Bio


Dr Sanislo has over 20 years of experience in clinical and surgical practice in retinal and vitreoretinal diseases. He is the senior vitreoretinal surgeon at Stanford and maintains a large clinical practice as well as teaching ophthalmology residents and retina fellows. He also participates in clincal reasearch for varying retinal conditions. Dr. Sanislo recieved ophthalmology training as a resident here at Stanford, and recieved vitreoretinal training as a fellow at the Cleveland Clinic Foundation.

Research interests include treatment of age-related macular degeneration, diabetic retinopathy and other retinal diseases.

Dr. Sanislo has extensive clinical and surgical experience in the following diseases:
- Age-related macular degeneration
- Posterior uveitis / infectious and inflammatory disease of the posterior segment
- Diabetic retinopathy
- Myopic degeneration / pathologic myopia
- Macular pucker / epiretinal membranes
- Macular hole
- Repair of simple and complex retinal detachments
- Macular edema
- Retinal vascular occlusion

Clinical Focus


  • Ophthalmology
  • Vitreoretinal surgery and medical treatment
  • Posterior uveitis

Academic Appointments


Boards, Advisory Committees, Professional Organizations


  • Member, American Academy of Ophthalmology (1998 - Present)
  • Member, Association for Research in Ophthalology (1998 - Present)
  • Diplomat, American Board of Ophthalmology (1988 - Present)
  • Member, American Society of Retina Specialists (1998 - Present)
  • Member, Retina Society (2005 - Present)

Professional Education


  • Internship: Santa Clara Valley Medical Center (1992) CA
  • Residency: Stanford University Ophthalmology Residency (1996) CA
  • Fellowship: Cleveland Clinic Foundation Fellowships (1988) OH
  • Medical Education: University of Michigan GME Training Verifications (1991) MI
  • Board Certification: Ophthalmology, American Board of Ophthalmology (1998)

Clinical Trials


  • Lucentis in Advanced Macular Degeneration Not Recruiting

    Patients with low vision (visual acuity 20/400 or worse) were excluded from the large Phase III ranibizumab clinical trials. It is not known if treatment with ranibizumab results in improved visual function in such patients.Since ranibizumab has been shown to be the most effective therapy for exudative macular degeneration we propose to treat all patients in this study with monthly ranibizumab intravitreal injections. Patients will be assigned to one of two groups by the flip of a coin. Group #1 for "heads" and Group #2 for "tails". Group #1 patients will be treated for 3 monthly injections of 0.5 mg of ranibizumab and then as needed therapy. Group #2 will be treated with 6 monthly injections of 0.5 mg of ranibizumab and then as needed therapy.

    Stanford is currently not accepting patients for this trial. For more information, please contact Patricia Mattio, (650) 721 - 6884.

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  • MEK Inhibitor MEK162, Idarubicin, and Cytarabine in Treating Patients With Relapsed or Refractory Acute Myeloid Leukemia Not Recruiting

    This phase I trial studies the MEK inhibitor MEK162 to see if it is safe in patients when combined with idarubicin and cytarabine. MEK inhibitor MEK162 may stop the growth of cancer cells by blocking some of the enzymes needed for cell growth. Drugs used in chemotherapy, such as idarubicin and cytarabine, work in different ways to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. Giving MEK inhibitor MEK162, cytarabine, and idarubicin may be an effective treatment for acute myeloid leukemia.

    Stanford is currently not accepting patients for this trial. For more information, please contact Jack C. Taw, 650-723-2781.

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  • Non-Damaging Photothermal Therapy of Non-exudative Age Related Macular Degeneration Not Recruiting

    This is a randomized controlled study of non-damaging photothermal macular grid laser versus sham laser therapy in patients with dry age-related macular degeneration (AMD) and large high-risk drusen. The goal of the study is to determine if this treatment will reduce macular drusen volume and also whether this might improve visual acuity or reduce the risk of conversion to advanced age-related macular degeneration defined as development of choroidal neovascularization or geographic atrophy.

    Stanford is currently not accepting patients for this trial. For more information, please contact Mariana Nunez, 650-497-7846.

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  • Phase 2/3, Randomized, Double-Masked, Sham-Controlled Trial of QPI-1007 in Subjects With Acute Nonarteritic Anterior Ischemic Optic Neuropathy (NAION) Not Recruiting

    This study will determine the effect of QPI-1007 on visual function in subjects with recent-onset NAION and assess the safety and tolerability of intravitreal injections of QPI-1007 in this population. This study will also evaluate the structural changes in the retina following administration of QPI-1007.

    Stanford is currently not accepting patients for this trial. For more information, please contact Mariana Nunez, 650-497-7846.

    View full details

2019-20 Courses


All Publications


  • Intraoperative Optical Coherence Tomography Demonstrating Macular Hole Associated With Ruptured Retinal Arterial Macroaneurysm OPHTHALMIC SURGERY LASERS & IMAGING RETINA Greven, M. A., Sanislo, S. 2019; 50 (4): E125–E127

    Abstract

    A 67-year-old female presented with vitreous hemorrhage and sub-internal limited membrane (ILM) hemorrhage in her right eye associated with ruptured retinal arterial macroaneurysm. During pars plana vitrectomy, intraoperative optical coherence tomography aided in the diagnosis of a small macular hole previously obscured by the sub-ILM hemorrhage. Nonexpansile gas was placed followed by postoperative prone positioning, and the hole closed successfully. [Ophthalmic Surg Lasers Imaging Retina. 2019;50:e125-e127.].

    View details for DOI 10.3928/23258160-20190401-17

    View details for Web of Science ID 000465528700006

    View details for PubMedID 30998256

  • Sudden-Onset Painless Blurry Vision. JAMA ophthalmology Tang, P. H., Zubair, T., Sanislo, S. R. 2019

    View details for DOI 10.1001/jamaophthalmol.2019.1431

    View details for PubMedID 31169869

  • Reductions in final visual acuity occur even within the first 3 days after a macula-off retinal detachment. The British journal of ophthalmology Greven, M. A., Leng, T., Silva, R. A., Leung, L. B., Karth, P. A., Moshfeghi, D. M., Sanislo, S. R., Schachar, I. H. 2018

    Abstract

    PURPOSE: To determine if final visual acuity (VA) is affected by duration of macular detachment (DMD) within the first week of macula-off retinal detachment (RD).METHODS: This is a retrospective study of eyes that underwent repair within 7 days with vitrectomy or vitrectomy with scleral buckle for macula-off RD at Stanford University Hospital between 1 May 2007 and 1 May 2017. A generalised linear model was constructed using DMD, postoperative lens status, preoperative VA, patient age and surgeon as the independent variables and the final VA as the dependent variable. The main outcome measure was the final VA.RESULTS: Seventy-nine eyes met the entry criteria. Group 1 included 52 eyes with RD repaired within 3 days of DMD, and group 2 included 27 eyes repaired between 4 and 7 days of DMD. The average final VA in group 1 eyes was logarithm of the minimum angle of resolution (logMAR) 0.21 (Snellen 20/33) and in group 2 eyes was logMAR 0.54 (Snellen 20/69). In group 1 and group 2 eyes, preoperative VA (p=0.017and p=0.007), DMD (p=0.004 and p=0.041) and final lens status (p<0.0001and p<0.001) predicted postoperative VA. Post-hoc analysis showed significant differences in final VA between detachments of 1day vs 3 days (p=0.0009).CONCLUSION: DMD affects the final VA even among patients whose DMD is <3 days. Based on these results, interventions that shorten DMD, including those occurring within the first 3days, may result in improved long-term VA outcomes.

