Kevin Gertsch - Academia.edu (original) (raw)

Papers by Kevin Gertsch

Journal of Aapos, Aug 1, 2014

in children with higher spherical hyperopia (. +3.5 D) were disappointing. 31% had postoperative ... more in children with higher spherical hyperopia (. +3.5 D) were disappointing. 31% had postoperative cylindric errors exceeding their preoperative errors (cylindric error increased an average 0.35 D). None of the children lost UCVA, comparing pre-to postoperative measures. 4 eyes (1.4%) lost BCVA. Discussion: Refractive surgery reduces substantially astigmatic refractive errors in children with compound myopic astigmatism. Correction of astigmatism is less efficacious in children with hyperopic astigmatism. Conclusion: Excimer laser keratectomy is a useful treatment alternative for children with compound myopic astigmatism. 091 The role of saccadic vector optokinetic perimetry (SVOP) in the diagnosis of ocular and neurological visual loss in infants and young children-a case series.

Investigative Ophthalmology & Visual Science, Apr 30, 2014

Investigative Ophthalmology & Visual Science, 2014

Journal of American Association for Pediatric Ophthalmology and Strabismus, 2013

Surface Science Spectra

Highly toxic metals abound in the environment as a result of pollution. Macrocyclic ligands have ... more Highly toxic metals abound in the environment as a result of pollution. Macrocyclic ligands have been designed that are selective in binding certain toxic metals. This allows for a sensitive means of detecting these poisonous metals. Here we report the XPS analysis of 7,13-bis͑͑8-hydroxy-2-quinolinyl͒methyl͒-1,4-dimethyl-1,4,7,13-tetraaza-10-thiacyclopentadecane.

Retinal Cases & Brief Reports

To compare objectively measured changes in plus disease after bevacizumab and laser for Type 1 re... more To compare objectively measured changes in plus disease after bevacizumab and laser for Type 1 retinopathy of prematurity. ROPtool (a computer program) analyzed fundus images at baseline, 1 week, and subsequent examinations. Six infants (9 eyes) were treated with bevacizumab and 7 (12 eyes) with laser. One week after treatment, bevacizumab compared with laser resulted in a greater median percent change from pretreatment in tortuosity (-53.8 vs. -0.2%, P < 0.001) and overall plus disease (-20.1 vs. -3.1%, P < 0.001). Change in dilation did not differ (-3.5 vs. -5.5%, P = 0.48). After week 1, all median ROPtool parameters continued to decrease for both groups. At last follow-up (median 3, range: 2-10 weeks), both bevacizumab and laser significantly decreased tortuosity (-54.3 and -23.8%), dilation (-8.7 and -7.5%), and overall plus disease (-27.3 and -10.3%). Improvement in plus disease, in particular tortuosity, likely occurs more quickly after bevacizumab compared with laser, particularly at 1 week after treatment. These results guide clinical expectations for plus disease resolution after both treatment modalities.

Ophthalmic Plastic and Reconstructive Surgery

Investigative Opthalmology & Visual Science, 2017

PURPOSE. To compare progression of retinopathy of prematurity (ROP) before and after institution ... more PURPOSE. To compare progression of retinopathy of prematurity (ROP) before and after institution of an oxygen therapy protocol to inhibit active proliferation and progression of ROP in premature infants. METHODS. A retrospective cohort study was performed of premature infants undergoing ROP screening before (cohort A) and after (cohort B) implementation of an oxygen therapy protocol to inhibit further progression for those with stage 2 ROP or worse. Statistical analysis with v 2 , Fisher's exact test, or Wilcoxon rank sum test was performed; and logistic regression models were created to determine the odds ratio of cohort B developing ROP progression beyond stage 2, compared to cohort A, adjusting for other risk factors for ROP. RESULTS. In cohort A, without oxygen therapy protocol (2002-2007), 44% (54/122) of infants progressed beyond stage 2, compared to 23% (24/103) of infants after protocol implementation (cohort B, 2008-2012) (P ¼ 0.001). No significant differences between cohort A and B were found for gestational age, birth weight, survival, sepsis, bronchopulmonary dysplasia, oxygen at discharge, or need for diuretics. Infants with stage 2 ROP in cohort B, with oxygen therapy protocol, had significantly decreased risk of ROP beyond stage 2 (odds ratio 0.37, 95% confidence interval 0.20-0.67; P ¼ 0.0013), compared to cohort A, correcting for differences in birth weight and necrotizing enterocolitis. CONCLUSIONS. Progression from stage 2 to stage 3 ROP in premature infants was significantly decreased after implementation of an oxygen therapy protocol, without a corresponding increase in pulmonary morbidity. This study suggests that appropriate oxygen therapy may play a role in inhibiting progression of stage 2 ROP, potentially decreasing the risk of lifelong visual loss in this vulnerable population.

