 1.3-5.0). Eight patients (57%) had a therapeutic INR at the time of CVO. Their visual acuity and perfusion status were similar to those of patients with subtherapeutic INR. At the last follow-up (median, 16 months), visual acuity and perfusion status of the group of 14 eyes were similar to baseline findings (P = 0.62). Clinical features and outcomes were similar to those for a cohort of patients with CVO who were not being treated with systemic anticoagulation.CVO can occur in patients being treated with Coumadin for systemic anticoagulation. Final visual acuity and perfusion status were similar to those in a cohort of patients with CVO who were not treated with Coumadin. Although visual acuity is unaffected, ensuring that the INR for these patients remains in the therapeutic range may be important to help prevent secondary systemic thrombotic and embolic disease.

  View details for Web of Science ID 000241684700006

  View details for PubMedID 16508428

• Impact of fluorescein angiographic characteristics of macular lesions on outcomes after macular translocation 360 degrees surgery in eyes with age-related macular degeneration RETINA-THE JOURNAL OF RETINAL AND VITREOUS DISEASES Mruthyunjaya, P., Stinnett, S. S., Toth, C. A. 2005; 25 (5): 597-607

  Abstract

  To evaluate the relationship between preoperative lesion size and composition and visual outcomes at 1 year after macular translocation surgery with 360 degree peripheral retinectomy (MT360) for neovascular age-related macular degeneration (AMD).A prospective, interventional, consecutive, noncomparative case series of 64 patients with bilateral neovascular AMD treated with MT360 in the eye with more recent vision loss. Masked reviewers graded preoperative fluorescein angiograms for lesion size in Macular Photocoagulation Study disk areas (MPS DAs) and predominant lesion composition (classic or occult choroidal neovascularization or subretinal hemorrhage). Median changes in distance and near visual acuities and reading speed at 12 months after surgery were analyzed with respect to lesion size and composition.There was no significant difference between the outcomes for small-, medium- or large-sized preoperative lesions. Patients in each predominant lesion composition group had median improvement in visual outcomes with significant improvement in near visual acuity and reading speed for predominantly classic and occult lesions.MT360 stabilizes or improves visual function in patients with neovascular AMD irrespective of lesion size categories and with a variety of lesion compositions. Removal of the subretinal lesion and repositioning of the fovea over a healthier retinal pigment epithelial bed may account for these improvements.

  View details for Web of Science ID 000235012800010

  View details for PubMedID 16077357

• Recurrence of retinal pigment epithelial changes after macular translocation with 360 degrees peripheral retinectomy for geographic atrophy ARCHIVES OF OPHTHALMOLOGY Cahill, M. T., Mruthyunjaya, P., Rickman, C. B., Toth, C. A. 2005; 123 (7): 935-938

  Abstract

  To assess the prevalence of recurrence of macular geographic atrophy (GA) of the retinal pigment epithelium (RPE) after macular translocation with 360 degrees retinectomy (MT360) in one institution.A retrospective review of all cases of GA that were treated with MT360 in 1 institution. Demographic and clinical data including the duration of preoperative visual loss, preoperative and postoperative visual acuity, and the prevalence of postoperative foveal RPE atrophy were recorded for these patients, and these data were compared with similar data from patients who underwent MT360 for neovascular age-related macular degeneration (AMD) as part of the prospective Duke Macular Translocation Study, Duke University Eye Center, Durham, NC.Four eyes in 4 patients with GA secondary to AMD underwent MT360 and were compared with 63 eyes in 63 patients who underwent MT360 for neovascular AMD as part of the Duke Macular Translocation Study. The mean duration of preoperative visual loss was higher in the GA group (11.3 months) than in the neovascular AMD group (1.7 months) (P = .08). The prevalence of postoperative foveal RPE atrophy was significantly higher in the GA group (n = 3; 75.0%) than in the neovascular AMD group (n = 5; 8.3%) (P<.01); in the GA group, this corresponded to recurrence of the GA lesions. In contrast, the postoperative RPE atrophy seen in the neovascular AMD group was due to postoperative mechanical forces such as laser therapy or RPE tearing. There was no significant difference in the mean preoperative or postoperative visual acuity in either group.Subfoveal RPE atrophy can reoccur following MT360 in eyes with nonneovascular AMD and GA; RPE atrophy similar to this has not been found in a large consecutive series of patients with neovascular AMD after MT360. Further research is needed to assess if the potential for visual recovery in eyes with end-stage nonneovascular AMD is outweighed by the possibility of postoperative recurrence of GA.

