Joseph Ferencz | Tel Aviv University (original) (raw)

Papers by Joseph Ferencz

Research paper thumbnail of Early Detection Of Exudative Age-related Macular Degeneration With A Home-based Preferential Hyperacuity Perimeter

Investigative Ophthalmology & Visual Science, 2011

Research paper thumbnail of Toward Earlier Detection of Choroidal Neovascularization Secondary to Age-Related Macular Degeneration

Retina, 2010

Purpose: The primary purpose of this study was to evaluate the ability of a home device preferent... more Purpose: The primary purpose of this study was to evaluate the ability of a home device preferential hyperacuity perimeter to discriminate between patients with choroidal neovascularization (CNV) and intermediate age-related macular degeneration (AMD), and the secondary purpose was to investigate the dependence of sensitivity on lesion characteristics. Methods: All participants were tested with the home device in an unsupervised mode. The first part of this work was retrospective using tests performed by patients with intermediate AMD and newly diagnosed CNV. In the second part, the classifier was prospectively challenged with tests performed by patients with intermediate AMD and newly diagnosed CNV. The dependence of sensitivity on lesion characteristics was estimated with tests performed by patients with CNV of both parts. Results: In 66 eyes with CNV and 65 eyes with intermediate AMD, both sensitivity and specificity were 0.85. In the retrospective part (34 CNV and 43 intermediate AMD), sensitivity and specificity were 0.85 6 0.12 (95% confidence interval) and 0.84 6 0.11 (95% confidence interval), respectively. In the prospective part (32 CNV and 22 intermediate AMD), sensitivity and specificity were 0.84 6 0.13 (95% confidence interval) and 0.86 6 0.14 (95% confidence interval), respectively. Chi-square analysis showed no dependence of sensitivity on type (P = 0.44), location (P = 0.243), or size (P = 0.73) of the CNV lesions. Conclusion: A home device preferential hyperacuity perimeter has good sensitivity and specificity in discriminating between patients with newly diagnosed CNV and intermediate AMD. Sensitivity is not dependent on lesion characteristics.

Research paper thumbnail of Toward Earlier Detection of Choroidal Neovascularization Secondary to Age-Related Macular Degeneration

Research paper thumbnail of Exposure to verteporfin and bevacizumab therapy for choroidal neovascularization secondary to punctate inner choroidopathy during pregnancy

Research paper thumbnail of Vancomycin Concentration in the Vitreous After Intravenous and Intravitreal Administration for Postoperative Endophthalmitis

Archives of Ophthalmology, 1999

To measure the concentrations of vancomycin in the vitreous of patients with postoperative endoph... more To measure the concentrations of vancomycin in the vitreous of patients with postoperative endophthalmitis after administration of 1 g of vancomycin hydrochloride intravenously and injection of 1 mg of vancomycin hydrochloride into the vitreous, and to determine whether these concentrations are adequate for treatment of gram-positive infections. Methods: Patients with acute postoperative endophthalmitis were treated with intravenous administration of 1 g of vancomycin hydrochloride followed by vitrectomy and collection of vitreous samples 1 to 5 hours later. Intravitreal vancomycin and ceftazidime were given. Vitreous samples were cultured and their vancomycin concentrations assayed. Minimal inhibitory concentrations of vancomycin for the isolated vitreal pathogens, and serum and vitreous cidal activity were determined. Results: Eighteen patients with acute postoperative endophthalmitis were studied. Fourteen vitreous samples were available after intravenous vancomycin administration , and 4 vitreous samples were available after intravitreal vancomycin administration. After intravenous injection, vitreous vancomycin concentrations ranged from 0.4 to 4.5 µg/mL. Minimal inhibitory concentrations in these samples, obtained from 10 bacterial isolates, were below the therapeutic levels for most causative organisms, including staphylococci. Vitreous cidal activity values were negative at a dilution of 1:2 in 9 of 10 patients examined. After a 1-mg intravitreal injection, vancomycin concentrations in vitreous samples obtained by a second tap from 4 patients 44 to 72 hours later were 182, 138, 58, and 25 µg/mL. In 2 patients in whom measurements were obtained, vitreous cidal activity values were 1:512 and 1:32. Conclusion: Vitreous vancomycin concentrations for the treatment of gram-positive endophthalmitis were nontherapeutic after intravenous administration but therapeutic after intravitreal administration.

