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Mruthyunjaya, Prithvi

Overview:

Dr. Mruthyunjaya specializes in the diagnosis, treatment, and surveillance of patients with ocular cancers and advanced retinal diseases.  He is fellowship trained in both Vitreoretinal surgery and Ocular Oncology.  He is skilled at performing complex retinal surgical procedures including repair of retinal detachments, epiretinal membrane peeling, macular hole surgery, and surgery for diabetic retinopathy.  He has extensive expertise in small-gauge vitrectomy and is adept at using the latest technologies to optimize surgical outcomes.  He cares for patients with diabetic retinopathy, macular degeneration, ocular inflammation, and macular holes.

As the Ocular Oncologist for the Duke Eye Center, Dr. Mruthyunjaya serves patients from across the 5 state region and across the country.  He provides compassionate and individualized care for patients with suspected or confirmed ocular cancers involving the conjunctiva, iris, vitreous, retina, and choroid--in adults and children.  Many of his patients are treated for ocular melanoma, lymphoma, retinoblastoma, and metastatic lesions found in the eye.  He performs complex diagnostic procedures including biopsies of small ocular tumors and surgeries to treat malignant cancers including vitrectomy, retinal injections of chemotherapy, plaque radiation therapy, and lesion excision surgeries.  He is a member of the Duke Cancer Institute which gives him unprecedented access to experts in oncology at Duke for collaborative care for his patients. 

His research interests are in translational therapies in ocular oncology in particular use of targeted drug therapy in ocular melanomas and retinoblastomas. He is interested in the use of predictive modelling to define survival characteristics in ocular cancers. He has focused on identifying novel patterns in health care delivery and in new techniques for vitreoretinal surgery and ocular imaging to diagnose complex retinal conditions. 

He is a member of numerous societies including the American Academy of Ophthalmology, the Retina Society (elected member), American Society of Retina Specialists, International Society of Ocular Oncology, and the North Carolina Retina Club among others.  He has been award the Achievement Award by the American Academy of Ophthalmology along with other honors including the Heed and AOS Knapp fellowships, the Edward K Isby Jr. Award for excellence in residency training, the Hornaday Fellow Award, and the Ronald G. Michels Foundation Fellowship. 

He is actively involved in numerous Ophthalmology Organizations and has been an invited speaker and moderator at state, national and international meetings in both Ocular Oncology and Vitreoretinal diseases.  He is an examiner for the American Board of Ophthalmology and has been invited to design future curriculum for Board eligibility.  He has been named one of the Best Doctors in America since 2012.

Dr. Mruthyunjaya is dedicated to teaching the next generation of outstanding ophthalmologists and retinal specialists at Duke.   He works closely with Ocular Pathologists to enhance training across specialities.  He is also director of Medical Education to help improve the quality of care by eye care specialists across the region. 

Positions:

Adjunct Associate Professor in the Department of Ophthalmology

Ophthalmology, Vitreoretinal Diseases & Surgery
School of Medicine

Member of the Duke Cancer Institute

Duke Cancer Institute
School of Medicine

Education:

M.D. 1996

M.D. — Albany Medical College

Publications:

Association between Tumor Regression Rate and Gene Expression Profile after Iodine 125 Plaque Radiotherapy for Uveal Melanoma.

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 (I125) 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 I125 plaque brachytherapy.Multicenter, retrospective cohort study.Adult UM patients treated with I125 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.

Authors
Mruthyunjaya, P; Seider, MI; Stinnett, S; Schefler, A; Ocular Oncology Study Consortium,
MLA Citation
Mruthyunjaya, P, Seider, MI, Stinnett, S, Schefler, A, and Ocular Oncology Study Consortium, . "Association between Tumor Regression Rate and Gene Expression Profile after Iodine 125 Plaque Radiotherapy for Uveal Melanoma." Ophthalmology 124.10 (October 2017): 1532-1539.
PMID
28549517
Source
epmc
Published In
Ophthalmology: Journal of The American Academy of Ophthalmology
Volume
124
Issue
10
Publish Date
2017
Start Page
1532
End Page
1539
DOI
10.1016/j.ophtha.2017.04.013

Comparison of Visual Outcomes in Coats' Disease: A 20-Year Experience.

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.

Authors
Ong, SS; Buckley, EG; McCuen, BW; Jaffe, GJ; Postel, EA; Mahmoud, TH; Stinnett, SS; Toth, CA; Vajzovic, L; Mruthyunjaya, P
MLA Citation
Ong, SS, Buckley, EG, McCuen, BW, Jaffe, GJ, Postel, EA, Mahmoud, TH, Stinnett, SS, Toth, CA, Vajzovic, L, and Mruthyunjaya, P. "Comparison of Visual Outcomes in Coats' Disease: A 20-Year Experience." Ophthalmology 124.9 (September 2017): 1368-1376.
PMID
28461016
Source
epmc
Published In
Ophthalmology: Journal of The American Academy of Ophthalmology
Volume
124
Issue
9
Publish Date
2017
Start Page
1368
End Page
1376
DOI
10.1016/j.ophtha.2017.03.051

Therapies for Macular Edema Associated with Branch Retinal Vein Occlusion: A Report by the American Academy of Ophthalmology.

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.

Authors
Ehlers, JP; Kim, SJ; Yeh, S; Thorne, JE; Mruthyunjaya, P; Schoenberger, SD; Bakri, SJ
MLA Citation
Ehlers, JP, Kim, SJ, Yeh, S, Thorne, JE, Mruthyunjaya, P, Schoenberger, SD, and Bakri, SJ. "Therapies for Macular Edema Associated with Branch Retinal Vein Occlusion: A Report by the American Academy of Ophthalmology." Ophthalmology 124.9 (September 2017): 1412-1423.
PMID
28551163
Source
epmc
Published In
Ophthalmology: Journal of The American Academy of Ophthalmology
Volume
124
Issue
9
Publish Date
2017
Start Page
1412
End Page
1423
DOI
10.1016/j.ophtha.2017.03.060

Neuro-oculo-cutaneous cavernous hemangiomas: a CCM1 mutation-associated phakomatosis.

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.

Authors
Labowsky, MT; Walter, SD; McDonald, MT; Mruthyunjaya, P
MLA Citation
Labowsky, MT, Walter, SD, McDonald, MT, and Mruthyunjaya, P. "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 (September 2017).
PMID
28867399
Source
epmc
Published In
Journal of AAPOS
Publish Date
2017
DOI
10.1016/j.jaapos.2017.06.012

Pediatric conjunctival melanoma arising from a compound nevus.

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.

Authors
Liu, KC; Mruthyunjaya, P; Proia, AD; Vora, GK
MLA Citation
Liu, KC, Mruthyunjaya, P, Proia, AD, and Vora, GK. "Pediatric conjunctival melanoma arising from a compound nevus." Journal of AAPOS : the official publication of the American Association for Pediatric Ophthalmology and Strabismus (August 28, 2017).
PMID
28860029
Source
epmc
Published In
Journal of AAPOS
Publish Date
2017
DOI
10.1016/j.jaapos.2017.04.014

Multifocal iris melanoma in a 2-year-old managed with I-125 plaque brachytherapy.

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.

Authors
Lee, AR; Grewal, DS; Cummings, TJ; Enyedi, LB; Larrier, NA; Mruthyunjaya, P
MLA Citation
Lee, AR, Grewal, DS, Cummings, TJ, Enyedi, LB, Larrier, NA, and Mruthyunjaya, P. "Multifocal iris melanoma in a 2-year-old managed with I-125 plaque brachytherapy." Journal of AAPOS : the official publication of the American Association for Pediatric Ophthalmology and Strabismus (August 24, 2017).
PMID
28844752
Source
epmc
Published In
Journal of AAPOS
Publish Date
2017
DOI
10.1016/j.jaapos.2017.03.014

Everolimus to treat aggressive retinal astrocytic hamartoma in tuberous sclerosis complex.

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.

Authors
Nallasamy, N; Seider, MI; Gururangan, S; Mruthyunjaya, P
MLA Citation
Nallasamy, N, Seider, MI, Gururangan, S, and Mruthyunjaya, P. "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 21.4 (August 2017): 328-331.
PMID
28733147
Source
epmc
Published In
Journal of AAPOS
Volume
21
Issue
4
Publish Date
2017
Start Page
328
End Page
331
DOI
10.1016/j.jaapos.2017.04.012

Pigmented Iridociliary Lesion and Increased Intraocular Pressure.

Authors
Schwartz, TM; Walter, SD; Mruthyunjaya, P
MLA Citation
Schwartz, TM, Walter, SD, and Mruthyunjaya, P. "Pigmented Iridociliary Lesion and Increased Intraocular Pressure." JAMA ophthalmology 135.7 (July 2017): 805-806.
PMID
28448661
Source
epmc
Published In
JAMA Ophthalmology
Volume
135
Issue
7
Publish Date
2017
Start Page
805
End Page
806
DOI
10.1001/jamaophthalmol.2016.5128

MOLECULAR PROGNOSTICS FOR UVEAL MELANOMA.

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.

Authors
Seider, MI; Mruthyunjaya, P
MLA Citation
Seider, MI, and Mruthyunjaya, P. "MOLECULAR PROGNOSTICS FOR UVEAL MELANOMA." Retina (Philadelphia, Pa.) (June 29, 2017).
PMID
28665870
Source
epmc
Published In
Retina
Publish Date
2017
DOI
10.1097/iae.0000000000001757

Diagnostic and Therapeutic Challenges.

Authors
Iu, LP; Fan, MC; Wong, IY; Mruthyunjaya, P
MLA Citation
Iu, LP, Fan, MC, Wong, IY, and Mruthyunjaya, P. "Diagnostic and Therapeutic Challenges." Retina (Philadelphia, Pa.) (June 23, 2017).
PMID
28661968
Source
epmc
Published In
Retina
Publish Date
2017
DOI
10.1097/iae.0000000000001751

MULTICOLOR IMAGING OF INNER RETINAL ALTERATIONS AFTER INTERNAL LIMITING MEMBRANE PEELING.

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.