  View details for Web of Science ID 000230352900006

  View details for PubMedID 16009834

• Change in visual function after macular translocation with 360 degrees retinectomy for neovascular age-related macular degeneration OPHTHALMOLOGY Mruthyunjaya, P., Stinnett, S. S., Toth, C. A. 2004; 111 (9): 1715-1724

  Abstract

  To measure the change in vision and visual outcomes at 12 months after macular translocation with 360 degrees retinectomy (MT360) and silicone oil tamponade in patients with bilateral vision loss resulting from subfoveal choroidal neovascular membranes in age-related macular degeneration (AMD).A prospective, interventional, consecutive, noncomparative case series.Sixty-four patients with bilateral vision loss resulting from neovascular AMD.Eligible patients had AMD with subfoveal choroidal neovascularization in the operative eye and a maximum of 6 months of central vision loss. Preoperative and 12-month postoperative evaluations included standardized testing of near and distance acuity and reading speed. Patients underwent MT360 with silicone oil tamponade, followed 2 months later by extraocular muscle surgery and silicone oil removal.Change in distance acuity, near acuity, and reading speed at 12 months after MT360 compared with those values before surgery.Sixty-one patients were followed up for 12 months. All eyes were translocated successfully. Median distance acuity letter score improved from 62 letters (Snellen equivalent of approximately 20/125) before surgery to 69 letters (approximately 20/80) by 12 months after surgery (P = 0.03). Median near acuity improved from 0.70 logarithm of the minimum angle of resolution (logMAR) units (approximately 20/100) before surgery to 0.44 logMAR units (approximately 20/55) at 12 months (P<0.001). Median reading speed improved from 71 words per minute (wpm) before surgery to 105 wpm at 12 months after surgery (P<0.001). At 12 months, distance acuity improved by 1 or more lines in 32 patients (52%). In patients with either preoperative distance or near acuity of 20/80 or better, 74% and 95% of patients, respectively, remained in this range of acuity. In patients with either preoperative distance or near acuity of worse than 20/80, 40% and 48% of patients, respectively, improved to 20/80 or better. Postoperative retinal detachment developed in 5 patients (8%), with the macula involved in 2 patients, and all retinas were reattached successfully.Macular translocation with 360 degrees retinectomy with silicone oil tamponade is effective in significantly improving visual function in patients with neovascular AMD, as demonstrated by the improvement in distance and near acuity and reading speed at 12 months after surgery in these patients. Although this is a complex surgical intervention, patients with preoperative visual acuity of 20/80 or better at near or distance are highly likely to retain the 20/80 or better acuity at 12 months after surgery. Macular translocation with 360 degrees retinectomy is an effective treatment option for patients with vision loss in their second eye resulting from neovascular AMD.

  View details for DOI 10.1016/j.ophtha.2004.03.022

  View details for Web of Science ID 000223606300017

  View details for PubMedID 15350328

• Diagnostics and therapeutic challenges RETINA-THE JOURNAL OF RETINAL AND VITREOUS DISEASES Mruthyunjaya, P., Fekrat, S., Reed, J. B., Mittra, R., Gallemore, R. P. 2003; 23 (3): 392-399

  View details for Web of Science ID 000183932600017

• An intravitreal sustained-release fluocinolone acetonide device to treat severe experimental uveitis Mruthyunjaya, P., Khalatbari, D., Yang, P., Stinnett, S., Hanes, M., Jaffe, G. J. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2003: U469

  View details for Web of Science ID 000184607001678

• Fluocinolone acetonide formulated with sodium hyaluronate as a sustained release drug delivery pellet in the treatment of experimental proliferative vitreoretinopathy Khalatbari, D., Mruthyunjaya, P., Yang, P., Stinnett, S., Chen, J., Ashton, P., Jaffe, G. J. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2003: U95