Research paper thumbnail of Prognostic factors for visual acuity improvement after intravitreal triamcinolone injection

Eye, 2007

In some patients with macular oedema, intravitreal triamcinolone acetonide injection (IVTA) fails... more In some patients with macular oedema, intravitreal triamcinolone acetonide injection (IVTA) fails to improve visual acuity, although oedema shows clinical and angiographic improvement. Side effects can include increased intraocular pressure, cataract development, and (rarely) endophthalmitis. Our purpose was to identify prognostic factors for visual acuity improvement after IVTA. Methods Data on patients treated by IVTA for macular oedema were retrospectively reviewed. Three months postinjection, visual acuity was rated as 'improved' (two or more Snellen lines gained) or 'nonimproved' (unchanged or worsened). Comparative demographic data and pre-and post-IVTA clinical and fluorescein angiographic findings were analysed with SPSS software. Results Of 57 eyes (57 patients), 27 (47%) improved after IVTA. Initial visual acuity ('good', 'moderate', or 'poor') and aetiology of macular oedema (diabetic, venous occlusion, or pseudophakic) did not differ between the two groups. Improvement occurred in significantly more eyes with clinical or angiographic evidence of cystoid macular oedema (CME) than in those with diffuse retinal thickening (P ¼ 0.04) or diffuse leakage on fluorescein angiography (P ¼ 0.02), respectively, and in significantly more pseudophakic than phakic eyes (P ¼ 0.046). Conclusions Pseudophakia and clinical or angiographic CME, but not aetiology or initial visual acuity, were prognostic of visual acuity improvement after IVTA for macular oedema.

Research paper thumbnail of Endogenous endophthalmitis as the leading sign of endocarditis

Annals of Ophthalmology, 2001

Research paper thumbnail of Topical Brimonidine Possibly Reduces Collateral Damage caused by Laser Photocoagulation for Choroidal Neovascularization

Research paper thumbnail of Treatment of total exudative retinal detachment due to central retinal vein occlusion by intravitreal bevacizumab in a patient with p-ANCA vasculitis

Clinical ophthalmology (Auckland, N.Z.), 2007

Objective: To report on the use of intravitreal bevacizumab (an anti-vascular endothelial growth ... more Objective: To report on the use of intravitreal bevacizumab (an anti-vascular endothelial growth factor [VEGF] monoclonal antibody) as treatment of diffuse exudative retinal detachment due to ischemic central retinal vein occlusion (CRVO). Design: Interventional case report. Patient: A 27-year old woman on peritoneal dialysis because of end stage renal failure (ESRF) due to perinuclear antineutrophil cytoplasmic antibody (p-ANCA) associated vasculitis presented with acute unilateral blurred vision. Visual acuity (VA) rapidly deteriorated. Examination revealed the development of total bullous exudative retinal detachment following ischemic CRVO. Intervention: Two intravitreal injections of bevacizumab (2.5 mg/0.1ml) were administered followed by panretinal laser photocoagulation. Main outcome measures: VA, retinal detachment, and changes in macular edema. Results: Prompt significant resolution of exudative retinal detachment with a corresponding gradual improvement of VA from light p...

Research paper thumbnail of Pars plana vitrectomy for posteriorly dislocated intraocular lenses: risk factors and surgical approach

International Ophthalmology

Research paper thumbnail of Lamellar Macular Holes Associated with End-Stage Exudative Age-Related Macular Degeneration

The Israel Medical Association journal : IMAJ, 2015

Reports of lamellar macular holes (LMHs) with underlying age-related macular degeneration (AMD) a... more Reports of lamellar macular holes (LMHs) with underlying age-related macular degeneration (AMD) are rare, and the specific definition, pathogenesis and surgical recommendations for this macular condition remain unclear. To present a series of LMHs in eyes with underlying end-stage AMD, and describe optical coherence tomography (OCT) detection of associated morphologic abnormalities. We reviewed the files of consecutive patients diagnosed with LMH and underlying end-stage AMD between September 2007 and September 2011. Sixteen eyes of 14 patients were included in this study. The average follow-up after the OCT-established diagnosis of LMH was 19.8 months (range 4-48). The average visual acuity (VA) at last follow-up visit was 20/400 (20/60-20/1200). The best-corrected VA was stable in 10 eyes (62.5%) and deteriorated in 6 (37.5%). There was a statistically significant correlation between VA and minimal foveal thickness (r = -0.598, P = 0.014). In this series of LMHs with underlying AM...