Authors
Feng, HL; Sharma, S; Asrani, S; Mruthyunjaya, P
MLA Citation
Feng, HL, Sharma, S, Asrani, S, and Mruthyunjaya, P. "MULTICOLOR IMAGING OF INNER RETINAL ALTERATIONS AFTER INTERNAL LIMITING MEMBRANE PEELING." Retinal cases & brief reports 11.3 (June 2017): 198-202.
PMID
27164506
Source
epmc
Published In
Retinal Cases and Brief Reports
Volume
11
Issue
3
Publish Date
2017
Start Page
198
End Page
202
DOI
10.1097/icb.0000000000000330

Anterior Chamber Angle Invasion of Iridociliary Melanoma.

Authors
Walter, SD; Cummings, TJ; Mruthyunjaya, P
MLA Citation
Walter, SD, Cummings, TJ, and Mruthyunjaya, P. "Anterior Chamber Angle Invasion of Iridociliary Melanoma." Ophthalmology 124.6 (June 2017): 842-.
PMID
28528829
Source
epmc
Published In
Ophthalmology: Journal of The American Academy of Ophthalmology
Volume
124
Issue
6
Publish Date
2017
Start Page
842
DOI
10.1016/j.ophtha.2016.12.003

Outcomes of 27-Gauge Vitrectomy-Assisted Choroidal and Subretinal Biopsy.

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.].

Authors
Grewal, DS; Cummings, TJ; Mruthyunjaya, P
MLA Citation
Grewal, DS, Cummings, TJ, and Mruthyunjaya, P. "Outcomes of 27-Gauge Vitrectomy-Assisted Choroidal and Subretinal Biopsy." Ophthalmic surgery, lasers & imaging retina 48.5 (May 2017): 406-415.
PMID
28499052
Source
epmc
Published In
OSLIRetina
Volume
48
Issue
5
Publish Date
2017
Start Page
406
End Page
415
DOI
10.3928/23258160-20170428-07

Intraoperative 4-Dimensional Microscope-Integrated Optical Coherence Tomography-Guided 27-Gauge Transvitreal Choroidal Biopsy for Choroidal Melanoma.

Authors
Grewal, DS; Bhullar, PK; Pasricha, ND; Carrasco-Zevallos, OM; Viehland, C; Keller, B; Shen, L; Izatt, JA; Kuo, AN; Toth, CA; Mruthyunjaya, P
MLA Citation
Grewal, DS, Bhullar, PK, Pasricha, ND, Carrasco-Zevallos, OM, Viehland, C, Keller, B, Shen, L, Izatt, JA, Kuo, AN, Toth, CA, and Mruthyunjaya, P. "Intraoperative 4-Dimensional Microscope-Integrated Optical Coherence Tomography-Guided 27-Gauge Transvitreal Choroidal Biopsy for Choroidal Melanoma." Retina (Philadelphia, Pa.) 37.4 (April 2017): 796-799.
PMID
27673716
Source
epmc
Published In
Retina
Volume
37
Issue
4
Publish Date
2017
Start Page
796
End Page
799
DOI
10.1097/iae.0000000000001326

Ocular Surface Epithelial Atypia Mimicking Squamous Neoplasia in Association With Ulcerative Colitis.

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.

Authors
Ong, SS; Walter, SD; Chen, X; Vora, GK; Daluvoy, M; Proia, AD; Mruthyunjaya, P
MLA Citation
Ong, SS, Walter, SD, Chen, X, Vora, GK, Daluvoy, M, Proia, AD, and Mruthyunjaya, P. "Ocular Surface Epithelial Atypia Mimicking Squamous Neoplasia in Association With Ulcerative Colitis." Cornea 36.4 (April 2017): 502-505.
PMID
28129293
Source
epmc
Published In
Cornea
Volume
36
Issue
4
Publish Date
2017
Start Page
502
End Page
505
DOI
10.1097/ico.0000000000001144

Diagnosis and Treatment of Acute Retinal Necrosis: A Report by the American Academy of Ophthalmology.

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.

Authors
Schoenberger, SD; Kim, SJ; Thorne, JE; Mruthyunjaya, P; Yeh, S; Bakri, SJ; Ehlers, JP
MLA Citation
Schoenberger, SD, Kim, SJ, Thorne, JE, Mruthyunjaya, P, Yeh, S, Bakri, SJ, and Ehlers, JP. "Diagnosis and Treatment of Acute Retinal Necrosis: A Report by the American Academy of Ophthalmology." Ophthalmology 124.3 (March 2017): 382-392. (Review)
PMID
28094044
Source
epmc
Published In
Ophthalmology: Journal of The American Academy of Ophthalmology
Volume
124
Issue
3
Publish Date
2017
Start Page
382
End Page
392
DOI
10.1016/j.ophtha.2016.11.007

Association of Pediatric Choroidal Neovascular Membranes at the Temporal Edge of Optic Nerve and Retinochoroidal Coloboma.

To describe the characteristics of pediatric choroidal neovascular membranes (CNVs) 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 of age with CNV and retinochoroidal and optic nerve coloboma from 1995-2015 who underwent OCT imaging using either handheld (Bioptigen, Morrisville, NC) or tabletop OCT (Spectralis; Heidelberg, Carlsbad, CA).Eight eyes of 8 patients (3 males, 5 females) with a mean age of 4.1 ± 3.9 years (range 6 months-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, CNVs were located at the temporal margin of the coloboma closest to the 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, 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 the 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.

Authors
Grewal, DS; Tran-Viet, D; Vajzovic, L; Mruthyunjaya, P; Toth, CA
MLA Citation
Grewal, DS, Tran-Viet, D, Vajzovic, L, Mruthyunjaya, P, and Toth, CA. "Association of Pediatric Choroidal Neovascular Membranes at the Temporal Edge of Optic Nerve and Retinochoroidal Coloboma." American journal of ophthalmology 174 (February 2017): 104-112.
PMID
27793604
Source
epmc
Published In
American Journal of Ophthalmology
Volume
174
Publish Date
2017
Start Page
104
End Page
112
DOI
10.1016/j.ajo.2016.10.010

Advances in the management of conjunctival melanoma.

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.

Authors
Vora, GK; Demirci, H; Marr, B; Mruthyunjaya, P
MLA Citation
Vora, GK, Demirci, H, Marr, B, and Mruthyunjaya, P. "Advances in the management of conjunctival melanoma." Survey of ophthalmology 62.1 (January 2017): 26-42. (Review)
PMID
27321895
Source
epmc
Published In
Survey of Ophthalmology
Volume
62
Issue
1
Publish Date
2017
Start Page
26
End Page
42
DOI
10.1016/j.survophthal.2016.06.001

Wide field of view swept-source optical coherence tomography for peripheral retinal disease.

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.

Authors
McNabb, RP; Grewal, DS; Mehta, R; Schuman, SG; Izatt, JA; Mahmoud, TH; Jaffe, GJ; Mruthyunjaya, P; Kuo, AN
MLA Citation
McNabb, RP, Grewal, DS, Mehta, R, Schuman, SG, Izatt, JA, Mahmoud, TH, Jaffe, GJ, Mruthyunjaya, P, and Kuo, AN. "Wide field of view swept-source optical coherence tomography for peripheral retinal disease." The British journal of ophthalmology 100.10 (October 2016): 1377-1382.
PMID
26755643
Source
epmc
Published In
British Journal of Ophthalmology
Volume
100
Issue
10
Publish Date
2016
Start Page
1377
End Page
1382
DOI
10.1136/bjophthalmol-2015-307480

Portable Optical Coherence Tomography Detection or Confirmation of Ophthalmoscopically Invisible or Indeterminate Active Retinoblastoma.

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.].

Authors
Seider, MI; Grewal, DS; Mruthyunjaya, P
MLA Citation
Seider, MI, Grewal, DS, and Mruthyunjaya, P. "Portable Optical Coherence Tomography Detection or Confirmation of Ophthalmoscopically Invisible or Indeterminate Active Retinoblastoma." Ophthalmic surgery, lasers & imaging retina 47.10 (October 2016): 965-968.
PMID
27759865
Source
epmc
Published In
OSLIRetina
Volume
47
Issue
10
Publish Date
2016
Start Page
965
End Page
968
DOI
10.3928/23258160-20161004-12

Primary adenocarcinoma of pigmented ciliary epithelium in a phthisical eye.

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.

Authors
Kumar, JB; Proia, AD; Mruthyunjaya, P; Sharma, S
MLA Citation
Kumar, JB, Proia, AD, Mruthyunjaya, P, and Sharma, S. "Primary adenocarcinoma of pigmented ciliary epithelium in a phthisical eye." Survey of ophthalmology 61.4 (July 2016): 502-505. (Review)
PMID
26597037
Source
epmc
Published In
Survey of Ophthalmology
Volume
61
Issue
4
Publish Date
2016
Start Page
502
End Page
505
DOI
10.1016/j.survophthal.2015.11.001

Impact of Microscope-Integrated OCT on Ophthalmology Resident Performance of Anterior Segment Surgical Maneuvers in Model Eyes.

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.

Authors
Todorich, B; Shieh, C; DeSouza, PJ; Carrasco-Zevallos, OM; Cunefare, DL; Stinnett, SS; Izatt, JA; Farsiu, S; Mruthyunjaya, P; Kuo, AN; Toth, CA
MLA Citation
Todorich, B, Shieh, C, DeSouza, PJ, Carrasco-Zevallos, OM, Cunefare, DL, Stinnett, SS, Izatt, JA, Farsiu, S, Mruthyunjaya, P, Kuo, AN, and Toth, CA. "Impact of Microscope-Integrated OCT on Ophthalmology Resident Performance of Anterior Segment Surgical Maneuvers in Model Eyes." Investigative ophthalmology & visual science 57.9 (July 2016): OCT146-OCT153.
PMID
27409466
Source
epmc
Published In
Investigative Ophthalmology and Visual Science
Volume
57
Issue
9
Publish Date
2016
Start Page
OCT146
End Page
OCT153
DOI
10.1167/iovs.15-18818

Scleral Buckling with Chandelier Illumination.

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.

Authors
Seider, MI; Nomides, REK; Hahn, P; Mruthyunjaya, P; Mahmoud, TH
MLA Citation
Seider, MI, Nomides, REK, Hahn, P, Mruthyunjaya, P, and Mahmoud, TH. "Scleral Buckling with Chandelier Illumination." Journal of ophthalmic & vision research 11.3 (July 2016): 304-309. (Review)
PMID
27621789
Source
epmc
Published In
Journal of Ophthalmic and Vision Research
Volume
11
Issue
3
Publish Date
2016
Start Page
304
End Page
309
DOI
10.4103/2008-322x.188402

SMALL-GAUGE VALVED VERSUS NONVALVED CANNULA PARS PLANA VITRECTOMY FOR RETINAL DETACHMENT REPAIR.

