Search

Brandon D Ayres,1 Marc R Bloomenstein,2 Jennifer Loh,3 Thomas Chester,4 Bobby Saenz,5,6 Julio Echegoyen,7 Shane R Kannarr,8 Victor L Perez,9 Tomasita C Rodriguez,10 Jaime E Dickerson Jr10,11 1Private Practice, Philadelphia, PA, USA; 2Schwartz Laser Eye Center, Scottsdale, AZ, USA; 3Loh Ophthalmology Associates, Miami, FL, USA; 4Cleveland Eye Clinic, Brecksville, OH, USA; 5Rosenberg School of Optometry, University of the Incarnate Word, San Antonio, TX, USA; 6LASIK San Antonio, Kerrville, TX, USA; 7Gordon Schanzlin New Vision Institute, La Jolla, CA, USA; 8Kannarr Eye Care, Pittsburg, KS, USA; 9Department of Ophthalmology, Duke University Medical Center, Durham, NC, USA; 10Sight Sciences, Menlo Park, CA, USA; 11North Texas Eye Research Institute, University of North Texas Health Science Center, Fort Worth, TX, USACorrespondence: Jaime E Dickerson Jr, Email jdickerson@sightsciences.comPurpose: We compare outcomes in eyes with dry eye disease (DED) treated with TearCare (TC) or topical cyclosporine 0.05% (RESTASIS; CsA).Setting: Nineteen ophthalmic and optometric practices in 11 US states.Design: Multicenter, randomized, assessor-masked, controlled IRB-approved trial. Eligible subjects: ≥ 22 years of age, dry eye symptoms within 3– 6 months, Tear Break-up Time (TBUT) ≥ 1 to ≤ 7 s, Meibomian Gland Secretion Score (MGSS) ≤ 12, Ocular Surface Disease Index (OSDI) of 23– 79. Randomized (1:1) to TC or CsA. TC subjects treated at baseline and month 5; CsA was twice daily for 6 months.Methods: Follow-up visits were scheduled for Day 1, Week 1, Months 1, 3, and 6 with primary inference at Month 6. Primary outcomes: TBUT and OSDI; secondary outcomes: MGSS, conjunctival and corneal staining, eye dryness score (EDS), symptoms assessment in dry eye (SANDE) score, and Schirmer tear score (STS). Safety assessments included adverse events, best corrected visual acuity, intraocular pressure, and slit-lamp findings.Results: Overall, 345 subjects, 172 TC and 173 CsA. TBUT improved at all time points in both groups (p< 0.0001), with statistically greater improvement for TC versus CsA (p=0.0006). OSDI improved significantly at all time points in both groups (p< 0.0001) with no significant differences between treatments. MGSS and other measures of meibomian gland function improved significantly more with TC eyes versus CsA; other secondary outcomes showed significant improvements in both groups with no difference between groups. Treatment-related adverse events were uncommon (10 total, 8 in the CsA group consistent with prior CsA studies); most (9/10) mild.Conclusion: TC provides statistically superior and sustained improvement in TBUT and multiple measures of meibomian gland secretion, and non-inferior improvement in OSDI, corneal and conjunctival staining, SANDE, EDS, and STS versus CsA. TC should be a preferred treatment for DED associated with MGD.Keywords: dry eye disease, meibomian gland dysfunction, restasis, TearCare, cyclosporine

Brandon D Ayres,1 Marc R Bloomenstein,2 Jennifer Loh,3 Thomas Chester,4 Bobby Saenz,5,6 Julio Ehegoyen,7 Shane R Kannarr,8 Victor L Perez,9 Tomasita C Rodriguez,10 Jaime E Dickerson Jr10,11 1Private Practice, Philadelphia, PA, USA; 2Schwartz Laser Eye Center, Scottsdale, AZ, USA; 3Loh Ophthalmology Associates, Miami, FL, USA; 4Cleveland Eye Clinic, Brecksville, OH, USA; 5Rosenberg School of Optometry, San Antonio, TX, USA; 6LASIK San Antonio, Kerrville, TX, USA; 7Gordon Schanzlin New Vision Institute, La Jolla, CA, USA; 8Kannarr Eye Care, Pittsburg, KS, USA; 9Bascom Palmer Eye Institute, University of Miami, Miami, FL, USA; 10Sight Sciences, Menlo Park, CA, USA; 11North Texas Eye Research Institute, University of North Texas Health Science Center, Fort Worth, TX, USACorrespondence: Jaime E Dickerson Jr, Email jdickerson@sightsciences.com

Allister Gibbons,1 Ella H Leung,1 Luis J Haddock,1 Carlos A Medina,1 Viviana Fernandez,2 Jean-Marie A Parel,1,2 Heather A Durkee,2 Guillermo Amescua,1 Eduardo C Alfonso,1 Victor L Perez1,3 1Bascom Palmer Eye Institute/University of Miami Miller School of Medicine, Miami, FL, 2Ophthalmic Biophysics Center, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, 3Ocular Surface Center, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA Purpose: To determine the indications, long-term clinical and visual outcomes, and complications of the aphakic snap-on type I Boston keratoprosthesis (KPro). Design: Retrospective, non-comparative case series. Methods: Forty-five eyes of 43 patients with type I aphakic snap-on KPros with at least 1 year of follow-up were included. The past medical histories, preoperative indications, best-corrected visual acuities (BCVAs), postoperative complications, and retention rates were analyzed. Results: The most common indication for KPro implantation was a failed corneal graft (89%). The mean preoperative BCVA was count fingers–hand motion (2.14±0.45 logarithm of minimum angle of resolution [logMAR]), which initially improved to 20/200 (1.04±0.85 logMAR; P