Research paper thumbnail of Treatment of total exudative retinal detachment due to central retinal vein occlusion by intravitreal bevacizumab in a patient with p-ANCA vasculitis

Clinical Ophthalmology, Sep 1, 2007

Objective:To report on the use of intravitreal bevacizumab (an anti-vascular endothelial growth f... more Objective:To report on the use of intravitreal bevacizumab (an anti-vascular endothelial growth factor [VEGF] monoclonal antibody) as treatment of diffuse exudative retinal detachment due to ischemic central retinal vein occlusion (CRVO).Design:Interventional case report.Patient:A 27-year old woman on peritoneal dialysis because of end stage renal failure (ESRF) due to perinuclear antineutrophil cytoplasmic antibody (p-ANCA) associated vasculitis presented with acute unilateral blurred vision. Visual acuity (VA) rapidly deteriorated. Examination revealed the development of total bullous exudative retinal detachment following ischemic CRVO.Intervention:Two intravitreal injections of bevacizumab (2.5 mg/0.1ml) were administered followed by panretinal laser photocoagulation.Main outcome measures:VA, retinal detachment, and changes in macular edema.Results:Prompt significant resolution of exudative retinal detachment with a corresponding gradual improvement of VA from light perception to finger counting. At follow-up examination after 8-months, the retina remained attached.Conclusion:Intravitreal bevacizumab proved to be a useful treatment modality in diffuse exudative retinal detachment due to CRVO.

Research paper thumbnail of Is Serum Ferritin High in Patients with Diabetic Retinopathy? A Controlled Study

It is suggested that an excessive absorption and storage of dietary iron might contribute in the ... more It is suggested that an excessive absorption and storage of dietary iron might contribute in the pathogenesis of type II diabetes mellitus and its complications. However, previous studies had methodological problems including design, lack of matched controls and unspecified inclusion criteria. The aim of the study was to evaluate the relationship between diabetic retinopathy and serum ferritin levels in well-defined diabetic patients and controls. The study population comprised of 3 groups: patients with type II diabetes mellitus and severe diabetic retinopathy, diabetic patients without retinopathy, and non-diabetic, non-retinopathy patients. The groups were well matched by age, gender and hemoglobin levels, whereas diabetes characteristics and treatment differed. Serum iron, transferrin and ferritin levels were compared between the patients' groups. Twenty-two patients had diabetes and retinopathy, 29 patients had diabetes without retinopathy and 40 were non-diabetic, non-retinopathy patients. Serum iron or ferritin levels did not differ significantly between the 3 groups. Also, there was no correlation between HbA1c level and serum iron or ferritin levels between the 2 diabetic patients' groups. Our findings suggest that iron does not have a major role in the development of diabetes mellitus or diabetic retinopathy.

Research paper thumbnail of Utilizing gravity in the removal of a large intraocular foreign body

Ophthalmic surgery and lasers

This article describes an unconventional technique for the removal of a nonmagnetic intraocular f... more This article describes an unconventional technique for the removal of a nonmagnetic intraocular foreign body that is too large or too smooth to be grasped by intraocular forceps and does not float on perfluorocarbon liquids. By flipping the patient to a face-down position and allowing the gravitational forces to help remove the object, one can hope to avoid further ocular damage. This approach should be considered in similar cases of very large and smooth intravitreal foreign bodies to avoid severe and irreversible damage to the retina.

Research paper thumbnail of Treatment of total exudative retinal detachment due to central retinal vein occlusion by intravitreal bevacizumab in a patient with p-ANCA vasculitis

Clinical ophthalmology (Auckland, N.Z.), 2007

To report on the use of intravitreal bevacizumab (an anti-vascular endothelial growth factor [VEG... more To report on the use of intravitreal bevacizumab (an anti-vascular endothelial growth factor [VEGF] monoclonal antibody) as treatment of diffuse exudative retinal detachment due to ischemic central retinal vein occlusion (CRVO). Interventional case report. A 27-year old woman on peritoneal dialysis because of end stage renal failure (ESRF) due to perinuclear antineutrophil cytoplasmic antibody (p-ANCA) associated vasculitis presented with acute unilateral blurred vision. Visual acuity (VA) rapidly deteriorated. Examination revealed the development of total bullous exudative retinal detachment following ischemic CRVO. Two intravitreal injections of bevacizumab (2.5 mg/0.1ml) were administered followed by panretinal laser photocoagulation. VA, retinal detachment, and changes in macular edema. Prompt significant resolution of exudative retinal detachment with a corresponding gradual improvement of VA from light perception to finger counting. At follow-up examination after 8-months, the...

