Michael Dollin - Academia.edu (original) (raw)

Papers by Michael Dollin

Ophthalmic surgery, lasers & imaging retina, 2015

To report the effect of a "no-talking" policy during intravitreal injection (IVI) on po... more To report the effect of a "no-talking" policy during intravitreal injection (IVI) on post-injection endophthalmitis. Retrospective, comparative, consecutive case series of patients receiving IVI between Jan. 1, 2009, and Dec. 31, 2012. A 24-month "usual care" period was compared to a 24-month no-talking period, during which a strategy to further minimize speech during IVI was implemented. During the usual care period, 47,155 IVIs were performed, with nine culture-positive cases (0.019%), including seven due to oral pathogens (0.015%). During the no-talking period, 82,658 IVIs were performed, with eight culture-positive cases (0.010%), including two due to oral pathogens (0.002%). The no-talking policy was associated with a decreased endophthalmitis risk (P = .004), including oral pathogen-associated endophthalmitis (P = .02). This study demonstrates that a more stringent no-talking policy during IVI may reduce the risk of post-injection endophthalmitis. [Ophthalm...

Graefe's archive for clinical and experimental ophthalmology = Albrecht von Graefes Archiv fur klinische und experimentelle Ophthalmologie, Jan 5, 2015

Retina, 2015

To compare infectious organisms and visual outcomes of endophthalmitis after intravitreal injecti... more To compare infectious organisms and visual outcomes of endophthalmitis after intravitreal injection (IVI) with endophthalmitis after pars plana vitrectomy (PPV). Retrospective, comparative, consecutive case series of patients diagnosed with presumed infectious endophthalmitis after IVI of an anti-vascular endothelial growth factor medication or PPV between January 1, 2009, and October 1, 2012, from one center. Main outcome measures were infectious organism and final visual acuity. Forty-four cases of presumed infectious endophthalmitis (17 culture positive) occurred after IVI and 19 cases (9 culture positive) occurred after PPV. Of note, 56.3% of culture-positive IVI cases were due to bacteria associated with oral flora, primarily Streptococcus species, compared with none in the PPV group (P = 0.01). There was a trend approaching significance for IVI patients to have lost ≥3 lines of visual acuity compared with PPV patients at final follow-up (P = 0.07). Within the IVI group, patients were more likely to have lost ≥6 lines of visual acuity at final follow-up when endophthalmitis was due to an organism associated with oral flora (P = 0.007). Endophthalmitis after IVI has a higher likelihood of being due to oral flora compared with endophthalmitis after PPV. Among IVI patients, worse visual outcomes occurred when endophthalmitis was due to oral flora.

Ophthalmic Surgery, Lasers and Imaging Retina, 2015

To investigate outcomes of contemporary surgical techniques for repair of rhegmatogenous retinal ... more To investigate outcomes of contemporary surgical techniques for repair of rhegmatogenous retinal detachments (RRD) associated with giant retinal tears (GRT). Retrospective, consecutive case series including 58 eyes of 58 patients. Mean age was 52 years (range: 16 to 83 years). All patients underwent 23-gauge pars plana vitrectomy with use of perfluorocarbon liquid and intravitreal tamponade (28 with silicone oil, 25 with octafluoropropane gas, and five with sulfur hexafluoride gas). Scleral buckle (SB) was placed in 30 eyes (52%). At a mean follow-up of 17 months, mean visual acuity improved from 20/500 preoperatively to 20/88 at final follow-up. Fifty-one patients (88%) had single-surgery anatomic success, and all patients achieved final retinal reattachment. Use of SB (P = 1.0), silicone oil (P = .1), or 360° endophotocoagulation (P = .7) did not correlate with higher rates of successful repair. Contemporary vitreoretinal surgery techniques achieve high rates of primary anatomic success in GRT-related RRDs. [Ophthalmic Surg Lasers Imaging Retina. 2015;46:566-570.].