    View details for PubMedID 30504489

  • A fatal case of Susac syndrome: The importance of ophthalmic examination in confirming the diagnosis. American journal of ophthalmology case reports Shields, R. A., Kleinman, R. A., Smith, S. J., Sanislo, S. R., Nguyen, Q. D. 2018; 12: 18–20

    Abstract

    Purpose: To report a fatal case of Susac syndrome in a 24-year-old female.Observations: A 24-year-old female presented with progressive encephalopathy of unknown etiology. Her previous evaluation consisted of laboratory testing, imaging, and a brain biopsy to investigate for infectious and rheumatologic diseases. Several months after onset of symptoms, she underwent ophthalmic examination, which demonstrated bilateral branch retinal artery occlusions. Further review of her medical record revealed a recent history of hearing loss. Based on the retinal and systemic findings, the patient was diagnosed with Susac syndrome. The patient was started on intensive immunosuppression; however, she became more obtunded and succumbed several months after her diagnosis.Conclusions and importance: The timely and accurate diagnosis of Susac syndrome, which classically manifests as the triad of encephalopathy, vestibulocochlear abnormalities, and retinal arteriolar occlusions, may help to reduce the morbidity of invasive testing and to prevent fatality.

    View details for PubMedID 30112461

  • Orbital, eyelid, and nasopharyngeal silicone oil granuloma presenting as ptosis & pseudo-xanthelasma. American journal of ophthalmology case reports Powers, M. A., Wood, E. H., Erickson, B. P., Singh, K., Sanislo, S. R., Kossler, A. L. 2018; 11: 45–48

    Abstract

    Purpose: To highlight the presentation and management of a patient with eyelid, orbital and nasopharyngeal silicone oil migration through a glaucoma drainage implant presenting as pseudo-xanthelasma and ptosis.Observations: A 68-year male presented with unilateral ptosis and presumed xanthelasma. He had a history of glaucoma drainage implant surgery, pseudophakia, and multiple retinal detachment repairs with silicone oil. During ptosis repair it was discovered that his presumed xanthelasma was in fact an eyelid silicone granuloma. Additional work up revealed silicone infiltration of the eyelids, orbits, and nasopharynx, resulting from emulsified silicone oil leakage through his glaucoma valve implant.Conclusions and Importance: Silicone oil may emulsify with time, with potential egress via a glaucoma filtration device. Clinicians should be alert for eyelid, orbital and sinonasal findings that may indicate occult migration.

    View details for PubMedID 29978139

  • Correspondence. Retina (Philadelphia, Pa.) Gaynon, M. W., Wood, E. H., Powers, M. A., Sanislo, S. R. 2018; 38 (5): e36–e37

    View details for PubMedID 29547455

  • Visualization of Lamellar Hole-Associated Epiretinal Proliferation With Blue-Reflectance Imaging RETINA-THE JOURNAL OF RETINAL AND VITREOUS DISEASES Gaynon, M. W., Wood, E. H., Powers, M. A., Sanislo, S. R. 2018; 38 (5): E36–E37
  • The superficial and deep retinal capillary plexus in cases of fovea plana imaged by spectral-domain optical coherence tomography angiography. American journal of ophthalmology case reports Kaidonis, G., Silva, R. A., Sanislo, S. R., Leng, T. 2017; 6: 41–44

    Abstract

    Purpose: To describe the appearance of the superficial and deep retinal capillary plexi in three patients with fovea plana of differing severity using spectral-domain optical coherence tomography angiography (OCTA).Observations: In the first case of grade 1 fovea plana (a patient with 20/25 vision), OCTA showed an orderly branching pattern of vessels from the superficial and deep retinal plexi extending to the center of the fovea. The second case of grade 3 fovea plana (20/30 vision) showed some disruption of the orderly vascular pattern with small caliber vessels from both superficial and deep layers densely covering the fovea center. Case 3 represented a patient with grade 4 fovea plana associated with PAX6 mutation and poor visual acuity. OCTA revealed a disorganized pattern of large and small caliber vessels from the superficial capillary network extending into the center of the fovea.Conclusions and importance: Previously available imaging modalities were unable to specifically target different layers of the retinal vasculature. Using OCTA we have been able to show progressive changes in the vascular pattern in the deep and superficial retinal layers of patients with different grades of fovea plana. This novel imaging technique may play a role in the classification and assessment of patients with fovea plana.

    View details for PubMedID 29260054

  • Regarding 'Advances of optical coherence tomography in myopia and pathologic myopia'. Eye (London, England) Wood, E. H., Powers, M. A., Sanislo, S. R., Gaynon, M. W. 2017

    View details for DOI 10.1038/eye.2017.29

    View details for PubMedID 28282059

  • NONDAMAGING RETINAL LASER THERAPY FOR TREATMENT OF CENTRAL SEROUS CHORIORETINOPATHY: What is the Evidence? Retina (Philadelphia, Pa.) Wood, E. H., Karth, P. A., Sanislo, S. R., Moshfeghi, D. M., Palanker, D. V. 2016: -?

    Abstract

    To summarize the literature addressing subthreshold or nondamaging retinal laser therapy (NRT) for central serous chorioretinopathy (CSCR) and to discuss results and trends that provoke further investigation.Analysis of current literature evaluating NRT with micropulse or continuous wave lasers for CSCR.Sixteen studies including 398 patients consisted of retrospective case series, prospective nonrandomized interventional case series, and prospective randomized clinical trials. All studies but one evaluated chronic CSCR, and laser parameters varied greatly between studies. Mean central macular thickness decreased, on average, by ∼80 μm by 3 months. Mean best-corrected visual acuity increased, on average, by about 9 letters by 3 months, and no study reported a decrease in acuity below presentation. No retinal complications were observed with the various forms of NRT used, but six patients in two studies with micropulse laser experienced pigmentary changes in the retinal pigment epithelium attributed to excessive laser settings.Based on the current evidence, NRT demonstrates efficacy and safety in 12-month follow-up in patients with chronic and possibly acute CSCR. The NRT would benefit from better standardization of the laser settings and understanding of mechanisms of action, as well as further prospective randomized clinical trials.