Research paper thumbnail of Persistent elevation of intraocular pressure following intravitreal injection of bevacizumab

The Israel Medical Association journal : IMAJ, 2013

The number of patients treated with intravitreal injections has increased significantly over the ... more The number of patients treated with intravitreal injections has increased significantly over the past few years, mainly following the introduction of anti-vascular endothelial growth factor antibody intraocular drugs. Bevacizumab is mostly used in this group of medications. To describe persistent elevation of intraocular pressure (IOP) following intravitreal injection of bevacizumab. We reviewed consecutive cases of persistent IOP elevation after intravitreal bevacizumab injection for exudative age-related macular degeneration (AMD). A total of 424 patients (528 eyes) met the inclusion criteria and received 1796 intravitreal injections of bevacizumab. Persistent IOP elevation was found in 19 eyes (3.6%, 19/528) of 18 patients (4.2%, 18/424) with IOP elevated 30-70 mmHg 3-30 days after injection. Mean IOP was 42.6 mmHg (range 30-70); IOP elevations occurred after an average of 7.8 injections of bevacizumab (range 3-13). Injected eyes (19/528) had a significantly higher incidence of e...

Research paper thumbnail of Autosomal Dominant Crystalline Dystrophy

Ophthalmology, 1991

A black woman was identified with a tapetoretinal degeneration with sparkling intraretinal crysta... more A black woman was identified with a tapetoretinal degeneration with sparkling intraretinal crystals, retinal pigment epithelial and choroidal atrophy, night blindness, color vision abnormalities, and paracentral scotomas. This constellation of findings is most consistent with the diagnosis of Bietti's crystalline dystrophy. Eight other family members were identified with intraretinal crystals similar to those seen in the proband but in varying degrees of progression. Transmission electron microscopy of circulating lymphocytes in several patients demonstrated crystals and granular osmophilic material of unknown composition contained within abnormal lysosomes. These crystals are similar in appearance and location to those seen in cholesterol ester storage disease. This family demonstrates an autosomal dominant inheritance pattern, as well as other differences from classic Bietti's crystalline dystrophy. The authors, therefore, suggest that this new entity be named autosomal dominant crystalline dystrophy.

Research paper thumbnail of Topical brimonidine reduces collateral damage caused by laser photocoagulation for choroidal neovascularization

Graefe's Archive for Clinical and Experimental Ophthalmology, 2005

To evaluate the neuroprotective efficacy of brimonidine applied topically to the eyes of patients... more To evaluate the neuroprotective efficacy of brimonidine applied topically to the eyes of patients undergoing laser treatment for extrafoveal or juxtafoveal choroidal neovascularization (CNV). In this prospective, controlled, double-masked pilot study, 20 eyes were randomized to receive either brimonidine 0.2% (study group, 11 eyes) or placebo (matched control group, 9 eyes). Medications were topically applied twice a day during a period of 4-48 h before laser treatment and were continued for 1 month. Two eyes in each group had severe visual loss owing to recurrence of CNV. In the remaining 16 eyes there was a significant improvement in the study group, but no improvement in the control group (P=0.027). Topical brimonidine improves the visual outcome of laser-treated classic extrafoveal or juxtafoveal CNV, possibly by protecting the neuroretina against collateral damage caused by the laser treatment.

Research paper thumbnail of Is Serum Ferritin High in Patients with Diabetic Retinopathy? A Controlled Study

Endocrine Research, 2004

It is suggested that an excessive absorption and storage of dietary iron might contribute in the ... more It is suggested that an excessive absorption and storage of dietary iron might contribute in the pathogenesis of type II diabetes mellitus and its complications. However, previous studies had methodological problems including design, lack of matched controls and unspecified inclusion criteria. The aim of the study was to evaluate the relationship between diabetic retinopathy and serum ferritin levels in well-defined diabetic patients and controls. The study population comprised of 3 groups: patients with type II diabetes mellitus and severe diabetic retinopathy, diabetic patients without retinopathy, and non-diabetic, non-retinopathy patients. The groups were well matched by age, gender and hemoglobin levels, whereas diabetes characteristics and treatment differed. Serum iron, transferrin and ferritin levels were compared between the patients' groups. Twenty-two patients had diabetes and retinopathy, 29 patients had diabetes without retinopathy and 40 were non-diabetic, non-retinopathy patients. Serum iron or ferritin levels did not differ significantly between the 3 groups. Also, there was no correlation between HbA1c level and serum iron or ferritin levels between the 2 diabetic patients' groups. Our findings suggest that iron does not have a major role in the development of diabetes mellitus or diabetic retinopathy.