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.

Authors
Oellers, P; Stinnett, S; Mruthyunjaya, P; Hahn, P
MLA Citation
Oellers, P, Stinnett, S, Mruthyunjaya, P, and Hahn, P. "SMALL-GAUGE VALVED VERSUS NONVALVED CANNULA PARS PLANA VITRECTOMY FOR RETINAL DETACHMENT REPAIR." Retina (Philadelphia, Pa.) 36.4 (April 2016): 744-749.
PMID
26398696
Source
epmc
Published In
Retina
Volume
36
Issue
4
Publish Date
2016
Start Page
744
End Page
749
DOI
10.1097/iae.0000000000000762

A Comparative Study of Rebound Tonometry With Tonopen and Goldmann Applanation Tonometry Following Vitreoretinal Surgery.

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.

Authors
Grewal, DS; Stinnett, SS; Folgar, FA; Schneider, EW; Vajzovic, L; Asrani, S; Freedman, SF; Mruthyunjaya, P; Hahn, P
MLA Citation
Grewal, DS, Stinnett, SS, Folgar, FA, Schneider, EW, Vajzovic, L, Asrani, S, Freedman, SF, Mruthyunjaya, P, and Hahn, P. "A Comparative Study of Rebound Tonometry With Tonopen and Goldmann Applanation Tonometry Following Vitreoretinal Surgery." American journal of ophthalmology 161 (January 2016): 22-8.e1-8-.
PMID
26408266
Source
epmc
Published In
American Journal of Ophthalmology
Volume
161
Publish Date
2016
Start Page
22-8.e1-8
DOI
10.1016/j.ajo.2015.09.022

Subretinal Hyperreflective Material in the Comparison of Age-Related Macular Degeneration Treatments Trials.

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.

Authors
Willoughby, AS; Ying, G-S; Toth, CA; Maguire, MG; Burns, RE; Grunwald, JE; Daniel, E; Jaffe, GJ; Comparison of Age-Related Macular Degeneration Treatments Trials Research Group,
MLA Citation
Willoughby, AS, Ying, G-S, Toth, CA, Maguire, MG, Burns, RE, Grunwald, JE, Daniel, E, Jaffe, GJ, and Comparison of Age-Related Macular Degeneration Treatments Trials Research Group, . "Subretinal Hyperreflective Material in the Comparison of Age-Related Macular Degeneration Treatments Trials." Ophthalmology 122.9 (September 2015): 1846-53.e5.
PMID
26143666
Source
epmc
Published In
Ophthalmology: Journal of The American Academy of Ophthalmology
Volume
122
Issue
9
Publish Date
2015
Start Page
1846
End Page
53.e5
DOI
10.1016/j.ophtha.2015.05.042

En face imaging of retinal pathology using multicolor confocal scanning laser ophthalmoscopy

Authors
Feng, H; Sharma, S; Asrani, SG; Stinnett, S; Mruthyunjaya, P
MLA Citation
Feng, H, Sharma, S, Asrani, SG, Stinnett, S, and Mruthyunjaya, P. "En face imaging of retinal pathology using multicolor confocal scanning laser ophthalmoscopy." June 2015.
Source
wos-lite
Published In
Investigative Ophthalmology and Visual Science
Volume
56
Issue
7
Publish Date
2015

Ultra wide-field swept-source optical coherence tomography for peripheral eye disease

Authors
McNabb, RP; Grewal, DS; Schuman, S; Mruthyunjaya, P; Izatt, JA; Kuo, AN
MLA Citation
McNabb, RP, Grewal, DS, Schuman, S, Mruthyunjaya, P, Izatt, JA, and Kuo, AN. "Ultra wide-field swept-source optical coherence tomography for peripheral eye disease." June 2015.
Source
wos-lite
Published In
Investigative Ophthalmology and Visual Science
Volume
56
Issue
7
Publish Date
2015

Impact of Microscope Integrated OCT on ophthalmology resident performance of anterior segment maneuvers in model eyes

Authors
Bozho-Todorich, ; Shieh, C; DeSouza, P; Carrasco-Zevallos, O; Cunefare, D; Izatt, JA; Farsiu, S; Mruthyunjaya, P; Kuo, AN; Toth, CA
MLA Citation
Bozho-Todorich, , Shieh, C, DeSouza, P, Carrasco-Zevallos, O, Cunefare, D, Izatt, JA, Farsiu, S, Mruthyunjaya, P, Kuo, AN, and Toth, CA. "Impact of Microscope Integrated OCT on ophthalmology resident performance of anterior segment maneuvers in model eyes." June 2015.
Source
wos-lite
Published In
Investigative Ophthalmology and Visual Science
Volume
56
Issue
7
Publish Date
2015

Retained Intraocular Perfluoro-n-octane After Valved Cannula Pars Plana Vitrectomy for Retinal Detachment.

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.

Authors
Oellers, P; Schneider, EW; Fekrat, S; Mahmoud, TH; Mruthyunjaya, P; Hahn, P
MLA Citation
Oellers, P, Schneider, EW, Fekrat, S, Mahmoud, TH, Mruthyunjaya, P, and Hahn, P. "Retained Intraocular Perfluoro-n-octane After Valved Cannula Pars Plana Vitrectomy for Retinal Detachment." Ophthalmic surgery, lasers & imaging retina 46.4 (April 2015): 451-456.
PMID
25970866
Source
epmc
Published In
OSLIRetina
Volume
46
Issue
4
Publish Date
2015
Start Page
451
End Page
456
DOI
10.3928/23258160-20150422-08

Conjunctival pseudotumor caused by herpes simplex virus infection.

Authors
Vora, GK; Marr, B; Cummings, TJ; Mruthyunjaya, P
MLA Citation
Vora, GK, Marr, B, Cummings, TJ, and Mruthyunjaya, P. "Conjunctival pseudotumor caused by herpes simplex virus infection." JAMA ophthalmology 133.1 (January 2015): 105-107.
PMID
25232655
Source
epmc
Published In
JAMA Ophthalmology
Volume
133
Issue
1
Publish Date
2015
Start Page
105
End Page
107
DOI
10.1001/jamaophthalmol.2014.3316

Conjunctival melanoma.

Authors
Yiu, G; Cummings, TJ; Mruthyunjaya, P
MLA Citation
Yiu, G, Cummings, TJ, and Mruthyunjaya, P. "Conjunctival melanoma." JAMA ophthalmology 132.12 (December 2014): 1432-.
PMID
25340828
Source
epmc
Published In
JAMA Ophthalmology
Volume
132
Issue
12
Publish Date
2014
Start Page
1432
DOI
10.1001/jamaophthalmol.2014.585

The Effects of Auditory Integration Training (AIT) on Mismatch Negativity in Children with Autism

Authors
Sokhadze, EM; Akaydin, KA; Edelson, SM; Brockett, S; Alworth, L; Weihing, J; Hensley, MK; Mruthyunjaya, P; Casanova, MF
MLA Citation
Sokhadze, EM, Akaydin, KA, Edelson, SM, Brockett, S, Alworth, L, Weihing, J, Hensley, MK, Mruthyunjaya, P, and Casanova, MF. "The Effects of Auditory Integration Training (AIT) on Mismatch Negativity in Children with Autism." December 2014.
Source
wos-lite
Published In
Applied Psychophysiology and Biofeedback
Volume
39
Issue
3-4
Publish Date
2014
Start Page
302
End Page
302

Corticosteroids for the Treatment of Diabetic Macular Edema

Authors
Sharma, S; Mruthyunjaya, P
MLA Citation
Sharma, S, and Mruthyunjaya, P. "Corticosteroids for the Treatment of Diabetic Macular Edema." Current Ophthalmology Reports 2.4 (December 2014): 158-166.
Source
crossref
Published In
Current Ophthalmology Reports
Volume
2
Issue
4
Publish Date
2014
Start Page
158
End Page
166
DOI
10.1007/s40135-014-0051-7

Hyperextension Myelopathy: a rare ischemic injury of the spinal cord presenting in a 7-year-old cheerleader

Authors
Haralur-Sreekantaiah, Y; Mruthyunjaya, P; Skjei, KL
MLA Citation
Haralur-Sreekantaiah, Y, Mruthyunjaya, P, and Skjei, KL. "Hyperextension Myelopathy: a rare ischemic injury of the spinal cord presenting in a 7-year-old cheerleader." October 2014.
Source
wos-lite
Published In
Annals of Neurology
Volume
76
Publish Date
2014
Start Page
S182
End Page
S183

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

Authors
Perez, BA; Mettu, P; Vajzovic, L; Alkaissi, A; Steffey, BA; Cai, J; Stinnett, S; Mruthyunjaya, P; Kirsch, DG
MLA Citation
Perez, BA, Mettu, P, Vajzovic, L, Alkaissi, A, Steffey, BA, Cai, J, Stinnett, S, Mruthyunjaya, P, and Kirsch, DG. "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." September 1, 2014.
Source
wos-lite
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
90
Publish Date
2014
Start Page
S306
End Page
S306

Vitamin D deficiency in neovascular versus nonneovascular age-related macular degeneration.

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.

Authors
Itty, S; Day, S; Lyles, KW; Stinnett, SS; Vajzovic, LM; Mruthyunjaya, P
MLA Citation
Itty, S, Day, S, Lyles, KW, Stinnett, SS, Vajzovic, LM, and Mruthyunjaya, P. "Vitamin D deficiency in neovascular versus nonneovascular age-related macular degeneration." Retina (Philadelphia, Pa.) 34.9 (September 2014): 1779-1786.
PMID
24946100
Source
epmc
Published In
Retina
Volume
34
Issue
9
Publish Date
2014
Start Page
1779
End Page
1786
DOI
10.1097/iae.0000000000000178

Choroidal metastatasis from a neuroendocrine tumor masquerading as choroidal melanoma.

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.