Graefe's Archive for Clinical and Experimental Ophthalmology, 2015

The purpose of this study was to evaluate the effect of prophylactic topical antibiotics on bacte... more The purpose of this study was to evaluate the effect of prophylactic topical antibiotics on bacterial resistance patterns in endophthalmitis following intravitreal injection of anti-vascular endothelial growth factor (VEGF) medications. In this retrospective case-control study, billing records and an infection log were used to identify all cases of endophthalmitis following intravitreal injection of ranibizumab, bevacizumab, or aflibercept between January 1, 2009 and September 30, 2013 at a single retina practice. A 28-month period when topical antibiotic drops were prescribed for use four times a day for 4 days following intravitreal injection was compared to a 21-month period when topical antibiotics were not prescribed. Patients treated during an 8-month transition period were excluded as prescription practices were changed. During the study period, a total of 172,096 anti-VEGF injections were performed. During the period when antibiotics were prescribed, 28 cases of suspected infectious endophthalmitis occurred from a total of 57,654 injections, ten of which were culture-positive. During the period when antibiotics were not used, 24 cases of suspected endophthalmitis occurred from a total of 89,825 injections, six of which were culture-positive. During the antibiotic period, four of the ten (40 %) culture-positive cases grew bacteria resistant to the prescribed prophylactic antibiotics. In contrast, none of the six culture-positive cases grew bacteria resistant to those antibiotics during the period when antibiotics were not used (odds ratio = 9.0; 95 % confidence interval = 0.40-203.3; p = 0.17). The use of prophylactic topical antibiotics following intravitreal injection may lead to higher rates of antibiotic-resistant bacteria in culture-positive endophthalmitis cases.

American Journal of Ophthalmology, 2014

To better characterize a novel spectral-domain optical coherence tomography (OCT) presentation, t... more To better characterize a novel spectral-domain optical coherence tomography (OCT) presentation, termed paracentral acute middle maculopathy, to describe this finding in patients with nonischemic central retinal vein occlusion (CRVO), and to support a proposed pathogenesis of intermediate and deep retinal capillary ischemia. Retrospective observational case series. Clinical histories, high-resolution digital color imaging, red-free photography, fluorescein angiography, near-infrared reflectance, and spectral-domain OCT images of 484 patients with acute CRVO from 2 centers were evaluated for the presence of coexisting paracentral acute middle maculopathy. Of 484 patients diagnosed with CRVO, 25 (5.2%) demonstrated evidence of concurrent paracentral acute middle maculopathy. Patients averaged 51 years of age and presented with complaints of paracentral scotomas. All patients demonstrated hyper-reflective plaquelike lesions at the level of the inner nuclear layer by spectral-domain OCT and showed corresponding dark-gray lesions on near-infrared reflectance and perivenular deep retinal whitening on color fundus photography. There was no fluorescein angiographic correlate to these lesions. On follow-up spectral-domain OCT imaging, the lesions had resolved into areas of inner nuclear layer atrophy with persistence of scotomas. Paracentral acute middle maculopathy refers to characteristic hyper-reflective spectral-domain OCT lesions involving the middle layers of the retina at the level of the inner nuclear layer that may develop in response to ischemia of the intermediate and deep capillary plexuses. This series is the largest to describe this spectral-domain OCT finding to date, and it is the first to associate it with nonischemic CRVO.

Ophthalmology, 2014

To compare the incidence of endophthalmitis after intravitreal injection with and without topical... more To compare the incidence of endophthalmitis after intravitreal injection with and without topical postinjection antibiotic prophylaxis. Retrospective case-control study. All patients treated with intravitreal injection of ranibizumab, bevacizumab, or aflibercept for a variety of retinal vascular diseases at a single, large retina practice between January 1, 2009, and October 1, 2012, were included. The total numbers of patients and injections were determined from a review of billing code and practice management records. Endophthalmitis cases were determined from billing records and from an infection log. All cases of endophthalmitis were confirmed with chart review. A 28-month period when topical antibiotics were prescribed after intravitreal injection was compared with a 9-month period when topical antibiotics were not prescribed. Patients treated during an 8-month transition period were excluded to allow for the conversion of antibiotic prescription practices. Incidence of endophthalmitis, visual acuity outcomes, and microbial spectrum. During the study period, a total of 117 171 intravitreal injections were performed (57 654 injections during the topical antibiotic period, 24 617 during the transition period, and 34 900 during the no-antibiotic period), with a total of 44 cases of suspected endophthalmitis (0.038%; 1 in 2663 injections), 17 of which showed culture-positive results (0.015%; 1 in 6892 injections). During the 28-month topical antibiotic period, there were 28 cases of suspected endophthalmitis (0.049%; 1 in 2059 injections), 10 of which showed culture-positive results (0.017%; 1 in 5765 injections). During the 9-month no-antibiotic period, there were 11 cases of suspected endophthalmitis (0.032%; 1 in 3173 injections), 4 of which showed culture-positive results (0.011%; 1 in 8725 injections). Topical antibiotic use was associated with a trend toward increased risk of suspected endophthalmitis (odds ratio [OR], 1.54; 95% confidence interval [CI], 0.77-3.10) and culture-positive endophthalmitis (OR, 1.51; 95% CI, 0.47-4.83). The incidence of endophthalmitis after intravitreal injection is low. Using postinjection topical antibiotic drops does not reduce the risk of endophthalmitis developing and is associated with a trend toward higher incidence of endophthalmitis.