Research paper thumbnail of Orbital cellulitis following silicone-sponge scleral buckles

Clinical Ophthalmology, 2013

Background: Acute or chronic infection of the scleral explant is rare. We report seven cases of s... more Background: Acute or chronic infection of the scleral explant is rare. We report seven cases of scleral explant infections that caused orbital cellulitis. Materials and methods: This was a retrospective chart review of oculoplastics at oculoplastics and vitreo-retinal units in a secondary referral hospital. All subjects had orbital cellulitis secondary to scleral buckle in the range of January 1990 to March 2010. Demographics, imaging studies, and pathology specimens were reviewed. Results: A total of 841 silicone-sponge scleral buckle implants for rhegmatogenous retinal detachment were performed. Forty were extracted (4.75%; annual rate of 1.9 cases). Seven (0.83%) had orbital cellulitis. The mean time from implantation to presentation was 5.7 years. There was bacterial growth in all specimens, with Staphylococcus aureus in four. Conclusions: Patients who are operated on with silicone-sponge scleral buckling for rhegmatogenous retinal detachment sometimes require removal of the implant because of infection. However, the infection rate is low. Patients should be followed in the long term for possible complications.

Research paper thumbnail of Early Detection Of Exudative Age-related Macular Degeneration With A Home-based Preferential Hyperacuity Perimeter

Investigative Ophthalmology & Visual Science, 2011

Research paper thumbnail of Toward Earlier Detection of Choroidal Neovascularization Secondary to Age-Related Macular Degeneration

Retina, 2010

Purpose: The primary purpose of this study was to evaluate the ability of a home device preferent... more Purpose: The primary purpose of this study was to evaluate the ability of a home device preferential hyperacuity perimeter to discriminate between patients with choroidal neovascularization (CNV) and intermediate age-related macular degeneration (AMD), and the secondary purpose was to investigate the dependence of sensitivity on lesion characteristics. Methods: All participants were tested with the home device in an unsupervised mode. The first part of this work was retrospective using tests performed by patients with intermediate AMD and newly diagnosed CNV. In the second part, the classifier was prospectively challenged with tests performed by patients with intermediate AMD and newly diagnosed CNV. The dependence of sensitivity on lesion characteristics was estimated with tests performed by patients with CNV of both parts. Results: In 66 eyes with CNV and 65 eyes with intermediate AMD, both sensitivity and specificity were 0.85. In the retrospective part (34 CNV and 43 intermediate AMD), sensitivity and specificity were 0.85 6 0.12 (95% confidence interval) and 0.84 6 0.11 (95% confidence interval), respectively. In the prospective part (32 CNV and 22 intermediate AMD), sensitivity and specificity were 0.84 6 0.13 (95% confidence interval) and 0.86 6 0.14 (95% confidence interval), respectively. Chi-square analysis showed no dependence of sensitivity on type (P = 0.44), location (P = 0.243), or size (P = 0.73) of the CNV lesions. Conclusion: A home device preferential hyperacuity perimeter has good sensitivity and specificity in discriminating between patients with newly diagnosed CNV and intermediate AMD. Sensitivity is not dependent on lesion characteristics.

Research paper thumbnail of Toward Earlier Detection of Choroidal Neovascularization Secondary to Age-Related Macular Degeneration

Research paper thumbnail of Exposure to verteporfin and bevacizumab therapy for choroidal neovascularization secondary to punctate inner choroidopathy during pregnancy

Research paper thumbnail of Vancomycin Concentration in the Vitreous After Intravenous and Intravitreal Administration for Postoperative Endophthalmitis