Neurology, Jan 21, 2015

Unilateral abducens nerve palsy in a child with rapidly increasing head circumference A 12-month-... more Unilateral abducens nerve palsy in a child with rapidly increasing head circumference A 12-month-old healthy, normally developing boy presented with rapidly increasing head circumference over 2 months and 1 week of strabismus. Head circumference was 50 cm (.99th percentile; mother 5 59.5 cm; father 5 56.5 cm). Examination showed limited abduction OD, overshoot of adduction OD, and no papilledema. MRI (figure) showed the right anterior inferior cerebellar artery traversing the root entry zone of the right abducens nerve, a cause of unilateral cranial nerve VI palsy recognized in adults 1 but not in children. 2 Neuroimaging was otherwise normal. The patient was diagnosed with benign familial macrocephaly and discharged with ophthalmology follow-up for conservative management.

Journal of American Association for Pediatric Ophthalmology and Strabismus, 2014

Journal of American Association for Pediatric Ophthalmology and Strabismus, 2015

To describe and validate a Web-based structured simulation curriculum of strabismus surgery for r... more To describe and validate a Web-based structured simulation curriculum of strabismus surgery for residents in training using noncadaveric eye models. A pre- and posttest of cognitive skills, objective wet laboratory structured assessment of technique, and summative global evaluation form were implemented as part of a systematic ophthalmology wet lab (OWL) curriculum. Strabismus techniques were taught using a structured simulation method on noncadaveric models of eyes. Likert scale questionnaires were administered to assess the comfort level with strabismus surgery of residents before and after participation in the wet laboratory. Statistical analysis was performed using the paired t test. Seven residents participated in the curriculum. Average test scores improved from 65% to 91% (P = 0.0002). Resident comfort level improved from an average score (assessed by Likert scale of 1-5) with standard deviation of 2.6 ± 1.0 to 4.3 ± 0.5 for passing scleral sutures (P = 0.0008), of 2.6 ± 0.5 to 4.3 ± 0.5 for isolating and suturing muscles (P = 0.00004), and of 2.7 ± 1.0 to 4.6 ± 0.5 for comfort with naming instruments (P = 0.0007). In this study of 7 residents, knowledge and comfort level with strabismus surgery statistically improved with a structured simulation curriculum.

Oncology Letters, 2012

Intraocular lymphoma is a rare ocular malignancy that may occur in the retina or the uvea. Retina... more Intraocular lymphoma is a rare ocular malignancy that may occur in the retina or the uvea. Retina or vitreoretinal lymphoma accounts for the majority of cases and is often secondary to diffuse large B-cell lymphoma. In the present study, a 66-year-old Caucasian male with a history of Waldenstrom's macroglobulinemia with diffuse large B-cell lymphoma, presented with blurred vision in the left eye one month following cycle 4 of an R-CHOP regimen. At the time of onset, the patient was being treated for bacterial pneumonia. Visual acuity was 20/25 in his right eye (OD) and 20/30 in the left (OS). Ophthalmologic examination showed intraretinal white infiltrates associated with hemorrhage in the superotemporal midperiphery of the retina and vitritis OS. Initial diagnostic considerations included infectious (cytomegalovirus retinitis, syphilis, toxoplasmosis, tuberculosis), inflammatory (retinal vasculitis associated with autoimmune disease or hypercoagulable states) or malignant (intraocular lymphoma) diseases. The patient did not respond to intravitreal injection of foscarnet and oral valgancyclovir. Systemic work-up and aqueous fluid biopsy were inconclusive. Diagnostic vitrectomy yielded inconclusive results and the patient continued to have progressive loss of vision. A repeat diagnostic vitrectomy with retinal and subretinal biopsy confirmed large B cells consistent with metastatic B-cell lymphoma. A concomitant PET/CT scan was performed that revealed bilateral new pulmonary nodules resulting in additional chemotherapy. Our case shows the diagnostic dilemmas in patients with systemic lymphoma and the possible role of concurrent systemic restaging in patients with ocular complaints, even when in systemic remission.