    View details for PubMedID 27841848

  • Barriers to Follow-Up and Strategies to Improve Adherence to Appointments for Care of Chronic Eye Diseases. Investigative ophthalmology & visual science Thompson, A. C., Thompson, M. O., Young, D. L., Lin, R. C., Sanislo, S. R., Moshfeghi, D. M., Singh, K. 2015; 56 (8): 4324-4331

    Abstract

    To understand factors associated with poor attendance of follow-up appointments for care of glaucoma (GL), AMD, and diabetic retinopathy (DR) in a tertiary referral center, and to identify strategies to improve adherence.Cross-sectional study of 240 adults attending follow-up appointments for GL, AMD, or DR. Cases (N = 102) were patients with poor follow-up who missed and failed to reschedule an appointment within 1 month of the recommended follow-up date during the preceding year. Controls (N = 138) were patients who completed the assigned follow-up. Data regarding the factors impacting adherence to appointments were collected via an orally administered questionnaire. Multivariate logistic regression was performed to determine factors associated with poor follow-up.In a multivariate logistic regression model, independent factors significantly associated with poor follow-up included incorrectly answering more than 50% of questions about eye disease (adjusted odds ratio [OR] = 3.24, P = 0.001), legal blindness (adjusted OR 2.64, P = 0.013), the presence of glaucomatous versus retinal disease (adjusted OR 2.06, P = 0.013), and difficulty for the study subject and/or escort taking time away from work for the appointments (adjusted OR 1.80, P = 0.049). Subjects identified the following strategies to improve follow-up: contact with others having the same eye condition (41.3%), greater education regarding eye disease (40.8%), and improved transportation services to the clinic (44.6%).Low disease knowledge scores, legal blindness, and difficulty getting time away from work for appointments adversely impacted follow-up independent of eye disease diagnosis. Improvements in patient education, transportation services, and clinic efficiency may increase adherence to recommended appointment intervals.

    View details for DOI 10.1167/iovs.15-16444

    View details for PubMedID 26176869

  • Ocular toxoplasmosis in the United States: recent and remote infections. Clinical infectious diseases Jones, J. L., Bonetti, V., Holland, G. N., Press, C., Sanislo, S. R., Khurana, R. N., Montoya, J. G. 2015; 60 (2): 271-273

    Abstract

    We tested all samples from patients with ocular toxoplasmosis sent to the Palo Alto Medical Foundation Toxoplasma Reference Laboratory from June 2004 through August 2010 for serologic evidence of recent Toxoplasma gondii infection. Of 205 patients aged 10-96 years, 11.7% had recent infection. Many people develop ocular disease soon after T. gondii infection.

    View details for DOI 10.1093/cid/ciu793

    View details for PubMedID 25301214

  • Prefoveal vitreous condensation in chronic inflammation. Ophthalmic surgery, lasers & imaging retina Paulus, Y. M., Wong, I. G., Sanislo, S., Moshfeghi, D. M. 2014; 45 (5): 447-450

    Abstract

    Uveitis can produce a host of signs throughout the eye. Cylinders, snowballs, condensations, and snowbanks in the vitreous have been described. The authors report two cases of chronic ocular inflammation with a novel sign of a prefoveal white vitreous condensation. One patient is a 6-year-old child with intermediate uveitis and positive results for PPD, and the second is a 65-year-old woman with bilateral recurrent intraocular lymphoma. Both cases responded well to vitrectomy and treatment of the inflammation.

    View details for DOI 10.3928/23258160-20140806-03

    View details for PubMedID 25153658

  • Prefoveal Vitreous Condensation in Chronic Inflammation OPHTHALMIC SURGERY LASERS & IMAGING RETINA Paulus, Y. M., Wong, I. G., Sanislo, S., Moshfeghi, D. M. 2014; 45 (5): 447-450

    Abstract

    Uveitis can produce a host of signs throughout the eye. Cylinders, snowballs, condensations, and snowbanks in the vitreous have been described. The authors report two cases of chronic ocular inflammation with a novel sign of a prefoveal white vitreous condensation. One patient is a 6-year-old child with intermediate uveitis and positive results for PPD, and the second is a 65-year-old woman with bilateral recurrent intraocular lymphoma. Both cases responded well to vitrectomy and treatment of the inflammation.

    View details for DOI 10.3928/23258160-20140806-03

    View details for Web of Science ID 000347297300014

    View details for PubMedID 25153658

  • 16 and 24 Gy low-voltage X-ray irradiation with ranibizumab therapy for neovascular age-related macular degeneration: 12-month outcomes. American journal of ophthalmology Morales-Canton, V., Quiroz-Mercado, H., Velez-Montoya, R., Zavala-Ayala, A., Moshfeghi, A. A., Shusterman, E. M., Kaiser, P. K., Sanislo, S. R., Gertner, M., Moshfeghi, D. M. 2013; 155 (6): 1000-1008 e2

    Abstract

    To describe the 12-month safety and efficacy outcomes of 16 or 24 Gy radiation using low-voltage x-ray irradiation in conjunction with intravitreal ranibizumab for neovascular age-related macular degeneration (AMD).Prospective, phase I, open-label, nonrandomized uncontrolled safety study.setting: Institutional. study population: Neovascular AMD patients. intervention: One x-ray irradiation treatment at 16 or 24 Gy was administered externally through 3 locations in the inferior pars plana. After 2 initial monthly loading doses of ranibizumab, subsequent ranibizumab was administered according to predetermined criteria. main outcome measures: Visual acuity, number of ranibizumab injections, safety and efficacy metrics at 12 months.Forty-seven eyes of 47 patients were enrolled and completed 12 months of follow-up: 16 Gy (n = 28) and 24 Gy (n = 19). There was no evidence of radiation retinopathy, optic neuropathy, or cataract. The mean visual acuity improved in both groups: +8.4 ± 11.9 letters and +7.8 ± 12 letters for 16 and 24 Gy, respectively. In both groups, 100% of subjects lost <15 letters, with 76% and 79% gaining ≥0 letters in the 16 Gy and 24 Gy groups, respectively. Patients received a mean of 1.0 additional injection over 12 months. The mean change in optical coherence tomography central subfield thickness from baseline to month 12 was -107 and -87 μm for the 16 Gy and 24 Gy groups, respectively.One treatment of 16 or 24 Gy low-voltage x-ray therapy with as-needed ranibizumab appears safe in subjects with neovascular AMD at 12 months. An overall improvement in visual acuity was observed. No radiation-related adverse effects were reported.