  View details for Web of Science ID 000184607000474

• Diagnostic yield of vitrectomy in eyes with suspected posterior segment infection or malignancy OPHTHALMOLOGY Mruthyunjaya, P., Jumper, J. M., McCallum, R., Patel, D. J., Cox, T. A., JAFFE, G. J. 2002; 109 (6): 1123-1129

  Abstract

  To determine the yield of diagnostic pars plana vitrectomy in eyes with suspected posterior segment inflammation or malignancy when clinical examination and systemic laboratory testing did not yield a specific diagnosis.Non-comparative interventional case seriesEighty-seven consecutive patients (90 eyes) who underwent diagnostic pars plana vitrectomy from 1989 through 1999.Vitreous samples were analyzed in a directed manner based on the preoperative clinical examination and systemic laboratory testing.Diagnosis from each test performed on the vitreous samples.Diagnostic vitrectomy was performed alone in 6 eyes (7%) and as part of a therapeutic procedure in the remaining 84 eyes. The diagnostic tests performed most frequently included cytopathology (83%), microbiologic culture and sensitivity (43%), polymerase chain reaction (PCR) (36%), and intraocular antibody levels for T. canis (14%). Of these, intraocular antibody testing and PCR had the highest positive yield, 46% and 39%, respectively. Overall, directed vitreous analysis identified a specific cause in 35 eyes (39%). Of the 65 cases in which an underlying infection was suspected preoperatively, the procedure yielded a specific diagnosis in 27 (42%). When intraocular malignancy was considered preoperatively (71 eyes), a diagnosis of intraocular lymphoma was obtained in seven (10%). This difference between these diagnostic yields was significant (P = 0.02, Fisher's exact test).Diagnostic vitrectomy with directed vitreous fluid analysis yields a specific cause and guides subsequent therapy in a high percentage of cases. This procedure is a valuable adjunct in cases that cannot be diagnosed by less invasive methods.

  View details for Web of Science ID 000175762400022

  View details for PubMedID 12045054

• Fluocinolone acetonide sustained drug delivery system in the treatment of experimental proliferative vitreoretinopathy Mruthyunjaya, P., Tseng, W., Stinnett, S., Ashton, P., Jaffe, G. J. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2002: U845

  View details for Web of Science ID 000184606700160

• Central retinal vein occlusion in patients on chronic Coumadin (R) anticoagulation Lai, J. C., Mruthyunjaya, P., Fekrai, S. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2002: U103

  View details for Web of Science ID 000184606600493

• Diagnostic yield of vitrectomy in eyes with suspected posterior segment infection or malignancy. Mruthyunjaya, P., Jumper, J. M., Patel, D., Jaffe, G. J. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2000: S96

  View details for Web of Science ID 000086246700501

• Frequency of vitreoretinal surgery in uveitis patients Mruthyunjaya, P., Jumper, J. M., Merrill, P., Kim, J. H., Jaffe, G. J. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 1999: S146

  View details for Web of Science ID 000079269200783

• Clinicomicrobiological review of Nocardia keratitis CORNEA Sridhar, M. S., Sharma, S., Reddy, M. K., Mruthyunjay, P., Rao, G. N. 1998; 17 (1): 17-22

  Abstract

  To present the clinical profile, laboratory results, and outcome of treatment in 16 patients with Nocardia keratitis.A retrospective review of 16 culture-proven cases of Nocardia keratitis was done. Clinical and microbiologic data were analyzed.Nocardia constituted 1.7% of laboratory-confirmed bacterial keratitis and was seen predominantly in male subjects (13 of 16) with a mean age of 39.1 years. Although the predisposing factor was unknown in the majority, a definite history of trauma was present in four (25%) cases. Patchy stromal infiltrates were seen in 12 patients. Wreath pattern of infiltrates (six of 16) and hypopyon (nine of 16) were notable features. Nocardia was detectable in corneal scrapings of 10 patients with Gram stain and all patients with 1% acid-fast preparation (six of six). Nocardia asteroides was the causative agent in all except one (N. caviae). All isolates were sensitive to gentamicin; however, topical 30% sulfacetamide was the preferred drug for treatment. Favorable outcome (healed scar) was achieved in 11.Although Nocardia keratitis is a rare condition, a high index of clinical suspicion should be kept in agricultural workers or in patients with trauma who have patchy stromal infiltrates. Sulfonamides are the initial drug of choice, and gentamicin could be an effective alternative. If recognized early, Nocardia keratitis responds to medical treatment with good visual recovery.