Journal of Pediatric Ophthalmology & Strabismus, 2015

To present experience with cataract extraction in 9 eyes of 7 pediatric patients with chronic uve... more To present experience with cataract extraction in 9 eyes of 7 pediatric patients with chronic uveitis and compare the technique of anterior optic capture in 5 eyes that underwent cataract extraction without optic capture of the intraocular lens (IOL) or were left aphakic. A retrospective review of pediatric patients with chronic uveitis undergoing cataract surgery was performed, examining the preoperative and postoperative visual acuity, immunosuppressive therapy, surgical technique, complications, subsequent procedures, and need for escalation of systemic immunosuppressive therapy. The technique of anterior optic capture is described in detail. Of the 9 eyes, 5 underwent cataract extraction with IOL placement with the haptics in the capsular bag and optic prolapsed through the anterior capsulorhexis. One eye underwent cataract extraction with IOL implantation in the bag. Three eyes had lensectomy without IOL placement. The eyes with anterior optic capture had no adverse outcomes and uveitis flares were controlled with topical medications and systemic immunosuppressants; the eye with IOL placement without optic capture had recurrent membranes and uveitis flares, necessitating increased systemic immunosuppression. All eyes achieved best-corrected visual acuity of 20/60 or better by 6 months following surgery and 20/30 or better at the most recent follow-up. The technique of cataract extraction with IOL placement and anterior prolapse of the optic through the anterior capsulorhexis shows promise to be a safe and viable option for pediatric patients with chronic uveitis treated with systemic immunotherapy. [J Pediatr Ophthalmol Strabismus. 2015;52(2):XX-XX.].

Review of Scientific Instruments, 2004

Mechanical scribing can be employed to create surfaces with recessed features. Through replica mo... more Mechanical scribing can be employed to create surfaces with recessed features. Through replica molding elastomeric copies of these scribed surfaces are created that function as stamps for microcontact printing. It is shown that this new method for creating masters for microcontact printing can be performed with a computer-controlled milling machine (CNC), making this method particularly straightforward and accessible to a large technical community that does not need to work in a particle free environment. Thus, no clean room, or other specialized equipment is required, as is commonly needed to prepare masters. Time-of-flight secondary ion mass spectrometry confirms surface pattering by this method. Finally, it is shown that feature size in the scribed master can be controlled by varying the force on the tip during scribing.

Journal of American Association for Pediatric Ophthalmology and Strabismus, 2015

To describe and validate a Web-based structured simulation curriculum of strabismus surgery for r... more To describe and validate a Web-based structured simulation curriculum of strabismus surgery for residents in training using noncadaveric eye models. A pre- and posttest of cognitive skills, objective wet laboratory structured assessment of technique, and summative global evaluation form were implemented as part of a systematic ophthalmology wet lab (OWL) curriculum. Strabismus techniques were taught using a structured simulation method on noncadaveric models of eyes. Likert scale questionnaires were administered to assess the comfort level with strabismus surgery of residents before and after participation in the wet laboratory. Statistical analysis was performed using the paired t test. Seven residents participated in the curriculum. Average test scores improved from 65% to 91% (P = 0.0002). Resident comfort level improved from an average score (assessed by Likert scale of 1-5) with standard deviation of 2.6 ± 1.0 to 4.3 ± 0.5 for passing scleral sutures (P = 0.0008), of 2.6 ± 0.5 to 4.3 ± 0.5 for isolating and suturing muscles (P = 0.00004), and of 2.7 ± 1.0 to 4.6 ± 0.5 for comfort with naming instruments (P = 0.0007). In this study of 7 residents, knowledge and comfort level with strabismus surgery statistically improved with a structured simulation curriculum.