Authors
Yiu, G; Cummings, TJ; Mruthyunjaya, P
MLA Citation
Yiu, G, Cummings, TJ, and Mruthyunjaya, P. "Choroidal metastatasis from a neuroendocrine tumor masquerading as choroidal melanoma." Ophthalmic surgery, lasers & imaging retina 45.5 (September 2014): 456-458.
PMID
25153655
Source
epmc
Published In
OSLIRetina
Volume
45
Issue
5
Publish Date
2014
Start Page
456
End Page
458
DOI
10.3928/23258160-20140725-01

Uveal melanoma treated with iodine-125 episcleral plaque: an analysis of dose on disease control and visual outcomes.

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.

Authors
Perez, BA; Mettu, P; Vajzovic, L; Rivera, D; Alkaissi, A; Steffey, BA; Cai, J; Stinnett, S; Dutton, JJ; Buckley, EG; Halperin, E; Marks, LB; Mruthyunjaya, P; Kirsch, DG
MLA Citation
Perez, BA, Mettu, P, Vajzovic, L, Rivera, D, Alkaissi, A, Steffey, BA, Cai, J, Stinnett, S, Dutton, JJ, Buckley, EG, Halperin, E, Marks, LB, Mruthyunjaya, P, and Kirsch, DG. "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 89.1 (May 2014): 127-136.
PMID
24613808
Source
epmc
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
89
Issue
1
Publish Date
2014
Start Page
127
End Page
136
DOI
10.1016/j.ijrobp.2014.01.026

Characterization of the choroid-scleral junction and suprachoroidal layer in healthy individuals on enhanced-depth imaging optical coherence tomography.

IMPORTANCE: 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). OBJECTIVE: 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. DESIGN, SETTING, AND PARTICIPANTS: 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. MAIN OUTCOMES AND MEASURES: 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. CONCLUSIONS AND RELEVANCE: 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.

Authors
Yiu, G; Pecen, P; Sarin, N; Chiu, SJ; Farsiu, S; Mruthyunjaya, P; Toth, CA
MLA Citation
Yiu, G, Pecen, P, Sarin, N, Chiu, SJ, Farsiu, S, Mruthyunjaya, P, and Toth, CA. "Characterization of the choroid-scleral junction and suprachoroidal layer in healthy individuals on enhanced-depth imaging optical coherence tomography." JAMA Ophthalmol 132.2 (February 2014): 174-181.
PMID
24336985
Source
pubmed
Published In
JAMA Ophthalmology
Volume
132
Issue
2
Publish Date
2014
Start Page
174
End Page
181
DOI
10.1001/jamaophthalmol.2013.7288

Reduced fluorescein angiography and fundus photography use in the management of neovascular macular degeneration and macular edema during the past decade.

PURPOSE: We assessed recent trends in the use of diagnostic testing for neovascular age-related macular degeneration (NVAMD) and macular edema (ME). METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.

Authors
Schneider, EW; Mruthyunjaya, P; Talwar, N; Harris Nwanyanwu, K; Nan, B; Stein, JD
MLA Citation
Schneider, EW, Mruthyunjaya, P, Talwar, N, Harris Nwanyanwu, K, Nan, B, and Stein, JD. "Reduced fluorescein angiography and fundus photography use in the management of neovascular macular degeneration and macular edema during the past decade. (Published online)" Invest Ophthalmol Vis Sci 55.1 (January 29, 2014): 542-549.
PMID
24346174
Source
pubmed
Published In
Investigative Ophthalmology and Visual Science
Volume
55
Issue
1
Publish Date
2014
Start Page
542
End Page
549
DOI
10.1167/iovs.13-13034

Retinal metastatic tumors

© Springer-Verlag Berlin Heidelberg 2014. Intraocular metastasis is the most common intraocular tumor. The most common primary tumor site is the lung in men and breast in women [1]. In the majority of cases, intraocular metastasis is limited to choroid. Other ocular structures, like the vitreous, optic nerve, and iris, may also be involved and rarely, a tumor may metastasize to the retina.

Authors
Vajzovic, L; Mruthyunjaya, P
MLA Citation
Vajzovic, L, and Mruthyunjaya, P. "Retinal metastatic tumors." Clinical Ophthalmic Oncology: Retinal Tumors. January 1, 2014. 91-102.
Source
scopus
Publish Date
2014
Start Page
91
End Page
102
DOI
10.1007/978-3-642-39489-8_8

Imaging microscopic pigment chemistry in conjunctival melanocytic lesions using pump-probe laser microscopy.

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.

Authors
Wilson, JW; Vajzovic, L; Robles, FE; Cummings, TJ; Mruthyunjaya, P; Warren, WS
MLA Citation
Wilson, JW, Vajzovic, L, Robles, FE, Cummings, TJ, Mruthyunjaya, P, and Warren, WS. "Imaging microscopic pigment chemistry in conjunctival melanocytic lesions using pump-probe laser microscopy." Investigative ophthalmology & visual science 54.10 (October 21, 2013): 6867-6876.
PMID
24065811
Source
epmc
Published In
Investigative Ophthalmology and Visual Science
Volume
54
Issue
10
Publish Date
2013
Start Page
6867
End Page
6876
DOI
10.1167/iovs.13-12432

Combination therapy for macular edema secondary to retinal vein occlusion.

Authors
Schneider, EW; Mruthyunjaya, P; Hariprasad, SM
MLA Citation
Schneider, EW, Mruthyunjaya, P, and Hariprasad, SM. "Combination therapy for macular edema secondary to retinal vein occlusion." Ophthalmic Surg Lasers Imaging Retina 44.5 (September 2013): 434-438. (Review)
PMID
24044704
Source
pubmed
Published In
OSLIRetina
Volume
44
Issue
5
Publish Date
2013
Start Page
434
End Page
438
DOI
10.3928/23258160-20130909-02

Preclinical evaluation and intraoperative human retinal imaging with a high-resolution microscope-integrated spectral domain optical coherence tomography device.

PURPOSE: 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. METHODS: 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. RESULTS: 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. CONCLUSION: 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.

Authors
Hahn, P; Migacz, J; O'Donnell, R; Day, S; Lee, A; Lin, P; Vann, R; Kuo, A; Fekrat, S; Mruthyunjaya, P; Postel, EA; Izatt, JA; Toth, CA
MLA Citation
Hahn, P, Migacz, J, O'Donnell, R, Day, S, Lee, A, Lin, P, Vann, R, Kuo, A, Fekrat, S, Mruthyunjaya, P, Postel, EA, Izatt, JA, and Toth, CA. "Preclinical evaluation and intraoperative human retinal imaging with a high-resolution microscope-integrated spectral domain optical coherence tomography device." Retina 33.7 (July 2013): 1328-1337.
PMID
23538579
Source
pubmed
Published In
Retina
Volume
33
Issue
7
Publish Date
2013
Start Page
1328
End Page
1337
DOI
10.1097/IAE.0b013e3182831293

Progression of diabetic retinopathy in the hypertension intervention nurse telemedicine study.

Authors
Muir, KW; Grubber, J; Mruthyunjaya, P; McCant, F; Bosworth, HB
MLA Citation
Muir, KW, Grubber, J, Mruthyunjaya, P, McCant, F, and Bosworth, HB. "Progression of diabetic retinopathy in the hypertension intervention nurse telemedicine study." JAMA Ophthalmol 131.7 (July 2013): 957-958. (Letter)
PMID
23702951
Source
pubmed
Published In
JAMA Ophthalmology
Volume
131
Issue
7
Publish Date
2013
Start Page
957
End Page
958
DOI
10.1001/jamaophthalmol.2013.81

SD-OCT and autofluorescence characteristics of autoimmune retinopathy.

AIMS: 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). METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.

Authors
Pepple, KL; Cusick, M; Jaffe, GJ; Mruthyunjaya, P
MLA Citation
Pepple, KL, Cusick, M, Jaffe, GJ, and Mruthyunjaya, P. "SD-OCT and autofluorescence characteristics of autoimmune retinopathy." Br J Ophthalmol 97.2 (February 2013): 139-144.
PMID
23221966
Source
pubmed
Published In
British Journal of Ophthalmology
Volume
97
Issue
2
Publish Date
2013
Start Page
139
End Page
144
DOI
10.1136/bjophthalmol-2012-302524

Imaging pigment chemistry in melanocytic conjunctival lesions with pump-probe microscopy

We extend nonlinear pump-probe microscopy, recently demonstrated to image the microscopic distribution of eumelanin and pheomelanin in unstained skin biopsy sections, to the case of melanocytic conjunctival lesions. The microscopic distribution of pigmentation chemistry serves as a functional indicator of melanocyte activity. In these conjunctival specimens (benign nevi, primary acquired melanoses, and conjunctival melanoma), we have observed pump-probe spectroscopic signatures of eumelanin, pheomelanin, hemoglobin, and surgical ink, in addition to important structural features that differentiate benign from malignant lesions. We will also discuss prospects for an in vivo 'optical biopsy' to provide additional information before having to perform invasive procedures. © 2013 Copyright SPIE.

Authors
Wilson, JW; Vajzovic, L; Robles, FE; Cummings, TJ; Mruthyunjaya, P; Warren, WS
MLA Citation
Wilson, JW, Vajzovic, L, Robles, FE, Cummings, TJ, Mruthyunjaya, P, and Warren, WS. "Imaging pigment chemistry in melanocytic conjunctival lesions with pump-probe microscopy." 2013.
Source
scival
Volume
8567
Publish Date
2013
DOI
10.1117/12.2003137

Circumscribed Choroidal Hemangioma

Authors
Day, S; Mruthyunjaya, P
MLA Citation
Day, S, and Mruthyunjaya, P. "Circumscribed Choroidal Hemangioma." Retina Fifth Edition. December 1, 2012. 2340-2350.
Source
scopus
Volume
3
Publish Date
2012
Start Page
2340
End Page
2350
DOI
10.1016/B978-1-4557-0737-9.00153-3

Evaluating the Relationship Between Prescription Dose and Overall Survival Among Patients Treated With I-125 Brachytherapy for Posterior Uveal Melanoma

Authors
Perez, B; Vajzovic, L; Mettu, P; Rivera, D; Alkaissi, A; Steffey, BA; Stinnett, S; Marks, LB; Mruthyunjaya, P; Kirsch, DG
MLA Citation
Perez, B, Vajzovic, L, Mettu, P, Rivera, D, Alkaissi, A, Steffey, BA, Stinnett, S, Marks, LB, Mruthyunjaya, P, and Kirsch, DG. "Evaluating the Relationship Between Prescription Dose and Overall Survival Among Patients Treated With I-125 Brachytherapy for Posterior Uveal Melanoma." November 1, 2012.
Source
wos-lite
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
84
Issue
3
Publish Date
2012
Start Page
S197
End Page
S197

Diagnostic yield of vitreous biopsy in presumed sarcoidosis-related posterior segment inflammation.