    View details for DOI 10.1016/j.ajo.2013.01.015

    View details for PubMedID 23497847

  • 16 and 24 Gy Low-voltage X-ray Irradiation With Ranibizumab Therapy for Neovascular Age-Related Macular Degeneration: 12-Month Outcomes. American journal of ophthalmology Morales-Canton, V., Quiroz-Mercado, H., Velez-Montoya, R., Zavala-Ayala, A., Moshfeghi, A. A., Shusterman, E. M., Kaiser, P. K., Sanislo, S. R., Gertner, M., Moshfeghi, D. M. 2013; 155 (6): 1000-1008 e2

    View details for DOI 10.1016/j.ajo.2013.01.015

    View details for PubMedID 23497847

  • Herpes simplex virus type 2 mediated acute retinal necrosis in a pediatric population: case series and review GRAEFES ARCHIVE FOR CLINICAL AND EXPERIMENTAL OPHTHALMOLOGY Silva, R. A., Berrocal, A. M., Moshfeghi, D. M., Blumenkranz, M. S., Sanislo, S., Davis, J. L. 2013; 251 (2): 559-566

    Abstract

    We report 15 eyes with herpes simples virus type 2 (HSV-2) mediated acute retinal necrosis (ARN) in order to better characterize pathogenesis, clinical course, diagnosis, and outcomes of the disease.Retrospective observational case series of 14 patients (15 eyes) all aged 21 years or younger with acute retinal necrosis resulting from HSV-2 and examined between 1995 and 2009. Patients were diagnosed by various techniques, including polymerase chain reaction (PCR) of aqueous, vitreous, and serum, antibody determination of serum and intraocular fluids, fundoscopic exam, a therapeutic trial of antivirals active against HSV-2, or a combination thereof.Mean age of presentation was 11.7 years (range, newborn to 21.0 years) with a standard deviation of 7.0 years. Mean initial vision was 20/200 (median, 20/400; range, 20/20 to LP). Eleven patients (73.3 %) had received oral, injectable, or topical corticosteroids, and 14 (93.3 %) had received antiviral therapy. All patients were diagnosed based on evaluation of intraocular fluids and tissue by antibody determinations, culture, PCR, histopathologic examination, or a combination thereof. Mean final visual acuity was 20/400 (median, CF; range, 20/25 to LP) with worsened visual acuity in five eyes (33.3 %). Anatomically, 14 of 15 eyes had healed or improved retinal appearance.In a pediatric population with acute retinal necrosis, HSV-2 should be considered as the prime candidate virus. Diagnosis of HSV-2 acute retinal necrosis is accomplished mainly by PCR of ocular specimens. Prompt diagnosis may lead to appropriate anti-viral therapy.

    View details for DOI 10.1007/s00417-012-2164-8

    View details for PubMedID 23052715

  • 16 Gy low-voltage x-ray irradiation followed by as needed ranibizumab therapy for age-related macular degeneration: 12 month outcomes of a 'radiation-first' strategy BRITISH JOURNAL OF OPHTHALMOLOGY Moshfeghi, A. A., Morales-Canton, V., Quiroz-Mercado, H., Velez-Montoya, R., Zavala-Ayala, A., Shusterman, E. M., Kaiser, P. K., Sanislo, S. R., Gertner, M., Moshfeghi, D. M. 2012; 96 (10): 1320-1324

    Abstract

    To describe 'radiation-first' combination treatment with a non-invasive, low-voltage x-ray irradiation system followed by as needed ranibizumab for neovascular age-related macular degeneration (AMD).Phase I study of non-invasive, low-voltage 16 Gy x-ray irradiation delivered in three beams via the inferior pars plana in patients with active neovascular AMD. Ranibizumab was administered as needed per protocol. Patients were followed monthly for safety and efficacy over 12 months.13 patients were enrolled and completed 12 months follow-up. Safety was good with no serious ocular/non-ocular adverse events or radiation-related ocular complications. 11 patients lost <15 Early Treatment of Diabetic Retinopathy Study (ETDRS) letters, seven gained ≥0 ETDRS letters and 0 gained ≥15 ETDRS letters. Patients received a total of 31 subsequent ranibizumab injections (of possible 156) over the 12 months following x-ray irradiation. Mean time to first injection was 3.9 months. One patient received no ranibizumab injections, three patients received one injection, four patients received two injections, and five patients received three or more injections.After 12 months, non-invasive, low-voltage x-ray irradiation with as needed ranibizumab rescue therapy demonstrated good safety with a visual acuity stabilising effect and reduction in retinal thickness in patients with neovascular AMD.

    View details for DOI 10.1136/bjophthalmol-2011-301222

    View details for Web of Science ID 000309215500010

    View details for PubMedID 22895887

  • Macular infarction following intravitreal bevacizumab for treatment of central retinal vein occlusion. Ophthalmic surgery, lasers & imaging : the official journal of the International Society for Imaging in the Eye Leung, L. B., Silva, R. A., Blumenkranz, M. S., Flynn, H. W., Sanislo, S. R. 2012; 43: e73-9

    Abstract

    Bevacizumab, a monoclonal antibody against vascular endothelial growth factor (VEGF), is widely used for the treatment of macular edema associated with central retinal vein occlusion (CRVO). The authors present a series of three patients with CRVO who suffered apparent macular infarction within weeks of intravitreal administration of bevacizumab. Of the nearly 200 patients undergoing intravitreal injections of bevacizumab for this indication over a surveillance period of 3 years, this event occurred in three patients. This has not been described in the natural history of the disease and is associated with poor visual outcomes.

    View details for DOI 10.3928/15428877-20120712-05

    View details for PubMedID 22823029

  • 24-Gy Low-Voltage X-Ray Irradiation With Ranibizumab Therapy for Neovascular AMD: 6-Month Safety and Functional Outcomes OPHTHALMIC SURGERY LASERS & IMAGING Morales Canton, V., Quiroz-Mercado, H., Velez-Montoya, R., Lopez-Miranda, M. J., Moshfeghi, A. A., Shusterman, E. M., Kaiser, P. K., Sanislo, S. R., Gertner, M., Moshfeghi, D. M. 2012; 43 (1): 20-24

    Abstract

    To describe the 6-month safety and preliminary efficacy outcomes of the use of 24-Gy radiation with intravitreal ranibizumab for patients with neovascular age-related macular degeneration (AMD).A single treatment of a non-invasive, externally delivered low-voltage x-ray irradiation at a dose of 24 Gy was administered in one session through three locations in the inferior pars plana in a consecutive series of patients with neo-vascular AMD (treatment naïve and previously treated). Optical coherence tomography (OCT) and Early Treatment Diabetic Retinopathy Study (ETDRS) visual acuity examinations were performed at 1 week, 1 month, and monthly thereafter with quarterly fluorescein angiography.Nineteen patients completed 6 months of follow-up. There was no evidence of radiation retinopathy, optic neuropathy, or cataract. The mean baseline ETDRS score was 38.3 ± 19.5 letters. At 6 months, the corresponding ETDRS score was 44.7 ± 16.8 letters. At 6 months, the mean change in visual acuity was 6.4 ± 9.8 ETDRS letters. Patients received an average of 0.4 additional ranibizumab injections following the initial two mandated injections.A single treatment of external 24-Gy low-voltage x-ray therapy in conjunction with ranibizumab demonstrated an overall improvement in visual acuity in patients with neovascular AMD at 6 months, with no radiation-related adverse effects.