Journal of American Association for Pediatric Ophthalmology and Strabismus, 2013

Journal of Aapos, Aug 1, 2014

in children with higher spherical hyperopia (. +3.5 D) were disappointing. 31% had postoperative ... more in children with higher spherical hyperopia (. +3.5 D) were disappointing. 31% had postoperative cylindric errors exceeding their preoperative errors (cylindric error increased an average 0.35 D). None of the children lost UCVA, comparing pre-to postoperative measures. 4 eyes (1.4%) lost BCVA. Discussion: Refractive surgery reduces substantially astigmatic refractive errors in children with compound myopic astigmatism. Correction of astigmatism is less efficacious in children with hyperopic astigmatism. Conclusion: Excimer laser keratectomy is a useful treatment alternative for children with compound myopic astigmatism. 091 The role of saccadic vector optokinetic perimetry (SVOP) in the diagnosis of ocular and neurological visual loss in infants and young children-a case series.

Investigative Ophthalmology & Visual Science, Apr 30, 2014

Investigative Ophthalmology & Visual Science, 2014

Journal of American Association for Pediatric Ophthalmology and Strabismus, 2013

Surface Science Spectra

Highly toxic metals abound in the environment as a result of pollution. Macrocyclic ligands have ... more Highly toxic metals abound in the environment as a result of pollution. Macrocyclic ligands have been designed that are selective in binding certain toxic metals. This allows for a sensitive means of detecting these poisonous metals. Here we report the XPS analysis of 7,13-bis͑͑8-hydroxy-2-quinolinyl͒methyl͒-1,4-dimethyl-1,4,7,13-tetraaza-10-thiacyclopentadecane.

Retinal Cases & Brief Reports

To compare objectively measured changes in plus disease after bevacizumab and laser for Type 1 re... more To compare objectively measured changes in plus disease after bevacizumab and laser for Type 1 retinopathy of prematurity. ROPtool (a computer program) analyzed fundus images at baseline, 1 week, and subsequent examinations. Six infants (9 eyes) were treated with bevacizumab and 7 (12 eyes) with laser. One week after treatment, bevacizumab compared with laser resulted in a greater median percent change from pretreatment in tortuosity (-53.8 vs. -0.2%, P < 0.001) and overall plus disease (-20.1 vs. -3.1%, P < 0.001). Change in dilation did not differ (-3.5 vs. -5.5%, P = 0.48). After week 1, all median ROPtool parameters continued to decrease for both groups. At last follow-up (median 3, range: 2-10 weeks), both bevacizumab and laser significantly decreased tortuosity (-54.3 and -23.8%), dilation (-8.7 and -7.5%), and overall plus disease (-27.3 and -10.3%). Improvement in plus disease, in particular tortuosity, likely occurs more quickly after bevacizumab compared with laser, particularly at 1 week after treatment. These results guide clinical expectations for plus disease resolution after both treatment modalities.

Ophthalmic Plastic and Reconstructive Surgery

Investigative Opthalmology & Visual Science, 2017

PURPOSE. To compare progression of retinopathy of prematurity (ROP) before and after institution ... more PURPOSE. To compare progression of retinopathy of prematurity (ROP) before and after institution of an oxygen therapy protocol to inhibit active proliferation and progression of ROP in premature infants. METHODS. A retrospective cohort study was performed of premature infants undergoing ROP screening before (cohort A) and after (cohort B) implementation of an oxygen therapy protocol to inhibit further progression for those with stage 2 ROP or worse. Statistical analysis with v 2 , Fisher's exact test, or Wilcoxon rank sum test was performed; and logistic regression models were created to determine the odds ratio of cohort B developing ROP progression beyond stage 2, compared to cohort A, adjusting for other risk factors for ROP. RESULTS. In cohort A, without oxygen therapy protocol (2002-2007), 44% (54/122) of infants progressed beyond stage 2, compared to 23% (24/103) of infants after protocol implementation (cohort B, 2008-2012) (P ¼ 0.001). No significant differences between cohort A and B were found for gestational age, birth weight, survival, sepsis, bronchopulmonary dysplasia, oxygen at discharge, or need for diuretics. Infants with stage 2 ROP in cohort B, with oxygen therapy protocol, had significantly decreased risk of ROP beyond stage 2 (odds ratio 0.37, 95% confidence interval 0.20-0.67; P ¼ 0.0013), compared to cohort A, correcting for differences in birth weight and necrotizing enterocolitis. CONCLUSIONS. Progression from stage 2 to stage 3 ROP in premature infants was significantly decreased after implementation of an oxygen therapy protocol, without a corresponding increase in pulmonary morbidity. This study suggests that appropriate oxygen therapy may play a role in inhibiting progression of stage 2 ROP, potentially decreasing the risk of lifelong visual loss in this vulnerable population.