Cornea, 2007

To report a case of unilateral lacrimal gland atrophy in a patient with hereditary angioedema (HA... more To report a case of unilateral lacrimal gland atrophy in a patient with hereditary angioedema (HAE). Observational case report with literature review. A 32-year-old woman with HAE presented with dryness and irritation of the left eye (OS). Investigations revealed features of unilateral severe dry OS with atrophy of the ipsilateral lacrimal gland confirmed by magnetic resonance imaging (MRI). Dry eye should be included in the ocular manifestations of HAE. Recurrent mucosal and soft-tissue inflammation secondary to HAE may lead to lacrimal gland atrophy. MRI is a useful, noninvasive tool in diagnosing lacrimal gland atrophy.

Canadian Journal of Ophthalmology / Journal Canadien d'Ophtalmologie, 2012

A 7-year-old boy was referred by the emergency department for a corneal limbal foreign body in hi... more A 7-year-old boy was referred by the emergency department for a corneal limbal foreign body in his right eye. The patient's parents had first noted the lesion 3 days earlier, after he had been swimming in Lake Manitoba while on vacation. He was asymptomatic other than some mild ocular irritation. The ocular and medical histories were unremarkable.

British Journal of Ophthalmology, 2009

Aims: To compare the degree of conjunctival autograft inflammation, subconjunctival haemorrhage (... more Aims: To compare the degree of conjunctival autograft inflammation, subconjunctival haemorrhage (SCH) and graft stability following the use of sutures or fibrin glue (FG) during pterygium surgery. Methods: Prospective, observer masked, clinical trial. 40 eyes of 40 patients undergoing primary pterygium surgery with conjunctival autograft were allocated into two groups. Group 1 (n = 20) had FG (Tisseel) for attaching the conjunctival autograft, whereas group 2 (n = 20) had sutures. Standardised digital slit-lamp photographs were taken at 1 week, 1 month and 3 months postoperatively. Sutures were masked using commercially available photoediting software. Two masked observers objectively graded the digital photographs for degree of inflammation, SCH and graft stability. Results: 34 of the 40 patients completed the study. When using FG, the degree of inflammation was significantly less than with sutures at 1 month (p = 0.019) and 3 months (p = 0.001) postoperatively. No significant difference was found for inflammation at 1 week postoperatively (p = 0.518). Conjunctival grafts secured with FG were as stable as those secured with sutures (p = 0.258, p = 0.076 and p = 0.624, at 1 week, 1 month and 3 months, respectively). No significant difference was found in degree of postoperative SCH between the groups (p = 0.417, p = 1 and p = 1, at 1 week, 1 month and 3 months, respectively). Conclusion: This is the first prospective clinical trial confirming that conjunctival grafts secured with FG during pterygium surgery not only are as stable as those secured with sutures, but also produce significantly less inflammation.

Canadian Journal of Ophthalmology / Journal Canadien d'Ophtalmologie, 2009

Objective: To report the development of adult-onset exposure keratitis in patients having undergo... more Objective: To report the development of adult-onset exposure keratitis in patients having undergone childhood ptosis repair with frontalis sling surgery (FSS). Study Design: Retrospective, noncomparative case series. Participants: Seven patients having received childhood FSS who were referred to us as adults with a complaint of ocular dryness that did not develop until years after surgery. Methods: Single-centre, clinic-based, chart review. Results: Four patients had bilateral, congenital ptosis and 3 had unilateral ptosis, secondary to childhood trauma and third nerve palsy (1). Mean age at first FSS was 6 years (range, 9 months-14 years). Five patients had received additional ophthalmic surgery, including strabismus surgery (2), repeat FSS (4), and prior failed levator resection (1). Mean age at referral to our centre with complaint of ocular dryness was 37 years (range, 23-46 years). Mean time from most recent FSS to presentation was 23 years (range, 17-36 years). On examination, 6 patients had related eyelid abnormalities, including bilateral entropion (1), ptosis recurrence (4), and peaked upper eyelid (1). All patients had measurable lagophthalmos (range, 0.5 mm-3 mm), and 5 had detectable punctate keratopathy (range, "trace" to "2+" on a scale of 0 to 4+). All patients were offered artificial lubricating drops, and 3 were deemed candidates for corrective eyelid surgery, resulting in improvement of exposure keratitis. Conclusions: Adult-onset exposure keratitis should be included as a potential late complication of FSS ptosis repair in children, particularly when multiple surgeries are required or complications occur.