Archives of Ophthalmology, 1999

To measure the concentrations of vancomycin in the vitreous of patients with postoperative endoph... more To measure the concentrations of vancomycin in the vitreous of patients with postoperative endophthalmitis after administration of 1 g of vancomycin hydrochloride intravenously and injection of 1 mg of vancomycin hydrochloride into the vitreous, and to determine whether these concentrations are adequate for treatment of gram-positive infections. Methods: Patients with acute postoperative endophthalmitis were treated with intravenous administration of 1 g of vancomycin hydrochloride followed by vitrectomy and collection of vitreous samples 1 to 5 hours later. Intravitreal vancomycin and ceftazidime were given. Vitreous samples were cultured and their vancomycin concentrations assayed. Minimal inhibitory concentrations of vancomycin for the isolated vitreal pathogens, and serum and vitreous cidal activity were determined. Results: Eighteen patients with acute postoperative endophthalmitis were studied. Fourteen vitreous samples were available after intravenous vancomycin administration , and 4 vitreous samples were available after intravitreal vancomycin administration. After intravenous injection, vitreous vancomycin concentrations ranged from 0.4 to 4.5 µg/mL. Minimal inhibitory concentrations in these samples, obtained from 10 bacterial isolates, were below the therapeutic levels for most causative organisms, including staphylococci. Vitreous cidal activity values were negative at a dilution of 1:2 in 9 of 10 patients examined. After a 1-mg intravitreal injection, vancomycin concentrations in vitreous samples obtained by a second tap from 4 patients 44 to 72 hours later were 182, 138, 58, and 25 µg/mL. In 2 patients in whom measurements were obtained, vitreous cidal activity values were 1:512 and 1:32. Conclusion: Vitreous vancomycin concentrations for the treatment of gram-positive endophthalmitis were nontherapeutic after intravenous administration but therapeutic after intravitreal administration.

Research paper thumbnail of Prognostic factors for visual acuity improvement after intravitreal triamcinolone injection

Eye, 2007

In some patients with macular oedema, intravitreal triamcinolone acetonide injection (IVTA) fails... more In some patients with macular oedema, intravitreal triamcinolone acetonide injection (IVTA) fails to improve visual acuity, although oedema shows clinical and angiographic improvement. Side effects can include increased intraocular pressure, cataract development, and (rarely) endophthalmitis. Our purpose was to identify prognostic factors for visual acuity improvement after IVTA. Methods Data on patients treated by IVTA for macular oedema were retrospectively reviewed. Three months postinjection, visual acuity was rated as 'improved' (two or more Snellen lines gained) or 'nonimproved' (unchanged or worsened). Comparative demographic data and pre-and post-IVTA clinical and fluorescein angiographic findings were analysed with SPSS software. Results Of 57 eyes (57 patients), 27 (47%) improved after IVTA. Initial visual acuity ('good', 'moderate', or 'poor') and aetiology of macular oedema (diabetic, venous occlusion, or pseudophakic) did not differ between the two groups. Improvement occurred in significantly more eyes with clinical or angiographic evidence of cystoid macular oedema (CME) than in those with diffuse retinal thickening (P ¼ 0.04) or diffuse leakage on fluorescein angiography (P ¼ 0.02), respectively, and in significantly more pseudophakic than phakic eyes (P ¼ 0.046). Conclusions Pseudophakia and clinical or angiographic CME, but not aetiology or initial visual acuity, were prognostic of visual acuity improvement after IVTA for macular oedema.

Research paper thumbnail of Endogenous endophthalmitis as the leading sign of endocarditis

Annals of Ophthalmology, 2001

Research paper thumbnail of Topical Brimonidine Possibly Reduces Collateral Damage caused by Laser Photocoagulation for Choroidal Neovascularization

Research paper thumbnail of Treatment of total exudative retinal detachment due to central retinal vein occlusion by intravitreal bevacizumab in a patient with p-ANCA vasculitis

Clinical ophthalmology (Auckland, N.Z.), 2007

Objective: To report on the use of intravitreal bevacizumab (an anti-vascular endothelial growth ... more Objective: To report on the use of intravitreal bevacizumab (an anti-vascular endothelial growth factor [VEGF] monoclonal antibody) as treatment of diffuse exudative retinal detachment due to ischemic central retinal vein occlusion (CRVO). Design: Interventional case report. Patient: A 27-year old woman on peritoneal dialysis because of end stage renal failure (ESRF) due to perinuclear antineutrophil cytoplasmic antibody (p-ANCA) associated vasculitis presented with acute unilateral blurred vision. Visual acuity (VA) rapidly deteriorated. Examination revealed the development of total bullous exudative retinal detachment following ischemic CRVO. Intervention: Two intravitreal injections of bevacizumab (2.5 mg/0.1ml) were administered followed by panretinal laser photocoagulation. Main outcome measures: VA, retinal detachment, and changes in macular edema. Results: Prompt significant resolution of exudative retinal detachment with a corresponding gradual improvement of VA from light p...