PURPOSE: 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. DESIGN: Retrospective interventional case series. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.

Authors
Scott, AW; Mruthyunjaya, P; McCallum, RM; Jaffe, GJ
MLA Citation
Scott, AW, Mruthyunjaya, P, McCallum, RM, and Jaffe, GJ. "Diagnostic yield of vitreous biopsy in presumed sarcoidosis-related posterior segment inflammation." Graefes Arch Clin Exp Ophthalmol 250.9 (September 2012): 1379-1385.
PMID
22434211
Source
pubmed
Published In
Graefe's Archive for Clinical and Experimental Ophthalmology
Volume
250
Issue
9
Publish Date
2012
Start Page
1379
End Page
1385
DOI
10.1007/s00417-012-1993-9

Association of vitamin D deficiency and age-related macular degeneration in medicare beneficiaries.

Authors
Day, S; Acquah, K; Platt, A; Lee, PP; Mruthyunjaya, P; Sloan, FA
MLA Citation
Day, S, Acquah, K, Platt, A, Lee, PP, Mruthyunjaya, P, and Sloan, FA. "Association of vitamin D deficiency and age-related macular degeneration in medicare beneficiaries." Arch Ophthalmol 130.8 (August 2012): 1070-1071. (Letter)
PMID
22893083
Source
pubmed
Published In
Archives of Ophthalmology
Volume
130
Issue
8
Publish Date
2012
Start Page
1070
End Page
1071
DOI
10.1001/archophthalmol.2012.439

Collaborative Ocular Oncology Group report number 1: prospective validation of a multi-gene prognostic assay in uveal melanoma.

PURPOSE: 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). DESIGN: Prospective, multicenter study. PARTICIPANTS: A total of 459 patients with posterior uveal melanoma were enrolled from 12 independent centers. TESTING: 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. MAIN OUTCOME MEASURES: Patients were managed for their primary tumor and monitored for metastasis. RESULTS: 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. CONCLUSIONS: 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.

Authors
Onken, MD; Worley, LA; Char, DH; Augsburger, JJ; Correa, ZM; Nudleman, E; Aaberg, TM; Altaweel, MM; Bardenstein, DS; Finger, PT; Gallie, BL; Harocopos, GJ; Hovland, PG; McGowan, HD; Milman, T; Mruthyunjaya, P; Simpson, ER; Smith, ME; Wilson, DJ; Wirostko, WJ; Harbour, JW
MLA Citation
Onken, MD, Worley, LA, Char, DH, Augsburger, JJ, Correa, ZM, Nudleman, E, Aaberg, TM, Altaweel, MM, Bardenstein, DS, Finger, PT, Gallie, BL, Harocopos, GJ, Hovland, PG, McGowan, HD, Milman, T, Mruthyunjaya, P, Simpson, ER, Smith, ME, Wilson, DJ, Wirostko, WJ, and Harbour, JW. "Collaborative Ocular Oncology Group report number 1: prospective validation of a multi-gene prognostic assay in uveal melanoma." Ophthalmology 119.8 (August 2012): 1596-1603.
PMID
22521086
Source
pubmed
Published In
Ophthalmology: Journal of The American Academy of Ophthalmology
Volume
119
Issue
8
Publish Date
2012
Start Page
1596
End Page
1603
DOI
10.1016/j.ophtha.2012.02.017

Image inversion spectral-domain optical coherence tomography optimizes choroidal thickness and detail through improved contrast.

PURPOSE: 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). METHODS: 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. RESULTS: 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. CONCLUSION: 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.

Authors
Lin, P; Mettu, PS; Pomerleau, DL; Chiu, SJ; Maldonado, R; Stinnett, S; Toth, CA; Farsiu, S; Mruthyunjaya, P
MLA Citation
Lin, P, Mettu, PS, Pomerleau, DL, Chiu, SJ, Maldonado, R, Stinnett, S, Toth, CA, Farsiu, S, and Mruthyunjaya, P. "Image inversion spectral-domain optical coherence tomography optimizes choroidal thickness and detail through improved contrast. (Published online)" Invest Ophthalmol Vis Sci 53.4 (April 6, 2012): 1874-1882.
PMID
22410550
Source
pubmed
Published In
Investigative Ophthalmology and Visual Science
Volume
53
Issue
4
Publish Date
2012
Start Page
1874
End Page
1882
DOI
10.1167/iovs.11-9290

Drug delivery to the posterior segment: Challenges

Authors
Mruthyunjaya, P
MLA Citation
Mruthyunjaya, P. "Drug delivery to the posterior segment: Challenges." Therapy for Ocular Angiogenesis: Principles and Practice. March 28, 2012.
Source
scopus
Publish Date
2012

Unanticipated vision loss after pars plana vitrectomy.

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.

Authors
Jain, N; McCuen, BW; Mruthyunjaya, P
MLA Citation
Jain, N, McCuen, BW, and Mruthyunjaya, P. "Unanticipated vision loss after pars plana vitrectomy." Surv Ophthalmol 57.2 (March 2012): 91-104. (Review)
PMID
22337337
Source
pubmed
Published In
Survey of Ophthalmology
Volume
57
Issue
2
Publish Date
2012
Start Page
91
End Page
104
DOI
10.1016/j.survophthal.2011.09.001

Retinal manifestations of oncologic and hematologic conditions.

Authors
Lin, P; Mruthyunjaya, P
MLA Citation
Lin, P, and Mruthyunjaya, P. "Retinal manifestations of oncologic and hematologic conditions." Int Ophthalmol Clin 52.1 (2012): 67-91. (Review)
PMID
22124239
Source
pubmed
Published In
International Ophthalmology Clinics
Volume
52
Issue
1
Publish Date
2012
Start Page
67
End Page
91
DOI
10.1097/IIO.0b013e31823bbd14

Medicare costs for neovascular age-related macular degeneration, 1994-2007.

PURPOSE: To assess changes in Medicare payments for neovascular age-related macular degeneration (AMD) since introduction of anti-vascular endothelial growth factor (VEGF) therapies. DESIGN: Retrospective, longitudinal cohort study. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.

Authors
Day, S; Acquah, K; Lee, PP; Mruthyunjaya, P; Sloan, FA
MLA Citation
Day, S, Acquah, K, Lee, PP, Mruthyunjaya, P, and Sloan, FA. "Medicare costs for neovascular age-related macular degeneration, 1994-2007." Am J Ophthalmol 152.6 (December 2011): 1014-1020.
PMID
21843875
Source
pubmed
Published In
American Journal of Ophthalmology
Volume
152
Issue
6
Publish Date
2011
Start Page
1014
End Page
1020
DOI
10.1016/j.ajo.2011.05.008

Ocular complications after anti-vascular endothelial growth factor therapy in Medicare patients with age-related macular degeneration.

PURPOSE: 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. DESIGN: Retrospective, longitudinal case-control study. METHODS: 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. RESULTS: 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). CONCLUSIONS: 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.

Authors
Day, S; Acquah, K; Mruthyunjaya, P; Grossman, DS; Lee, PP; Sloan, FA
MLA Citation
Day, S, Acquah, K, Mruthyunjaya, P, Grossman, DS, Lee, PP, and Sloan, FA. "Ocular complications after anti-vascular endothelial growth factor therapy in Medicare patients with age-related macular degeneration." Am J Ophthalmol 152.2 (August 2011): 266-272.
PMID
21664593
Source
pubmed
Published In
American Journal of Ophthalmology
Volume
152
Issue
2
Publish Date
2011
Start Page
266
End Page
272
DOI
10.1016/j.ajo.2011.01.053

Melanoma-associated retinopathy: a presenting sign of metastatic disease.

Authors
Handler, MZ; Mruthyunjaya, P; Nelson, K
MLA Citation
Handler, MZ, Mruthyunjaya, P, and Nelson, K. "Melanoma-associated retinopathy: a presenting sign of metastatic disease." J Am Acad Dermatol 65.1 (July 2011): e9-11. (Letter)
PMID
21679809
Source
pubmed
Published In
Journal of The American Academy of Dermatology
Volume
65
Issue
1
Publish Date
2011
Start Page
e9
End Page
11
DOI
10.1016/j.jaad.2010.09.015

Optimizing diagnosis and management of nocardia keratitis, scleritis, and endophthalmitis: 11-year microbial and clinical overview.

OBJECTIVE: 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. DESIGN: Retrospective, consecutive case series. PARTICIPANTS: 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. INTERVENTION: 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). MAIN OUTCOME MEASURES: 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. RESULTS: 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. CONCLUSIONS: 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. FINANCIAL DISCLOSURE(S): The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Authors
DeCroos, FC; Garg, P; Reddy, AK; Sharma, A; Krishnaiah, S; Mungale, M; Mruthyunjaya, P; Hyderabad Endophthalmitis Research Group,
MLA Citation
DeCroos, FC, Garg, P, Reddy, AK, Sharma, A, Krishnaiah, S, Mungale, M, Mruthyunjaya, P, and Hyderabad Endophthalmitis Research Group, . "Optimizing diagnosis and management of nocardia keratitis, scleritis, and endophthalmitis: 11-year microbial and clinical overview." Ophthalmology 118.6 (June 2011): 1193-1200.
PMID
21276615
Source
pubmed
Published In
Ophthalmology: Journal of The American Academy of Ophthalmology
Volume
118
Issue
6
Publish Date
2011
Start Page
1193
End Page
1200
DOI
10.1016/j.ophtha.2010.10.037

Retinal pigment epithelial detachments in age-related macular degeneration: classification and therapeutic options.

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.