    View details for DOI 10.3928/15428877-20111129-01

    View details for Web of Science ID 000305342600003

    View details for PubMedID 22251841

  • 16-Gy Low-Voltage X-ray Irradiation Followed by As-Needed Ranibizumab Therapy for AMD: 6-Month Outcomes of a "Radiation-First" Strategy OPHTHALMIC SURGERY LASERS & IMAGING Moshfeghi, A. A., Canton, V. M., Quiroz-Mercado, H., Velez-Montoya, R., Lopez-Miranda, M. J., Shusterman, E. M., Kaiser, P. K., Sanislo, S. R., Gertner, M., Moshfeghi, D. M. 2011; 42 (6): 460-467

    Abstract

    To describe the effect of a "radiation-first" combination treatment strategy for neovascular age-related macular degeneration (AMD) with ranibizumab rescue therapy.Non-invasive, externally delivered low-voltage x-ray irradiation at a dose of 16 Gy was given in a single session through three locations in the inferior pars plana in a consecutive series of patients with neovascular AMD. Ranibizumab was administered according to prospectively determined criteria.Thirteen patients completed a 6-month follow-up. All patients lost 15 or fewer ETDRS letters, 7 gained 0 or more ETDRS letters, and 0 gained more than 15 ETDRS letters. Patients received a total of 15 ranibizumab injections following x-ray irradiation at baseline. Two patients received no ranibizumab injections, seven patients received 1 injection, and four patients received 2 injections.Low-voltage x-ray treatment followed by ranibizumab rescue demonstrates an independent visual acuity stabilizing effect for patients with wet AMD.

    View details for DOI 10.3928/15428877-20110804-03

    View details for Web of Science ID 000305342500003

    View details for PubMedID 21830745

  • 16-Gy Low-Voltage X-ray Irradiation With Ranibizumab Therapy for AMD: 6-Month Safety and Functional Outcomes OPHTHALMIC SURGERY LASERS & IMAGING Canton, V. M., Quiroz-Mercado, H., Velez-Montoya, R., Lopez-Miranda, M. J., Moshfeghi, A. A., Shusterman, E. M., Kaiser, P. K., Sanislo, S. R., Gertner, M., Moshfeghi, D. M. 2011; 42 (6): 468-473

    Abstract

    To describe the 6-month safety and preliminary efficacy outcomes of the use of 16-Gy radiation with intravitreal ranibizumab for patients with neovascular age-related macular degeneration (AMD).A single treatment of a non-invasive, externally delivered low-voltage 16-Gy x-ray irradiation was administered in one session through three locations in the inferior pars plana. Optical coherence tomography (OCT) and Early Treatment Diabetic Retinopathy Study (ETDRS) visual acuity (VA) examinations were performed at 1 week, 1 month, and monthly thereafter, with quarterly fluorescein angiography (FA). After the two initial ranibizumab injections, subsequent injections were administered according to the following criteria: VA decline of 10 ETDRS letters compared with baseline, increase of 100-μm central foveal thickness on OCT compared with baseline, the development of new submacular hemorrhage, and the development of a new area of classic choroidal neovascularization on FA.Twenty-six patients completed a 6-month follow-up. There was no evidence of radiation retinopathy, optic neuropathy, or cataract. The mean baseline ETDRS score was 46.6 letters (range: 5 to 80; standard deviation [SD]: 21.5). At 6 months, the corresponding ETDRS score was 55.6 letters (range: 25 to 80; SD: 18.9) and the mean change in VA was 9.5 ETDRS letters (SD: 10.3). On responder analysis, 96% lost 15 or fewer ETDRS letters, 81% gained 0 or more ETDRS letters, and 50% gained 15 or more ETDRS letters. Patients received a total of 13 ranibizumab injections following two initial injections. At 6 months, patients received an average of 0.5 additional injections following the initial two mandated injections.A single treatment of externally applied, non-invasive 16-Gy low-voltage x-ray therapy in conjunction with ranibizumab demonstrated an overall improvement of VA in patients with neovascular AMD at 6 months with no radiation-related adverse effects.

    View details for DOI 10.3928/15428877-20110804-01

    View details for Web of Science ID 000305342500004

    View details for PubMedID 21830747

  • Photodynamic therapy rescue for subretinal fluid exacerbation after focal laser treatment in idiopathic central serous chorioretinopathy. The open ophthalmology journal Leng, T., Sanislo, S. R., Jack, R. L. 2011; 5: 6-9

    Abstract

    To report a case of subretinal leakage after focal laser treatment for idiopathic central serous chorioretinopathy (ICSC). This rare complication was successfully treated with photodynamic therapy (PDT).Interventional case report.A 36-year-old male presented with ICSC in his right eye. After a period of observation without resolution, he was treated with focal laser. That treatment resulted in a massive exacerbation of his subretinal fluid. PDT was successfully used to treat the severe exacerbation with rapid resolution of the subretinal fluid, improvement in visual acuity, decreased leakage on fluorescein angiography, and reduction of subretinal fluid on ophthalmoscopic exam and by optical coherence tomography.Ophthalmologists should consider the use of PDT in cases where focal laser causes an exacerbation of subretinal fluid in ICSC.

    View details for DOI 10.2174/1874364101105010006

    View details for PubMedID 21399767

  • Antibiotic Susceptibility Patterns of Ocular Bacterial Flora in Patients Undergoing Intravitreal Injections OPHTHALMOLOGY Moss, J. M., Sanislo, S. R., Ta, C. N. 2010; 117 (11): 2141-2145

    Abstract

    To determine the antibiotic susceptibility patterns of conjunctival flora in patients undergoing intravitreal (IVT) injection.Prospective, observational study.Patients (n = 85) scheduled to undergo 136 IVT injections at California Vitreoretinal Center at Stanford University.Conjunctival cultures were obtained on the day of the IVT injection from the injection site bulbar conjunctiva before the application of povidone-iodine or antibiotics.Bacterial isolates were identified and tested for antibiotic susceptibility using either the Kirby-Bauer disc-diffusion technique or MicroScan-WalkAway system.Our analysis included 136 samples collected from 90 eyes of 85 patients. Of those with positive cultures (n = 65), the most common bacterial isolates were coagulase-negative staphylococci (CNS), comprising 59 (83%) of the 71 bacterial strains. Among the CNS, all were susceptible to vancomycin and >80% were susceptible to gentamicin, chloramphenicol, tetracycline, and imipenem. Between 60% and 80% of the CNS were susceptible to the cephalosporins and newer generation fluoroquinolones. Fewer than 60% were susceptible to the penicillin analogs, erythromycin, and the earlier generation fluoroquinolones. Nearly half of the CNS (47%) were resistant to oxacillin/methicillin.Bacteria isolated from the injection site of patients undergoing IVT injections were mostly CNS. Most are sensitive to vancomycin, gentamicin, and chloramphenicol.Proprietary or commercial disclosure may be found after the references.