Research paper thumbnail of Pars plana vitrectomy for posteriorly dislocated intraocular lenses: risk factors and surgical approach

International Ophthalmology

Research paper thumbnail of Lamellar Macular Holes Associated with End-Stage Exudative Age-Related Macular Degeneration

The Israel Medical Association journal : IMAJ, 2015

Reports of lamellar macular holes (LMHs) with underlying age-related macular degeneration (AMD) a... more Reports of lamellar macular holes (LMHs) with underlying age-related macular degeneration (AMD) are rare, and the specific definition, pathogenesis and surgical recommendations for this macular condition remain unclear. To present a series of LMHs in eyes with underlying end-stage AMD, and describe optical coherence tomography (OCT) detection of associated morphologic abnormalities. We reviewed the files of consecutive patients diagnosed with LMH and underlying end-stage AMD between September 2007 and September 2011. Sixteen eyes of 14 patients were included in this study. The average follow-up after the OCT-established diagnosis of LMH was 19.8 months (range 4-48). The average visual acuity (VA) at last follow-up visit was 20/400 (20/60-20/1200). The best-corrected VA was stable in 10 eyes (62.5%) and deteriorated in 6 (37.5%). There was a statistically significant correlation between VA and minimal foveal thickness (r = -0.598, P = 0.014). In this series of LMHs with underlying AM...

Research paper thumbnail of Treatment of total exudative retinal detachment due to central retinal vein occlusion by intravitreal bevacizumab in a patient with p-ANCA vasculitis

Clinical Ophthalmology, Sep 1, 2007

Objective:To report on the use of intravitreal bevacizumab (an anti-vascular endothelial growth f... more Objective:To report on the use of intravitreal bevacizumab (an anti-vascular endothelial growth factor [VEGF] monoclonal antibody) as treatment of diffuse exudative retinal detachment due to ischemic central retinal vein occlusion (CRVO).Design:Interventional case report.Patient:A 27-year old woman on peritoneal dialysis because of end stage renal failure (ESRF) due to perinuclear antineutrophil cytoplasmic antibody (p-ANCA) associated vasculitis presented with acute unilateral blurred vision. Visual acuity (VA) rapidly deteriorated. Examination revealed the development of total bullous exudative retinal detachment following ischemic CRVO.Intervention:Two intravitreal injections of bevacizumab (2.5 mg/0.1ml) were administered followed by panretinal laser photocoagulation.Main outcome measures:VA, retinal detachment, and changes in macular edema.Results:Prompt significant resolution of exudative retinal detachment with a corresponding gradual improvement of VA from light perception to finger counting. At follow-up examination after 8-months, the retina remained attached.Conclusion:Intravitreal bevacizumab proved to be a useful treatment modality in diffuse exudative retinal detachment due to CRVO.

Research paper thumbnail of Is Serum Ferritin High in Patients with Diabetic Retinopathy? A Controlled Study

It is suggested that an excessive absorption and storage of dietary iron might contribute in the ... more It is suggested that an excessive absorption and storage of dietary iron might contribute in the pathogenesis of type II diabetes mellitus and its complications. However, previous studies had methodological problems including design, lack of matched controls and unspecified inclusion criteria. The aim of the study was to evaluate the relationship between diabetic retinopathy and serum ferritin levels in well-defined diabetic patients and controls. The study population comprised of 3 groups: patients with type II diabetes mellitus and severe diabetic retinopathy, diabetic patients without retinopathy, and non-diabetic, non-retinopathy patients. The groups were well matched by age, gender and hemoglobin levels, whereas diabetes characteristics and treatment differed. Serum iron, transferrin and ferritin levels were compared between the patients' groups. Twenty-two patients had diabetes and retinopathy, 29 patients had diabetes without retinopathy and 40 were non-diabetic, non-retinopathy patients. Serum iron or ferritin levels did not differ significantly between the 3 groups. Also, there was no correlation between HbA1c level and serum iron or ferritin levels between the 2 diabetic patients' groups. Our findings suggest that iron does not have a major role in the development of diabetes mellitus or diabetic retinopathy.

Research paper thumbnail of Utilizing gravity in the removal of a large intraocular foreign body

Ophthalmic surgery and lasers

This article describes an unconventional technique for the removal of a nonmagnetic intraocular f... more This article describes an unconventional technique for the removal of a nonmagnetic intraocular foreign body that is too large or too smooth to be grasped by intraocular forceps and does not float on perfluorocarbon liquids. By flipping the patient to a face-down position and allowing the gravitational forces to help remove the object, one can hope to avoid further ocular damage. This approach should be considered in similar cases of very large and smooth intravitreal foreign bodies to avoid severe and irreversible damage to the retina.