Authors
Pepple, K; Mruthyunjaya, P
MLA Citation
Pepple, K, and Mruthyunjaya, P. "Retinal pigment epithelial detachments in age-related macular degeneration: classification and therapeutic options." Semin Ophthalmol 26.3 (May 2011): 198-208. (Review)
PMID
21609233
Source
pubmed
Published In
Seminars in Ophthalmology
Volume
26
Issue
3
Publish Date
2011
Start Page
198
End Page
208
DOI
10.3109/08820538.2011.570850

One-Year Outcomes After Retinal Detachment Surgery Among Medicare Beneficiaries: What Is the Message? REPLY

Authors
Day, S; Grossman, DS; Mruthyunjaya, P; Lee, PP; Sloan, FA
MLA Citation
Day, S, Grossman, DS, Mruthyunjaya, P, Lee, PP, and Sloan, FA. "One-Year Outcomes After Retinal Detachment Surgery Among Medicare Beneficiaries: What Is the Message? REPLY." AMERICAN JOURNAL OF OPHTHALMOLOGY 151.4 (April 2011): 734-735.
Source
wos-lite
Published In
American Journal of Ophthalmology
Volume
151
Issue
4
Publish Date
2011
Start Page
734
End Page
735

Reply

Authors
Day, S; Grossman, DS; Mruthyunjaya, P; Lee, PP; Sloan, FA
MLA Citation
Day, S, Grossman, DS, Mruthyunjaya, P, Lee, PP, and Sloan, FA. "Reply." American Journal of Ophthalmology 151.4 (April 2011): 734-735.
Source
crossref
Published In
American Journal of Ophthalmology
Volume
151
Issue
4
Publish Date
2011
Start Page
734
End Page
735
DOI
10.1016/j.ajo.2010.11.033

Bacterial contamination of needles used for intravitreal injections: a prospective, multicenter study.

PURPOSE: To determine the incidence of bacterial contamination of needles used for intravitreal injections. METHODS: 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. RESULTS: 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). CONCLUSIONS: 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.

Authors
Stewart, JM; Srivastava, SK; Fung, AE; Mahmoud, TH; Telander, DG; Hariprasad, SM; Ober, MD; Mruthyunjaya, P
MLA Citation
Stewart, JM, Srivastava, SK, Fung, AE, Mahmoud, TH, Telander, DG, Hariprasad, SM, Ober, MD, and Mruthyunjaya, P. "Bacterial contamination of needles used for intravitreal injections: a prospective, multicenter study." Ocul Immunol Inflamm 19.1 (February 2011): 32-38.
PMID
21034310
Source
pubmed
Published In
Ocular Immunology and Inflammation (Informa)
Volume
19
Issue
1
Publish Date
2011
Start Page
32
End Page
38
DOI
10.3109/09273948.2010.520405

Central retinal vein occlusion.

Authors
Fekrat, S; Hahn P, ; Mruthyunjaya P,
MLA Citation
Fekrat, S, Hahn P, , and Mruthyunjaya P, . "Central retinal vein occlusion." Retina. Ed. Ryan SJ, Murphy R, and Schachat AP. Philadelphia: Elsevier Inc, 2011. (Chapter)
Source
manual
Publish Date
2011

Evaluation of contrast agents for enhanced visualization in optical coherence tomography.

PURPOSE: To identify and evaluate the use of contrast agents in optical coherence tomography (OCT) for ophthalmic applications. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.

Authors
Ehlers, JP; Gupta, PK; Farsiu, S; Maldonado, R; Kim, T; Toth, CA; Mruthyunjaya, P
MLA Citation
Ehlers, JP, Gupta, PK, Farsiu, S, Maldonado, R, Kim, T, Toth, CA, and Mruthyunjaya, P. "Evaluation of contrast agents for enhanced visualization in optical coherence tomography." Invest Ophthalmol Vis Sci 51.12 (December 2010): 6614-6619.
PMID
21051711
Source
pubmed
Published In
Investigative Ophthalmology and Visual Science
Volume
51
Issue
12
Publish Date
2010
Start Page
6614
End Page
6619
DOI
10.1167/iovs.10-6195

One-year outcomes after retinal detachment surgery among medicare beneficiaries.

PURPOSE: 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. DESIGN: Retrospective, longitudinal cohort analysis. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.

Authors
Day, S; Grossman, DS; Mruthyunjaya, P; Sloan, FA; Lee, PP
MLA Citation
Day, S, Grossman, DS, Mruthyunjaya, P, Sloan, FA, and Lee, PP. "One-year outcomes after retinal detachment surgery among medicare beneficiaries." Am J Ophthalmol 150.3 (September 2010): 338-345.
PMID
20591398
Source
pubmed
Published In
American Journal of Ophthalmology
Volume
150
Issue
3
Publish Date
2010
Start Page
338
End Page
345
DOI
10.1016/j.ajo.2010.04.009

Postoperative cilioretinal artery occlusion in Sturge Weber-associated glaucoma.

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.

Authors
Chang, L; Mruthyunjaya, P; Rodriguez-Rosa, RE; Freedman, SF
MLA Citation
Chang, L, Mruthyunjaya, P, Rodriguez-Rosa, RE, and Freedman, SF. "Postoperative cilioretinal artery occlusion in Sturge Weber-associated glaucoma." J AAPOS 14.4 (August 2010): 358-360.
PMID
20621528
Source
pubmed
Published In
Journal of American Association for Pediatric Ophthalmology and Strabismus
Volume
14
Issue
4
Publish Date
2010
Start Page
358
End Page
360
DOI
10.1016/j.jaapos.2010.04.014

Transpositional Autokeratoplasty in a Patient with Unilateral Choroidal Melanoma and Contralateral Exposure Keratopathy.

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.

Authors
Mehta, H; Hungerford, JL; Gartry, DS; Herbert, HM; Mruthyunjaya, P
MLA Citation
Mehta, H, Hungerford, JL, Gartry, DS, Herbert, HM, and Mruthyunjaya, P. "Transpositional Autokeratoplasty in a Patient with Unilateral Choroidal Melanoma and Contralateral Exposure Keratopathy. (Published online)" Ophthalmic Surg Lasers Imaging (March 9, 2010): 1-3.
PMID
20337330
Source
pubmed
Published In
Ophthalmic surgery, lasers & imaging : the official journal of the International Society for Imaging in the Eye
Publish Date
2010
Start Page
1
End Page
3
DOI
10.3928/15428877-20100215-41

Clinical and ocular pathological findings in Von Hippel-Lindau disease

Objectives: To report a patient with Von Hippel-Lindau (VHL) disease demonstrating classic ocular findings. Design'. Retrospective case report. Methods: Clinical and pathological findings. Main Outcome Measures: Clinical course and pathological findings. Results: Clinical and pathological analyses were diagnostic of VHL in a 44-year-old man. He first developed retinal hemangioblastomas and subsequently spinal hemangioblastomas as well as pancreatic, renal, and liver cysts. Unfortunately for this subject, he also developed renal cell carcinoma. Conclusion: Von Hippel-Lindau disease is an autosomal dominant genetic disorder that affects approximately 1 in 50000 individuals. Early recognition of the classic retinal findings of VHL could lead to an earlier diagnosis and be life saving.

Authors
Chong, GT; Cummings, TJ; Mruthyunjaya, P; Richard, MJ
MLA Citation
Chong, GT, Cummings, TJ, Mruthyunjaya, P, and Richard, MJ. "Clinical and ocular pathological findings in Von Hippel-Lindau disease." Clinical and Surgical Ophthalmology 27.6-7 (2009): 174-178.
Source
scival
Published In
Clinical and Surgical Ophthalmology
Volume
27
Issue
6-7
Publish Date
2009
Start Page
174
End Page
178

Identification of patients with diabetic macular edema from claims data: a validation study.

OBJECTIVE: 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. METHODS: 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. RESULTS: 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). CONCLUSIONS: 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.

Authors
Bearelly, S; Mruthyunjaya, P; Tzeng, JP; Suñer, IJ; Shea, AM; Lee, JT; Kowalski, JW; Curtis, LH; Schulman, KA; Lee, PP
MLA Citation
Bearelly, S, Mruthyunjaya, P, Tzeng, JP, Suñer, IJ, Shea, AM, Lee, JT, Kowalski, JW, Curtis, LH, Schulman, KA, and Lee, PP. "Identification of patients with diabetic macular edema from claims data: a validation study." Arch Ophthalmol 126.7 (July 2008): 986-989.
PMID
18625948
Source
pubmed
Published In
Archives of Ophthalmology
Volume
126
Issue
7
Publish Date
2008
Start Page
986
End Page
989
DOI
10.1001/archopht.126.7.986

Unusual case of diffuse choroidal melanoma masquerading as atypical central serous chorioretinopathy.

PURPOSE: 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. DESIGN: Interventional case report. METHODS: 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. RESULTS: Thirteen months after his initial presentation, circumpapillary diffuse choroidal melanoma was diagnosed. The patient underwent enucleation. No extrascleral extension was present. CONCLUSIONS: 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.

Authors
Scott, AW; Fekrat, S; Mruthyunjaya, P; Cummings, TJ; Cooney, MJ
MLA Citation
Scott, AW, Fekrat, S, Mruthyunjaya, P, Cummings, TJ, and Cooney, MJ. "Unusual case of diffuse choroidal melanoma masquerading as atypical central serous chorioretinopathy." Retinal cases & brief reports 2.4 (January 2008): 280-285.
PMID
25390591
Source
epmc
Published In
Retinal Cases and Brief Reports
Volume
2
Issue
4
Publish Date
2008
Start Page
280
End Page
285
DOI
10.1097/icb.0b013e318156d799

Choroidal metastasis of follicular thyroid adenocarcinoma diagnosed by 25-gauge transretinal biopsy.

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.

Authors
Scott, AW; Cummings, TJ; Kirkpatrick, JP; Mruthyunjaya, P
MLA Citation
Scott, AW, Cummings, TJ, Kirkpatrick, JP, and Mruthyunjaya, P. "Choroidal metastasis of follicular thyroid adenocarcinoma diagnosed by 25-gauge transretinal biopsy." Ann Ophthalmol (Skokie) 40.2 (2008): 110-112.
PMID
19013920
Source
pubmed
Published In
Annals of ophthalmology (Skokie, Ill.)
Volume
40
Issue
2
Publish Date
2008
Start Page
110
End Page
112

Malignant transformation of iris melanocytoma to iris ring melanoma.

Authors
Sagoo, MS; Mruthyunjaya, P; Cree, I; Luthert, PJ; Hungerford, JL
MLA Citation
Sagoo, MS, Mruthyunjaya, P, Cree, I, Luthert, PJ, and Hungerford, JL. "Malignant transformation of iris melanocytoma to iris ring melanoma." Br J Ophthalmol 91.11 (November 2007): 1571-1572. (Letter)
PMID
17947283
Source
pubmed
Published In
British Journal of Ophthalmology
Volume
91
Issue
11
Publish Date
2007
Start Page
1571
End Page
1572
DOI
10.1136/bjo.2006.105858

Efficacy of low-release-rate fluocinolone acetonide intravitreal implants to treat experimental uveitis.