    View details for DOI 10.1016/j.ophtha.2010.02.030

    View details for PubMedID 20561687

  • An extensive case of acute posterior multifocal placoid pigment epitheliopathy. Retinal cases & brief reports Chan, A., Blumenkranz, M. S., Sanislo, S. R. 2010; 4 (4): 336-338

    Abstract

    To report a case of extensive acute posterior multifocal placoid pigment epitheliopathy (APMPPE).Case report.An 18-year-old girl was admitted and treated with intravenous acyclovir and intravitreal gancyclovir for presumed acute retinal necrosis. As the lesions faded and vision improved, the findings became more consistent with an extensive form of APMPPE.Acute posterior multifocal placoid pigment epitheliopathy can present very aggressively early in its course. Despite macular involvement, as in this patient, vision can improve significantly.

    View details for DOI 10.1097/ICB.0b013e3181aff47e

    View details for PubMedID 25390912

  • Intravitreous Dexamethasone Effects on Different Patterns of Diabetic Macular Edema ARCHIVES OF OPHTHALMOLOGY Kuppermann, B. D., Chou, C., Weinberg, D. V., Whitcup, S. M., Haller, J. A., Blumenkranz, M. S. 2010; 128 (5): 642-643

    View details for Web of Science ID 000277466800020

    View details for PubMedID 20212194

  • Randomized Controlled Trial of an Intravitreous Dexamethasone Drug Delivery System in Patients With Diabetic Macular Edema ARCHIVES OF OPHTHALMOLOGY Haller, J. A., Kuppermann, B. D., Blumenkranz, M. S., Williams, G. A., Weinberg, D. V., Chou, C., Whitcup, S. M. 2010; 128 (3): 289-296

    Abstract

    To evaluate the safety and efficacy of a dexamethasone intravitreous drug delivery system (DDS) in eyes with diabetic macular edema (DME).Patients with persistent macular edema (> or = 90 days' duration) were randomized to treatment with 700 microg or 350 microg of dexamethasone DDS or observation. One eye from each patient was designated as the study eye. The analysis is of the eyes in this study with DME (n = 171).The primary outcome measure was the proportion of eyes that achieved an improvement in best-corrected visual acuity (BCVA) of 10 letters or more from baseline at day 90. Other outcome measures included fluorescein leakage, central retinal thickness, and safety parameters.At day 90, a BCVA improvement of 10 letters or more was seen in more eyes in the 700-microg group (33.3%) and 350-microg group (21.1%) than the observation group (12.3%; P = .007 vs 700-microg group). At day 180, a BCVA improvement of 10 letters or more was seen in 30% of eyes in the 700-microg group, 19% in the 350-microg group, and 23% in the observation group (P > or = .4 for treated vs observed eyes). There were also significantly greater improvements in central retinal thickness and fluorescein leakage in treated eyes than observed eyes (P = .03; day 90). Dexamethasone DDS was well tolerated.In eyes with persistent DME, treatment with 700 microg of intravitreal dexamethasone DDS is well tolerated and produces significant improvements in BCVA, central retinal thickness, and fluorescein leakage compared with observation (statistically significant at day 90).Dexamethasone DDS, 700 microg, may have potential as a treatment for persistent DME.clinicaltrials.gov Identifier: NCT00035906.

    View details for Web of Science ID 000275308100002

    View details for PubMedID 20212197

  • Photodynamic Therapy With and Without Adjunctive Intravitreal Triamcinolone Acetonide: A Retrospective Comparative Study OPHTHALMIC SURGERY LASERS & IMAGING Chan, A., Blumenkranz, M. S., Wu, K. H., Wang, G., Berker, N., Parast, L. M., Sanislo, S. R. 2009; 40 (6): 561-569

    Abstract

    To compare photodynamic therapy (PDT) with and without adjunctive intravitreal triamcinolone acetonide (IVTA) in the treatment of choroidal neovascularization secondary to age-related macular degeneration.Sixty-six eyes received PDT with IVTA and 73 eyes received PDT only. Outcome measures included changes in visual acuity and greatest linear dimension (GLD), the presence of angiographic leakage, the re-treatment rate, and adverse events.Patients treated with PDT with IVTA had reduced mean GLD compared to patients treated with PDT only at all study time points (3 [P = .0049], 6 [P = .003], and 12 [P = .05] months). Forty-four percent of patients in the PDT with IVTA group and 22% of patients in the PDT only group achieved angiographic closure at 3 months (P = .027). There were no significant differences in the final visual acuity outcome or the re-treatment rate between the two groups.PDT with IVTA therapy has a favorable outcome on GLD. There is a modest improvement in visual acuity with PDT with IVTA therapy, which diminishes over time.

    View details for DOI 10.3928/15428877-20091030-05

    View details for PubMedID 19928721

  • A Prospective Randomized Evaluation of Topical Gatifloxacin on Conjunctival Flora in Patients Undergoing Intravitreal Injections OPHTHALMOLOGY Moss, J. M., Sanislo, S. R., Ta, C. N. 2009; 116 (8): 1498-1501

    Abstract

    We sought to assess the efficacy of 3-day topical gatifloxacin use in combination with povidone-iodine (PVI) versus PVI alone in eliminating conjunctival bacterial flora in patients scheduled to undergo intravitreal (IVT) injection.Prospective, randomized single-blind clinical trial.We included 129 patients scheduled to undergo 273 IVT injections at California Vitreoretinal Center at Stanford University.Study patients were randomized to self-administration of gatifloxacin drops for 3 days before injection, or no pretreatment antibiotics. Cultures were collected from the bulbar conjunctiva at the injection site and at the corresponding location in the fellow eye before PVI preparation. After topical PVI treatment and immediately before injection, a third culture was obtained at the injection site. Additionally, the injection needle was also cultured after the procedure.Incidence of positive bacterial samples collected from injection site conjunctiva and injection needles.Three-day gatifloxacin use resulted in a significantly lower rate of SeptiChek (Becton Dickinson, Franklin Lakes, NJ) positive cultures compared with untreated controls (21% vs 48% respectively, P = 0.005). After topical PVI, the rate of positive bacterial cultures in gatifloxacin-treated and control eyes were similar (8% and 4%, respectively; P = 0.324).Although 3-day topical gatifloxacin use is effective in reducing the frequency of conjunctival bacterial growth relative to untreated eyes, antibiotic use confers no additional benefit in combination with PVI than eyes receiving PVI alone. This supports that topical PVI is an effective preinjection monotherapy for infection prophylaxis in the setting of IVT injections.