  View details for Web of Science ID 000071083100004

  View details for PubMedID 9436875

• Juvenile xanthogranuloma of the lacrimal sac fossa AMERICAN JOURNAL OF OPHTHALMOLOGY Mruthyunjaya, P., Meyer, D. R. 1997; 123 (3): 400-402

  Abstract

  Masses involving the medial canthus and lacrimal sac fossa include dacryocystoceles and, less commonly, mucoceles, hemangiomas, diverticula, and lacrimal sac neoplasms. To our knowledge, juvenile xanthogranuloma presenting as a lacrimal sac fossa mass has not been previously reported.We examined a 2-year-old boy who had epiphora in the left eye since birth and a mass in the left lacrimal sac fossa for 6 weeks. During surgery, left lacrimal probing disclosed obstruction at the level of the common canaliculus and lacrimal sac. Exploration and excision of the mass were performed.Histopathologic evaluation disclosed a juvenile xanthogranuloma characterized by an inflammatory cell infiltrate with foamy histiocytes and scattered Touton-type multinucleated giant cells.Juvenile xanthogranuloma should be included in the differential diagnosis of a medial canthal and lacrimal sac fossa mass.

  View details for Web of Science ID A1997WM32000017

  View details for PubMedID 9063253

• Subjective and objective outcomes of strabismus surgery in children JOURNAL OF PEDIATRIC OPHTHALMOLOGY & STRABISMUS Mruthyunjaya, P., Simon, J. W., PICKERING, J. D., Lininger, L. L. 1996; 33 (3): 167-170

  Abstract

  The negative psychosocial impact of strabismus in adults has been well documented. Despite the increasingly recognized importance of outcomes research, parents' satisfaction with strabismus treatment in childhood and their assessment of its functional impact and "quality of life" impact have not been investigated.A survey instrument was designed to assess parents' perceptions of preoperative, surgical, and postoperative phases of the clinical experience, including the long-term impact of surgery on their children.Overall satisfaction with the surgical result was rated "good" or "very good" in 85% of 77 children under age 6. The correlation between subjective satisfaction and objective alignment within 10 prism diopters (delta) of orthophoria was significant (P < .001). Parents of children under age 4 noted improved eye contact (61%) and appearance (94%). Parents of older children noted improved interactions with others (47%) and self-esteem (55%). Coordination was considered improved in 56% of the entire group. Subjective satisfaction and psychosocial benefits often occurred even in cases deemed objectively unsuccessful.Surgical correction of strabismus in childhood is clearly perceived by parents to be both successful and important to them and their children.

  View details for Web of Science ID A1996UN81900007

  View details for PubMedID 8771519

• Pseudoprogression of Metastatic Melanoma to the Orbit With Pembrolizumab. Ophthalmic plastic and reconstructive surgery Garcia, G. A., Topping, K. L., Mruthyunjaya, P. n., Kossler, A. L. ; 36 (2): e36–e40

  Abstract

  The management of metastatic melanoma to the orbit may involve a variety of therapeutic modalities including external-beam radiation, chemotherapy, and varying degrees of surgical resection or debulking. Pembrolizumab is an immunotherapeutic agent that has demonstrated efficacy in the treatment of metastatic melanoma. The authors present a case of metastatic melanoma to the orbit demonstrating profound pseudoprogression within hours of beginning pembrolizumab therapy, with associated mass effect and vision loss. Systemic corticosteroids, orbital external-beam radiation therapy, and a brief interruption in pembrolizumab halted expansion of the orbital lesion and vision loss. This case illustrates that rapid increase in orbital melanoma size, due to acute inflammatory response, may occur after initiation of systemic pembrolizumab therapy. Clinicians should be aware of this pseudoprogression mechanism as a potential cause of vision compromise in metastatic orbital melanoma. Prompt recognition and treatment may be needed to prevent permanent vision loss.

  View details for DOI 10.1097/IOP.0000000000001543

  View details for PubMedID 32134764