OBJECTIVE: 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. METHODS: 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. RESULTS: 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. CONCLUSION: Sustained-release fluocinolone intravitreal implants suppress ocular inflammation in a rabbit model of severe uveitis. CLINICAL RELEVANCE: 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.

Authors
Mruthyunjaya, P; Khalatbari, D; Yang, P; Stinnett, S; Tano, R; Ashton, P; Guo, H; Nazzaro, M; Jaffe, GJ
MLA Citation
Mruthyunjaya, P, Khalatbari, D, Yang, P, Stinnett, S, Tano, R, Ashton, P, Guo, H, Nazzaro, M, and Jaffe, GJ. "Efficacy of low-release-rate fluocinolone acetonide intravitreal implants to treat experimental uveitis." Arch Ophthalmol 124.7 (July 2006): 1012-1018.
PMID
16832025
Source
pubmed
Published In
Archives of Ophthalmology
Volume
124
Issue
7
Publish Date
2006
Start Page
1012
End Page
1018
DOI
10.1001/archopht.124.7.1012

Central retinal vein occlusion in patients treated with long-term warfarin sodium (Coumadin) for anticoagulation.

PURPOSE: To describe the clinical features of persons who developed central retinal vein occlusion (CVO) while being treated with Coumadin for chronic anticoagulation. METHODS: 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. RESULTS: 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. CONCLUSION: 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.

Authors
Mruthyunjaya, P; Wirostko, WJ; Chandrashekhar, R; Stinnett, S; Lai, JC; Deramo, V; Tang, J; Dev, S; Postel, EA; Connor, TB; Fekrat, S
MLA Citation
Mruthyunjaya, P, Wirostko, WJ, Chandrashekhar, R, Stinnett, S, Lai, JC, Deramo, V, Tang, J, Dev, S, Postel, EA, Connor, TB, and Fekrat, S. "Central retinal vein occlusion in patients treated with long-term warfarin sodium (Coumadin) for anticoagulation." Retina 26.3 (March 2006): 285-291.
PMID
16508428
Source
pubmed
Published In
Retina
Volume
26
Issue
3
Publish Date
2006
Start Page
285
End Page
291

Central Retinal Vein Occlusion

Authors
Mruthyunjaya, P; Fekrat, S
MLA Citation
Mruthyunjaya, P, and Fekrat, S. "Central Retinal Vein Occlusion." Retina: Fourth Edition. September 27, 2005. 1339-1348.
Source
scopus
Volume
2-3
Publish Date
2005
Start Page
1339
End Page
1348
DOI
10.1016/B978-0-323-02598-0.50076-8

Recurrence of retinal pigment epithelial changes after macular translocation with 360 degrees peripheral retinectomy for geographic atrophy.

OBJECTIVE: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.

Authors
Cahill, MT; Mruthyunjaya, P; Bowes Rickman, C; Toth, CA
MLA Citation
Cahill, MT, Mruthyunjaya, P, Bowes Rickman, C, and Toth, CA. "Recurrence of retinal pigment epithelial changes after macular translocation with 360 degrees peripheral retinectomy for geographic atrophy." Arch Ophthalmol 123.7 (July 2005): 935-938.
PMID
16009834
Source
pubmed
Published In
Archives of Ophthalmology
Volume
123
Issue
7
Publish Date
2005
Start Page
935
End Page
938
DOI
10.1001/archopht.123.7.935

Impact of fluorescein angiographic characteristics of macular lesions on outcomes after macular translocation 360 degree surgery in eyes with age-related macular degeneration.

PURPOSE: 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). METHODS: 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. RESULTS: 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. CONCLUSION: 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.

Authors
Mruthyunjaya, P; Stinnett, SS; Toth, CA
MLA Citation
Mruthyunjaya, P, Stinnett, SS, and Toth, CA. "Impact of fluorescein angiographic characteristics of macular lesions on outcomes after macular translocation 360 degree surgery in eyes with age-related macular degeneration." Retina 25.5 (July 2005): 597-607.
PMID
16077357
Source
pubmed
Published In
Retina
Volume
25
Issue
5
Publish Date
2005
Start Page
597
End Page
607

Relaxing retinotomy in proliferative vitreoretinopathy surgery: Long term results

Authors
Mruthyunjaya, PM; Stinnett, S; McCuen, BW
MLA Citation
Mruthyunjaya, PM, Stinnett, S, and McCuen, BW. "Relaxing retinotomy in proliferative vitreoretinopathy surgery: Long term results." 2005.
Source
wos-lite
Published In
Investigative Ophthalmology and Visual Science
Volume
46
Publish Date
2005

Revision vitrectomy with panretinal laser photocoagulation in post-vitrectomy diabetic vitreous hemorrhage

Authors
Tseng, H; Mruthyunjaya, P; Stinnett, S; Postel, EA
MLA Citation
Tseng, H, Mruthyunjaya, P, Stinnett, S, and Postel, EA. "Revision vitrectomy with panretinal laser photocoagulation in post-vitrectomy diabetic vitreous hemorrhage." 2005.
Source
wos-lite
Published In
Investigative Ophthalmology and Visual Science
Volume
46
Publish Date
2005

Intravitreal sustained-release fluocinolone acetonide device to treat severe experimental uveitis

Authors
Srivastava, S; Mruthyunjaya, P; Wiser, J; Peairs, J; Stinnett, S; Jaffe, G
MLA Citation
Srivastava, S, Mruthyunjaya, P, Wiser, J, Peairs, J, Stinnett, S, and Jaffe, G. "Intravitreal sustained-release fluocinolone acetonide device to treat severe experimental uveitis." 2005.
Source
wos-lite
Published In
Investigative Ophthalmology and Visual Science
Volume
46
Publish Date
2005

Change in visual function after macular translocation with 360 degrees retinectomy for neovascular age-related macular degeneration.

OBJECTIVE: 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). DESIGN: A prospective, interventional, consecutive, noncomparative case series. PARTICIPANTS: Sixty-four patients with bilateral vision loss resulting from neovascular AMD. METHODS: 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. MAIN OUTCOME MEASURES: Change in distance acuity, near acuity, and reading speed at 12 months after MT360 compared with those values before surgery. RESULTS: 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. CONCLUSIONS: 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.

Authors
Mruthyunjaya, P; Stinnett, SS; Toth, CA
MLA Citation
Mruthyunjaya, P, Stinnett, SS, and Toth, CA. "Change in visual function after macular translocation with 360 degrees retinectomy for neovascular age-related macular degeneration." Ophthalmology 111.9 (September 2004): 1715-1724.
PMID
15350328
Source
pubmed
Published In
Ophthalmology: Journal of The American Academy of Ophthalmology
Volume
111
Issue
9
Publish Date
2004
Start Page
1715
End Page
1724
DOI
10.1016/j.ophtha.2004.03.022

Fluocinolone acetonide formulated with sodium hyaluronate as a sustained release drug delivery pellet in the treatment of experimental proliferative vitreoretinopathy

Authors
Khalatbari, D; Mruthyunjaya, P; Yang, P; Stinnett, S; Chen, J; Ashton, P; Jaffe, GJ
MLA Citation
Khalatbari, D, Mruthyunjaya, P, Yang, P, Stinnett, S, Chen, J, Ashton, P, and Jaffe, GJ. "Fluocinolone acetonide formulated with sodium hyaluronate as a sustained release drug delivery pellet in the treatment of experimental proliferative vitreoretinopathy." May 2003.
Source
wos-lite
Published In
Investigative Ophthalmology and Visual Science
Volume
44
Publish Date
2003
Start Page
U95
End Page
U95

An intravitreal sustained-release fluocinolone acetonide device to treat severe experimental uveitis

Authors
Mruthyunjaya, P; Khalatbari, D; Yang, P; Stinnett, S; Hanes, M; Jaffe, GJ
MLA Citation
Mruthyunjaya, P, Khalatbari, D, Yang, P, Stinnett, S, Hanes, M, and Jaffe, GJ. "An intravitreal sustained-release fluocinolone acetonide device to treat severe experimental uveitis." May 2003.
Source
wos-lite
Published In
Investigative Ophthalmology and Visual Science
Volume
44
Publish Date
2003
Start Page
U469
End Page
U469

Diagnostics and therapeutic challenges

Authors
McDonald, HR; Berrocal, AM; Lieb, DF; Jr, HWF; Davis, JL; Mruthyunjaya, P; Fekrat, S; Reed, JB; Mittra, R; Gallemore, RP
MLA Citation
McDonald, HR, Berrocal, AM, Lieb, DF, Jr, HWF, Davis, JL, Mruthyunjaya, P, Fekrat, S, Reed, JB, Mittra, R, and Gallemore, RP. "Diagnostics and therapeutic challenges." Retina 23.3 (2003): 392-399.
PMID
25105315
Source
scival
Published In
Retina
Volume
23
Issue
3
Publish Date
2003
Start Page
392
End Page
399

Diagnostic yield of vitrectomy in eyes with suspected posterior segment infection or malignancy.

PURPOSE: 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. DESIGN: Non-comparative interventional case series PARTICIPANTS: Eighty-seven consecutive patients (90 eyes) who underwent diagnostic pars plana vitrectomy from 1989 through 1999. INTERVENTIONS: Vitreous samples were analyzed in a directed manner based on the preoperative clinical examination and systemic laboratory testing. MAIN OUTCOME MEASURES: Diagnosis from each test performed on the vitreous samples. RESULTS: 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). CONCLUSIONS: 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.