    View details for DOI 10.1016/j.ophtha.2009.02.024

    View details for PubMedID 19501409

  • Dexamethasone Posterior-Segment Drug Delivery System in the Treatment of Macular Edema Resulting from Uveitis or Irvine-Gass Syndrome AMERICAN JOURNAL OF OPHTHALMOLOGY Williams, G. A., Haller, J. A., Kuppermann, B. D., Blumenkranz, M. S., Weinberg, D. V., Chou, C., Whitcup, S. M. 2009; 147 (6): 1048-1054

    Abstract

    To evaluate the effects of a dexamethasone intravitreous drug delivery system (dexamethasone DDS) in patients with persistent macular edema (ME) resulting from uveitis or Irvine-Gass syndrome.Randomized, prospective, single-masked, controlled trial.Three hundred and fifteen patients with persistent (>or= 90 days) ME were randomized in a multicenter study to surgical placement of 350 or 700 microg dexamethasone DDS or observation. This study evaluated the subset of patients with uveitis or Irvine-Gass syndrome (n = 41). The primary outcome measure was the proportion of patients achieving a 10-letter or more improvement in best-corrected visual acuity (BCVA) at day 90. Change in fluorescein angiographic leakage and safety also were evaluated.At day 90, a 10-letter or more BCVA improvement was seen in 41.7% (5/12) of patients in the 350-microg group, in 53.8% (7/13) of patients in the 700-microg group, and in 14.3% (2/14) of patients in the observation group (P = .029 vs the 700-microg group). Improvement in visual acuity persisted to day 180. A 15-letter or more improvement was achieved in 53.8% (7/13) of 700-microg patients vs 7.1% (1/14) of observed patients (P = .008). There were significantly greater reductions in fluorescein leakage in treated patients than in observed patients. Dexamethasone DDS was well tolerated. Throughout the study, an increase in intraocular pressure of 10 mm Hg or more was seen in 5 of 13 patients in the 700-microg group, in 1 of 12 patients in the 350-microg group, and in no patients in the observation group. There were no reports of endophthalmitis.In patients with persistent ME resulting from uveitis or Irvine-Gass syndrome, 700-microg dexamethasone DDS was well tolerated and produced statistically significant improvements in visual acuity and fluorescein leakage.

    View details for DOI 10.1016/j.ajo.2008.12.033

    View details for Web of Science ID 000266508600019

    View details for PubMedID 19268890

  • TRIAMCINOLONE ACETONIDE PREPARATIONS Impact of Crystal Size on In Vitro Behavior RETINA-THE JOURNAL OF RETINAL AND VITREOUS DISEASES Moshfeghi, A. A., Nugent, A. K., Nomoto, H., Sanislo, S. R., Kitchens, J. W., Moshfeghi, D. M. 2009; 29 (5): 689-698

    Abstract

    To characterize the in vitro behavior of three preparations of triamcinolone acetonide (TA).Three preparations of TA were mixed with Balanced Salt Solution Plus: commercially available TA (Kenalog 40, Bristol-Myers Squibb, Princeton, NJ), compounded preservative-free triamcinolone acetonide (PFTA, New England Compounding Center, Framingham, MA), and triamcinolone acetonide injectable suspension (TAIS, TRIESENCE, Alcon, Inc., Fort Worth, TX). We determined the mean number of crystalline aggregates per high-power deconvolution microscopy field, largest aggregate area, and spectroscopic photometric absorption.Preservative-free triamcinolone acetonide had larger mean number of aggregates compared with TA (time 0 P = 0.002, 10 minutes P < 0.001) and TAIS (time 0 P < 0.001, 10 minutes P = 0.003). Aggregate size varied at both 0 and 10 minutes: TAIS > TA > PFTA. Spectroscopic photometric absorption decreased in direct correlation to aggregate size over time for all three preparations.In vitro, PFTA in Balanced Salt Solution Plus had more aggregates of smaller size than either TA or TAIS. By contrast, TAIS had much larger aggregate size than both PFTA and TA, and this increased over time. These findings correlate with the clinical observations that PFTA and TA tend to disperse throughout the vitreous, whereas TAIS tends to conglomerate and gravitate toward the most dependent portion of the eye in a globular fashion.

    View details for Web of Science ID 000266059000019

    View details for PubMedID 19373129

  • Surveillance for potential adverse events associated with the use of intravitreal bevacizumab for retinal and choroidal vascular disease RETINA-THE JOURNAL OF RETINAL AND VITREOUS DISEASES Wong, L. J., Desai, R. U., Jain, A., Feliciano, D., Moshfeghi, D. M., Sanislo, S. R., Blumenkranz, M. S. 2008; 28 (8): 1151-1158

    Abstract

    To systematically study potential adverse events associated with the use of intraocular bevacizumab at a single medical center.Retrospective study of all consecutive patients receiving intraocular bevacizumab injections at the Stanford University Department of Ophthalmology between November 15, 2005 and July 14, 2006. Bevacizumab was given for exudative age-related macular degeneration, retinal vascular occlusion, diabetic macular edema, neovascular glaucoma, and five other indications.We analyzed medical records of 186 subjects (203 eyes) who received a total of 578 injections of 1.25 mg of bevacizumab. The average follow-up was approximately 6 months. Five eyes with exudative age-related macular degeneration developed retinal pigment epithelial (RPE) tears, all with preexisting RPE detachments. These five eyes represented 2.9% of all age-related macular degeneration eyes treated and 7% of the age-related macular degeneration eyes with preexisting RPE detachments at initiation of treatment. Other adverse events were rare and included retinal ischemia, subretinal hemorrhage, vitreous hemorrhage, ocular irritation or pain, worsened hypertension, and headache. No death or thromboembolic events were observed.Intraocular bevacizumab appears to be well tolerated for the treatment of a variety of retinal and choroidal vascular diseases. RPE tears may occur when treating choroidal neovascularization, particularly in patients with preexisting RPE detachment.