Neurology, Jan 21, 2015

Unilateral abducens nerve palsy in a child with rapidly increasing head circumference A 12-month-... more Unilateral abducens nerve palsy in a child with rapidly increasing head circumference A 12-month-old healthy, normally developing boy presented with rapidly increasing head circumference over 2 months and 1 week of strabismus. Head circumference was 50 cm (.99th percentile; mother 5 59.5 cm; father 5 56.5 cm). Examination showed limited abduction OD, overshoot of adduction OD, and no papilledema. MRI (figure) showed the right anterior inferior cerebellar artery traversing the root entry zone of the right abducens nerve, a cause of unilateral cranial nerve VI palsy recognized in adults 1 but not in children. 2 Neuroimaging was otherwise normal. The patient was diagnosed with benign familial macrocephaly and discharged with ophthalmology follow-up for conservative management.

Journal of American Association for Pediatric Ophthalmology and Strabismus, 2014

Journal of American Association for Pediatric Ophthalmology and Strabismus, 2015

To describe and validate a Web-based structured simulation curriculum of strabismus surgery for r... more To describe and validate a Web-based structured simulation curriculum of strabismus surgery for residents in training using noncadaveric eye models. A pre- and posttest of cognitive skills, objective wet laboratory structured assessment of technique, and summative global evaluation form were implemented as part of a systematic ophthalmology wet lab (OWL) curriculum. Strabismus techniques were taught using a structured simulation method on noncadaveric models of eyes. Likert scale questionnaires were administered to assess the comfort level with strabismus surgery of residents before and after participation in the wet laboratory. Statistical analysis was performed using the paired t test. Seven residents participated in the curriculum. Average test scores improved from 65% to 91% (P = 0.0002). Resident comfort level improved from an average score (assessed by Likert scale of 1-5) with standard deviation of 2.6 ± 1.0 to 4.3 ± 0.5 for passing scleral sutures (P = 0.0008), of 2.6 ± 0.5 to 4.3 ± 0.5 for isolating and suturing muscles (P = 0.00004), and of 2.7 ± 1.0 to 4.6 ± 0.5 for comfort with naming instruments (P = 0.0007). In this study of 7 residents, knowledge and comfort level with strabismus surgery statistically improved with a structured simulation curriculum.

Oncology Letters, 2012

Intraocular lymphoma is a rare ocular malignancy that may occur in the retina or the uvea. Retina... more Intraocular lymphoma is a rare ocular malignancy that may occur in the retina or the uvea. Retina or vitreoretinal lymphoma accounts for the majority of cases and is often secondary to diffuse large B-cell lymphoma. In the present study, a 66-year-old Caucasian male with a history of Waldenstrom's macroglobulinemia with diffuse large B-cell lymphoma, presented with blurred vision in the left eye one month following cycle 4 of an R-CHOP regimen. At the time of onset, the patient was being treated for bacterial pneumonia. Visual acuity was 20/25 in his right eye (OD) and 20/30 in the left (OS). Ophthalmologic examination showed intraretinal white infiltrates associated with hemorrhage in the superotemporal midperiphery of the retina and vitritis OS. Initial diagnostic considerations included infectious (cytomegalovirus retinitis, syphilis, toxoplasmosis, tuberculosis), inflammatory (retinal vasculitis associated with autoimmune disease or hypercoagulable states) or malignant (intraocular lymphoma) diseases. The patient did not respond to intravitreal injection of foscarnet and oral valgancyclovir. Systemic work-up and aqueous fluid biopsy were inconclusive. Diagnostic vitrectomy yielded inconclusive results and the patient continued to have progressive loss of vision. A repeat diagnostic vitrectomy with retinal and subretinal biopsy confirmed large B cells consistent with metastatic B-cell lymphoma. A concomitant PET/CT scan was performed that revealed bilateral new pulmonary nodules resulting in additional chemotherapy. Our case shows the diagnostic dilemmas in patients with systemic lymphoma and the possible role of concurrent systemic restaging in patients with ocular complaints, even when in systemic remission.