Marwan Raymond Atallah, Sotiria Palioura, Victor L Perez, Guillermo Amescua Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA Abstract: Regeneration of the corneal surface after an epithelial insult involves division, migration, and maturation of a specialized group of stem cells located in the limbus. Several insults, both intrinsic and extrinsic, can precipitate destruction of the delicate microenvironment of these cells, resulting in limbal stem cell deficiency (LSCD). In such cases, reepithelialization fails and conjunctival epithelium extends across the limbus, leading to vascularization, persistent epithelial defects, and chronic inflammation. In partial LSCD, conjunctival epitheliectomy, coupled with amniotic membrane transplantation, could be sufficient to restore a healthy surface. In more severe cases and in total LSCD, stem cell transplantation is currently the best curative option. Before any attempts are considered to perform a limbal stem cell transplantation procedure, the ocular surface must be optimized by controlling causative factors and comorbid conditions. These factors include adequate eyelid function or exposure, control of the ocular surface inflammatory status, and a well-lubricated ocular surface. In cases of unilateral LSCD, stem cells can be obtained from the contralateral eye. Newer techniques aim at expanding cells in vitro or in vivo in order to decrease the need for large limbal resection that may jeopardize the “healthy” eye. Patients with bilateral disease can be treated using allogeneic tissue in combination with systemic immunosuppressive therapy. Another emerging option for this subset of patients is the use of noncorneal cells such as mucosal grafts. Finally, the use of keratoprosthesis is reserved for patients who are not candidates for any of the aforementioned options, wherein the choice of the type of keratoprosthesis depends on the severity of the disease. In summary, limbal stem cell transplantation improves both vision and quality-of-life in patients with ocular surface disorders associated with LSCD, and overall, the use of autologous tissue offers the best results. Future studies aim at improving cellular expansion and finding different sources of stem cells. Keywords: limbal stem cell deficiency (LSCD), simple limbal epithelial transplantation (SLET), cultivated limbal epithelial transplantation (CLET), keratolimbal allograft (KLAL)

Volkan Hurmeric,1 Pravin Vaddavalli,1 Anat Galor,1,2 Victor L Perez,1 Janika San Roman,1 Sonia H Yoo11Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine, Miami, FL, USA; 2Miami Veterans Affairs Medical Center, Miami, FL, USAPurpose: To assess the effect of single versus multiple subconjunctival ranibizumab injections in patients with an early pterygium recurrence.Setting: Single-center, academic practice.Study population: Nine patients with early pterygium recurrence.Observational procedure: Subconjunctival ranibizumab (0.5 mg/0.05 mL) was administered adjacent to pterygium recurrence. Group 1 (n = 5) received one injection; group 2 (n = 4) received three injections (time points 0, 2, and 4 weeks) with the ability to retreat as needed.Main outcome measures: Effect of ranibizumab on conjunctival hyperemia and corneal neovascular area over a 6-month follow-up period.Results: In the single injection group, a decrease in conjunctival hyperemia was noted in all patients on postinjection day 1. At follow up, hyperemia grade fluctuated, although all patients had less hyperemia than at baseline. In the recurrent injection group, the median number of injections was 8.5 (range 7 to 9) over the 6 months. In spite of the repeated injections, the pattern of conjunctival hyperemia was similar to that of the single injection group. In group 1, corneal neovascularization remained relatively unchanged over the 6-month period in four patients and decreased in one patient by 24%. In group 2, corneal neovascularization increased in one patient by 39%, remained stable in one patient, and decreased in two patients by 34% and 44%.Conclusion: This is the first study to evaluate the role of ranibizumab in the treatment of an early pterygium recurrence and the first to compare multiple versus single injections. Recurrent injections did not appear to be superior to a single injection with regards to conjunctival hyperemia.Keywords: pterygium, recurrence, ranibizumab, conjunctival hyperemia, corneal neovascularization

Jianhua Wang,1 Lele Cui,1 Meixiao Shen,1 Victor L Perez,1 Michael R Wang21Bascom Palmer Eye Institute, University of Miami Leonard M Miller School of Medicine, 2Electrical and Computer Engineering, University of Miami, Miami, FL, USAPurpose: This study was designed to determine the ability of ultra-high-resolution optical coherence tomography (UHR-OCT) to monitor tear meniscus volume after dry eye treatment with Restasis® (0.05% cyclosporine).Methods: UHR-OCT was used to image the upper and lower tear menisci (height and volume) in 14 consecutive dry eye patients at baseline. The treatment group was initiated on daily Restasis and measurements were repeated at 1 and 2 months while on treatment. All measurements were performed immediately after a blink.Results: The baseline tear meniscus volumes were 0.40 ± 0.19 µL (upper) and 0.43 ± 0.18 µL (lower). In the treatment group, tear meniscus heights showed significant increases of both upper (post-hoc test with Bonferroni correction: P = 0.003) and lower (P = 0.0003) tear menisci, after 1 month on Restasis. The tear meniscus volumes in the treatment group after 1 month of Restasis showed significant increases of both upper (P = 0.007) and lower (P = 0.007) tear menisci. At 2 months, the increase of the tear meniscus was still evident in all measured variables compared with baseline (P < 0.05).Conclusion: UHR-OCT offers a promising tool for monitoring dry eye treatment. With this method, a measurable increase in tear meniscus volume was evident after 1 month of treatment with Restasis in dry eye patients.Keywords: tear menisci, UHR-OCT, tear dynamics, dry eye, Restasis®