    View details for PubMedID 18685542

  • Perspective: Tissue engineering for RPE transplantation in AMD SPEKTRUM DER AUGENHEILKUNDE Stanzel, B. V., Englander, M., Strick, D. J., Sanislo, S. S., Huie, P., Blumenkranz, M. S., Binder, S., Marmor, M. F. 2007; 21 (4): 212-217
  • Retinal pigment epithelium tears after intravitreal injection of bevacizumab (Avastin) for neovascular age-related macular degeneration RETINA-THE JOURNAL OF RETINAL AND VITREOUS DISEASES Ronan, S. M., Yoganathan, P., Chien, F. Y., Corcostegui, I. A., Blumenkranz, M. S., Deramo, V. A., Elner, S. G., Fastenberg, D. A., Johnson, M. W., Lopez, M., Mateo, C., Moshfeghi, D. M., Navarro, R., Rosenblatt, B. J., Sanislo, S. R., Saxe, S. J., Zacks, D. N. 2007; 27 (5): 535-540

    Abstract

    Intravitreal bevacizumab (Avastin, Genentech, Inc., South San Francisco, CA) treatment of neovascular age-related macular degeneration (AMD) has become an important part of clinical retinal practice. We describe retinal pigment epithelium (RPE) tears that were noted after intravitreal injection of bevacizumab.In this multimember, retrospective case series, data on eyes that developed RPE tears after intravitreal bevacizumab injection were collected and analyzed. Previous treatments, type of lesion, time to tear, and preinjection and final visual acuities were all compared. The total numbers of bevacizumab injections were available from all four institutions and compiled to estimate the incidence rate.Four retina centers administered a total of 1,455 intravitreal 1.25-mg bevacizumab injections for neovascular AMD during the 9-month study period. Twelve patients presented with RPE tears within 4 days to 8 weeks of injection (mean +/- SD, 24.3 +/- 15.2 days from injection to tear). In each case, the RPE tear was preceded by an RPE detachment, and all had a component of serous sub-RPE fluid. On the basis of our collective data, we estimate an incidence rate of approximately 0.8%.RPE tears can occur after intravitreal injection of bevacizumab. The low incidence of this adverse event should not preclude anti-vascular endothelial growth factor therapy counseling for patients with neovascular AMD, but eyes with serous RPE detachments appear to be most vulnerable to this adverse event.

    View details for Web of Science ID 000247259400002

    View details for PubMedID 17558313

  • Candida (amphotericin-sensitive) lens abscess associated with decreasing arterial blood flow in a very low birth weight preterm infant PEDIATRICS Drohan, L., Colby, C. E., Brindle, M. E., Sanislo, S., Ariagno, R. L. 2002; 110 (5)

    Abstract

    In this report, we review the case of a candidal lens abscess in a premature infant girl who was 28 weeks' gestational age at birth. The culture obtained from the lens abscess grew Candida albicans sensitive to amphotericin B but resistant to flucytosine. This case is unique in that the infant developed a fungal lens cataract at 34 weeks' postconceptional age during the last week of a 30-day course of amphotericin B. The embryonic hyaloid artery system, which perfuses the developing lens, regresses between 29 and 32 weeks of gestation; thus, the mechanism for an infection of the lens may be inoculation of the lens by Candida before hyaloid artery system regression, followed by developmental loss of this blood supply, which makes the lens inaccessible to antimicrobial penetration. Candidal endophthalmitis with lens abscess is an uncommon morbidity that requires prompt recognition and surgical intervention for effective management.

    View details for PubMedID 12415071

  • Effects of the pulsed electron avalanche knife on retinal tissue ARCHIVES OF OPHTHALMOLOGY Palanker, D. V., Marmor, M. F., Branco, A., Huie, P., MILLER, J. M., Sanislo, S. R., Vankov, A., Blumenkranz, M. S. 2002; 120 (5): 636-640

    Abstract

    To evaluate the precision of retinal tissue dissection by the pulsed electron avalanche knife (PEAK) and to assess possible toxic effects from this device.To demonstrate precision of cutting, bovine retina (in vitro) and rabbit retina (in vivo) were incised with the PEAK. Samples were examined by scanning electron microscopy and histologic examination (light microscopy). To evaluate possible toxic effects in rabbit eyes, 30 000 pulses were delivered into the vitreous 1 cm above the retina. Histologic examinations and electroretinography were performed at intervals up to 1 month after exposure.Cuts in postmortem bovine retina showed extremely sharp edges with no signs of thermal damage. Full-thickness cuts in living attached rabbit retina were similarly sharp and were typically less than 100 microm wide. No signs of retinal toxic effects were detected by histologic examination or electroretinography.The PEAK is capable of precise cutting through retinal tissue, and there are no demonstrable retinal toxic effects from its use. The precision and tractionless nature of PEAK cutting offers advantages over mechanical tools and laser-based instrumentation. We believe this new device will prove useful in a variety of vitreoretinal surgical applications.

    View details for PubMedID 12003616

  • Pulsed Electron Avalanche Knife (PEAK) for intraocular surgery INVESTIGATIVE OPHTHALMOLOGY & VISUAL SCIENCE Palanker, D. V., MILLER, J. M., Marmor, M. F., Sanislo, S. R., Huie, P., Blumenkranz, M. S. 2001; 42 (11): 2673-2678

    Abstract

    To develop a better and more economical instrument for precise, tractionless, "cold" cutting during intraocular surgery. The use of highly localized electric fields rather than laser light as the means of tissue dissection was investigated.A high electric field at the tip of a fine wire can, like lasers, initiate plasma formation. Micrometer-length plasma streamers are generated when an insulated 25 micron (microm) wire, exposed to physiological medium at one end, is subjected to nanosecond electrical pulses between 1 and 8 kV in magnitude. The explosive evaporation of water in the vicinity of these streamers cuts soft tissue without heat deposition into surrounding material (cold cutting). Streamers of plasma and the dynamics of water evaporation were imaged using an inverted microscope and fast flash photography. Cutting effectiveness was evaluated on both polyacrylamide gels, on different tissues from excised bovine eyes, and in vivo on rabbit retina. Standard histology techniques were used to examine the tissue.Electric pulses with energies between 150 and 670 microJ produced plasma streamers in saline between 10 and 200 microm in length. Application of electric discharges to dense (10%) polyacrylamide gels resulted in fracturing of the gel without ejection of bulk material. In both dense and softer (6%) gels, layer by layer shaving was possible with pulse energy rather than number of pulses as the determinant of ultimate cutting depth. The instrument made precise partial or full-thickness cuts of retina, iris, lens, and lens capsule without any evidence of thermal damage. Because different tissues require distinct energies for dissection, tissue-selective cutting on complex structures can be performed if the appropriate pulse energies are used; for example, retina can be dissected without damage to the major retinal vessels.This instrument, called the Pulsed Electron Avalanche Knife (PEAK), can quickly and precisely cut intraocular tissues without traction. The small delivery probe and modest cost make it promising for many ophthalmic applications, including retinal, cataract, and glaucoma surgery. In addition, the instrument may be useful in nonophthalmic procedures such as intravascular surgery and neurosurgery.

    View details for Web of Science ID 000171433300037

    View details for PubMedID 11581215