Journal of Pediatric Ophthalmology & Strabismus, 2015

To present experience with cataract extraction in 9 eyes of 7 pediatric patients with chronic uve... more To present experience with cataract extraction in 9 eyes of 7 pediatric patients with chronic uveitis and compare the technique of anterior optic capture in 5 eyes that underwent cataract extraction without optic capture of the intraocular lens (IOL) or were left aphakic. A retrospective review of pediatric patients with chronic uveitis undergoing cataract surgery was performed, examining the preoperative and postoperative visual acuity, immunosuppressive therapy, surgical technique, complications, subsequent procedures, and need for escalation of systemic immunosuppressive therapy. The technique of anterior optic capture is described in detail. Of the 9 eyes, 5 underwent cataract extraction with IOL placement with the haptics in the capsular bag and optic prolapsed through the anterior capsulorhexis. One eye underwent cataract extraction with IOL implantation in the bag. Three eyes had lensectomy without IOL placement. The eyes with anterior optic capture had no adverse outcomes and uveitis flares were controlled with topical medications and systemic immunosuppressants; the eye with IOL placement without optic capture had recurrent membranes and uveitis flares, necessitating increased systemic immunosuppression. All eyes achieved best-corrected visual acuity of 20/60 or better by 6 months following surgery and 20/30 or better at the most recent follow-up. The technique of cataract extraction with IOL placement and anterior prolapse of the optic through the anterior capsulorhexis shows promise to be a safe and viable option for pediatric patients with chronic uveitis treated with systemic immunotherapy. [J Pediatr Ophthalmol Strabismus. 2015;52(2):XX-XX.].

Review of Scientific Instruments, 2004

Mechanical scribing can be employed to create surfaces with recessed features. Through replica mo... more Mechanical scribing can be employed to create surfaces with recessed features. Through replica molding elastomeric copies of these scribed surfaces are created that function as stamps for microcontact printing. It is shown that this new method for creating masters for microcontact printing can be performed with a computer-controlled milling machine (CNC), making this method particularly straightforward and accessible to a large technical community that does not need to work in a particle free environment. Thus, no clean room, or other specialized equipment is required, as is commonly needed to prepare masters. Time-of-flight secondary ion mass spectrometry confirms surface pattering by this method. Finally, it is shown that feature size in the scribed master can be controlled by varying the force on the tip during scribing.

Journal of American Association for Pediatric Ophthalmology and Strabismus, 2015

To describe and validate a Web-based structured simulation curriculum of strabismus surgery for r... more To describe and validate a Web-based structured simulation curriculum of strabismus surgery for residents in training using noncadaveric eye models. A pre- and posttest of cognitive skills, objective wet laboratory structured assessment of technique, and summative global evaluation form were implemented as part of a systematic ophthalmology wet lab (OWL) curriculum. Strabismus techniques were taught using a structured simulation method on noncadaveric models of eyes. Likert scale questionnaires were administered to assess the comfort level with strabismus surgery of residents before and after participation in the wet laboratory. Statistical analysis was performed using the paired t test. Seven residents participated in the curriculum. Average test scores improved from 65% to 91% (P = 0.0002). Resident comfort level improved from an average score (assessed by Likert scale of 1-5) with standard deviation of 2.6 ± 1.0 to 4.3 ± 0.5 for passing scleral sutures (P = 0.0008), of 2.6 ± 0.5 to 4.3 ± 0.5 for isolating and suturing muscles (P = 0.00004), and of 2.7 ± 1.0 to 4.6 ± 0.5 for comfort with naming instruments (P = 0.0007). In this study of 7 residents, knowledge and comfort level with strabismus surgery statistically improved with a structured simulation curriculum.

Journal of American Association for Pediatric Ophthalmology and Strabismus, 2013