Authors
Mruthyunjaya, P; Jumper, JM; McCallum, R; Patel, DJ; Cox, TA; Jaffe, GJ
MLA Citation
Mruthyunjaya, P, Jumper, JM, McCallum, R, Patel, DJ, Cox, TA, and Jaffe, GJ. "Diagnostic yield of vitrectomy in eyes with suspected posterior segment infection or malignancy." Ophthalmology 109.6 (June 2002): 1123-1129.
PMID
12045054
Source
pubmed
Published In
Ophthalmology: Journal of The American Academy of Ophthalmology
Volume
109
Issue
6
Publish Date
2002
Start Page
1123
End Page
1129

Fluocinolone acetonide sustained drug delivery system in the treatment of experimental proliferative vitreoretinopathy

Authors
Mruthyunjaya, P; Tseng, W; Stinnett, S; Ashton, P; Jaffe, GJ
MLA Citation
Mruthyunjaya, P, Tseng, W, Stinnett, S, Ashton, P, and Jaffe, GJ. "Fluocinolone acetonide sustained drug delivery system in the treatment of experimental proliferative vitreoretinopathy." May 2002.
Source
wos-lite
Published In
Investigative Ophthalmology and Visual Science
Volume
43
Publish Date
2002
Start Page
U845
End Page
U845

Central retinal vein occlusion in patients on chronic Coumadin (R) anticoagulation

Authors
Lai, JC; Mruthyunjaya, P; Fekrai, S
MLA Citation
Lai, JC, Mruthyunjaya, P, and Fekrai, S. "Central retinal vein occlusion in patients on chronic Coumadin (R) anticoagulation." May 2002.
Source
wos-lite
Published In
Investigative Ophthalmology and Visual Science
Volume
43
Publish Date
2002
Start Page
U103
End Page
U103

Diagnostic yield of vitrectomy in eyes with suspected posterior segment infection or malignancy.

Authors
Mruthyunjaya, P; Jumper, JM; Patel, D; Jaffe, GJ
MLA Citation
Mruthyunjaya, P, Jumper, JM, Patel, D, and Jaffe, GJ. "Diagnostic yield of vitrectomy in eyes with suspected posterior segment infection or malignancy." March 15, 2000.
Source
wos-lite
Published In
Investigative Ophthalmology and Visual Science
Volume
41
Issue
4
Publish Date
2000
Start Page
S96
End Page
S96

Frequency of vitreoretinal surgery in uveitis patients

Authors
Mruthyunjaya, P; Jumper, JM; Merrill, P; Kim, JH; Jaffe, GJ
MLA Citation
Mruthyunjaya, P, Jumper, JM, Merrill, P, Kim, JH, and Jaffe, GJ. "Frequency of vitreoretinal surgery in uveitis patients." March 15, 1999.
Source
wos-lite
Published In
Investigative Ophthalmology and Visual Science
Volume
40
Issue
4
Publish Date
1999
Start Page
S146
End Page
S146

Clinicomicrobiological review of Nocardia keratitis.

PURPOSE: To present the clinical profile, laboratory results, and outcome of treatment in 16 patients with Nocardia keratitis. METHODS: A retrospective review of 16 culture-proven cases of Nocardia keratitis was done. Clinical and microbiologic data were analyzed. RESULTS: 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. CONCLUSION: 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.

Authors
Sridhar, MS; Sharma, S; Reddy, MK; Mruthyunjay, P; Rao, GN
MLA Citation
Sridhar, MS, Sharma, S, Reddy, MK, Mruthyunjay, P, and Rao, GN. "Clinicomicrobiological review of Nocardia keratitis." Cornea 17.1 (January 1998): 17-22.
PMID
9436875
Source
pubmed
Published In
Cornea
Volume
17
Issue
1
Publish Date
1998
Start Page
17
End Page
22

Juvenile xanthogranuloma of the lacrimal sac fossa.

PURPOSE: 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. METHODS: 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. RESULTS: Histopathologic evaluation disclosed a juvenile xanthogranuloma characterized by an inflammatory cell infiltrate with foamy histiocytes and scattered Touton-type multinucleated giant cells. CONCLUSION: Juvenile xanthogranuloma should be included in the differential diagnosis of a medial canthal and lacrimal sac fossa mass.

Authors
Mruthyunjaya, P; Meyer, DR
MLA Citation
Mruthyunjaya, P, and Meyer, DR. "Juvenile xanthogranuloma of the lacrimal sac fossa." Am J Ophthalmol 123.3 (March 1997): 400-402.
PMID
9063253
Source
pubmed
Published In
American Journal of Ophthalmology
Volume
123
Issue
3
Publish Date
1997
Start Page
400
End Page
402

Subjective and objective outcomes of strabismus surgery in children.

BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSION: Surgical correction of strabismus in childhood is clearly perceived by parents to be both successful and important to them and their children.

Authors
Mruthyunjaya, P; Simon, JW; Pickering, JD; Lininger, LL
MLA Citation
Mruthyunjaya, P, Simon, JW, Pickering, JD, and Lininger, LL. "Subjective and objective outcomes of strabismus surgery in children." J Pediatr Ophthalmol Strabismus 33.3 (May 1996): 167-170.
PMID
8771519
Source
pubmed
Published In
Journal of pediatric ophthalmology and strabismus
Volume
33
Issue
3
Publish Date
1996
Start Page
167
End Page
170

THE MINIMUM INHIBITORY AND BACTERICIDAL CONCENTRATIONS OF ANTIBIOTICS FOR VITREOUS ISOLATES

Authors
GOPINATHAN, U; ADIRAJU, MV; DAS, T; MRUTHYUNJAYA, P; SHARMA, S
MLA Citation
GOPINATHAN, U, ADIRAJU, MV, DAS, T, MRUTHYUNJAYA, P, and SHARMA, S. "THE MINIMUM INHIBITORY AND BACTERICIDAL CONCENTRATIONS OF ANTIBIOTICS FOR VITREOUS ISOLATES." March 15, 1995.
Source
wos-lite
Published In
Investigative Ophthalmology and Visual Science
Volume
36
Issue
4
Publish Date
1995
Start Page
S155
End Page
S155
Show More

Research Areas:

  • Adolescent
  • Adrenal Cortex Hormones
  • Adult
  • Aged
  • Aged, 80 and over
  • Algorithms
  • Angiogenesis Inhibitors
  • Animals
  • Antibodies, Monoclonal
  • Antibodies, Monoclonal, Humanized
  • Anticoagulants
  • Aptamers, Nucleotide
  • Atrophy
  • Attitude of Health Personnel
  • Autoantigens
  • Autoimmune Diseases
  • Biopsy
  • Blood Coagulation
  • Brachytherapy
  • Case-Control Studies
  • Child
  • Choroidal Neovascularization
  • Chromosomes, Human, Pair 3
  • Cohort Studies
  • Coloring Agents
  • Combined Modality Therapy
  • Conjunctival Neoplasms
  • Contrast Media
  • Corneal Ulcer
  • Cryotherapy
  • Current Procedural Terminology
  • Cysts
  • Dacarbazine
  • Dacryocystitis
  • Databases, Factual
  • Diabetic Retinopathy
  • Diagnosis, Differential
  • Diagnostic Techniques, Ophthalmological
  • Disease Models, Animal
  • Disease Progression
  • Disease-Free Survival
  • Drug Therapy, Combination
  • Endophthalmitis
  • Equipment Contamination
  • Eye
  • Eye Diseases
  • Eye Enucleation
  • Eye Infections
  • Eye Infections, Bacterial
  • Eye Neoplasms
  • Eye Proteins
  • Female
  • Fluorescein Angiography
  • Follow-Up Studies
  • Forecasting
  • Fundus Oculi
  • Gene Expression Profiling
  • Gene Expression Regulation, Neoplastic
  • Glaucoma
  • Granuloma
  • Health Care Costs
  • Health Services
  • Health Services Research
  • Hematologic Diseases
  • Hemoglobins
  • Humans
  • Hypertension
  • Imaging, Three-Dimensional
  • Immunohistochemistry
  • Incidence
  • Insurance Claim Review
  • International Classification of Diseases
  • International Normalized Ratio
  • Intraocular Pressure
  • Intravitreal Injections
  • Keratitis
  • Lacrimal Apparatus Diseases
  • Lacrimal Duct Obstruction
  • Laser Coagulation
  • Laser Therapy
  • Lasers
  • Light
  • Longitudinal Studies
  • Lymphoma, Large B-Cell, Diffuse
  • Macular Degeneration
  • Macular Edema
  • Male
  • Medicare Part B
  • Melanins
  • Melanoma
  • Microscopy
  • Microscopy, Acoustic
  • Microscopy, Confocal
  • Microscopy, Fluorescence, Multiphoton
  • Middle Aged
  • Monitoring, Intraoperative
  • Needles
  • Neoplasm Recurrence, Local
  • Neoplasm Staging
  • Neoplasms
  • Nursing Care
  • Observer Variation
  • Office Visits
  • Oligonucleotide Array Sequence Analysis
  • Ophthalmologic Surgical Procedures
  • Ophthalmology
  • Optic Nerve Diseases
  • Optical coherence tomography
  • Paraneoplastic Syndromes, Ocular
  • Pigment Epithelium of Eye
  • Pilot Projects
  • Polymorphism, Single Nucleotide
  • Postoperative Complications
  • Prognosis
  • Proportional Hazards Models
  • Prospective Studies
  • Pseudophakia
  • Quality of Life
  • Questionnaires
  • Radiation Injuries
  • Radiotherapy Dosage
  • Reading
  • Real-Time Polymerase Chain Reaction
  • Recurrence
  • Reference Values
  • Reoperation
  • Reproducibility of Results
  • Retina
  • Retinal Artery Occlusion
  • Retinal Detachment
  • Retinal Diseases
  • Retinal Neoplasms
  • Retinal Neovascularization
  • Retinal Perforations
  • Retinal Vein Occlusion
  • Retinal Vessels
  • Retinoblastoma
  • Retrospective Studies
  • Sclera
  • Scleral Buckling
  • Scleritis
  • Sensitivity and Specificity
  • Silicone Oils
  • Skin Neoplasms
  • Strabismus
  • Sturge-Weber Syndrome
  • Surgery, Computer-Assisted
  • Telemedicine
  • Thrombosis
  • Thyroid Neoplasms
  • Time Factors
  • Tomography, Optical Coherence
  • Treatment Outcome
  • Tumor Markers, Biological
  • United States
  • Utilization
  • Uveal Neoplasms
  • Uveitis
  • Vascular Endothelial Growth Factor A
  • Vision Disorders
  • Visual Acuity
  • Visual Fields
  • Vitrectomy
  • Vitreoretinal Surgery
  • Vitreous Hemorrhage
  • Warfarin
  • Wet Macular Degeneration
  • Xanthogranuloma, Juvenile
  • Young Adult