Research paper thumbnail of Treatment of total exudative retinal detachment due to central retinal vein occlusion by intravitreal bevacizumab in a patient with p-ANCA vasculitis

Clinical ophthalmology (Auckland, N.Z.), 2007

To report on the use of intravitreal bevacizumab (an anti-vascular endothelial growth factor [VEG... more To report on the use of intravitreal bevacizumab (an anti-vascular endothelial growth factor [VEGF] monoclonal antibody) as treatment of diffuse exudative retinal detachment due to ischemic central retinal vein occlusion (CRVO). Interventional case report. A 27-year old woman on peritoneal dialysis because of end stage renal failure (ESRF) due to perinuclear antineutrophil cytoplasmic antibody (p-ANCA) associated vasculitis presented with acute unilateral blurred vision. Visual acuity (VA) rapidly deteriorated. Examination revealed the development of total bullous exudative retinal detachment following ischemic CRVO. Two intravitreal injections of bevacizumab (2.5 mg/0.1ml) were administered followed by panretinal laser photocoagulation. VA, retinal detachment, and changes in macular edema. Prompt significant resolution of exudative retinal detachment with a corresponding gradual improvement of VA from light perception to finger counting. At follow-up examination after 8-months, the...

Research paper thumbnail of Persistent elevation of intraocular pressure following intravitreal injection of bevacizumab

The Israel Medical Association journal : IMAJ, 2013

The number of patients treated with intravitreal injections has increased significantly over the ... more The number of patients treated with intravitreal injections has increased significantly over the past few years, mainly following the introduction of anti-vascular endothelial growth factor antibody intraocular drugs. Bevacizumab is mostly used in this group of medications. To describe persistent elevation of intraocular pressure (IOP) following intravitreal injection of bevacizumab. We reviewed consecutive cases of persistent IOP elevation after intravitreal bevacizumab injection for exudative age-related macular degeneration (AMD). A total of 424 patients (528 eyes) met the inclusion criteria and received 1796 intravitreal injections of bevacizumab. Persistent IOP elevation was found in 19 eyes (3.6%, 19/528) of 18 patients (4.2%, 18/424) with IOP elevated 30-70 mmHg 3-30 days after injection. Mean IOP was 42.6 mmHg (range 30-70); IOP elevations occurred after an average of 7.8 injections of bevacizumab (range 3-13). Injected eyes (19/528) had a significantly higher incidence of e...

Research paper thumbnail of Autosomal Dominant Crystalline Dystrophy

Ophthalmology, 1991

A black woman was identified with a tapetoretinal degeneration with sparkling intraretinal crysta... more A black woman was identified with a tapetoretinal degeneration with sparkling intraretinal crystals, retinal pigment epithelial and choroidal atrophy, night blindness, color vision abnormalities, and paracentral scotomas. This constellation of findings is most consistent with the diagnosis of Bietti's crystalline dystrophy. Eight other family members were identified with intraretinal crystals similar to those seen in the proband but in varying degrees of progression. Transmission electron microscopy of circulating lymphocytes in several patients demonstrated crystals and granular osmophilic material of unknown composition contained within abnormal lysosomes. These crystals are similar in appearance and location to those seen in cholesterol ester storage disease. This family demonstrates an autosomal dominant inheritance pattern, as well as other differences from classic Bietti's crystalline dystrophy. The authors, therefore, suggest that this new entity be named autosomal dominant crystalline dystrophy.

Research paper thumbnail of Topical brimonidine reduces collateral damage caused by laser photocoagulation for choroidal neovascularization

Graefe's Archive for Clinical and Experimental Ophthalmology, 2005

To evaluate the neuroprotective efficacy of brimonidine applied topically to the eyes of patients... more To evaluate the neuroprotective efficacy of brimonidine applied topically to the eyes of patients undergoing laser treatment for extrafoveal or juxtafoveal choroidal neovascularization (CNV). In this prospective, controlled, double-masked pilot study, 20 eyes were randomized to receive either brimonidine 0.2% (study group, 11 eyes) or placebo (matched control group, 9 eyes). Medications were topically applied twice a day during a period of 4-48 h before laser treatment and were continued for 1 month. Two eyes in each group had severe visual loss owing to recurrence of CNV. In the remaining 16 eyes there was a significant improvement in the study group, but no improvement in the control group (P=0.027). Topical brimonidine improves the visual outcome of laser-treated classic extrafoveal or juxtafoveal CNV, possibly by protecting the neuroretina against collateral damage caused by the laser treatment.

Research paper thumbnail of Is Serum Ferritin High in Patients with Diabetic Retinopathy? A Controlled Study

Endocrine Research, 2004

It is suggested that an excessive absorption and storage of dietary iron might contribute in the ... more It is suggested that an excessive absorption and storage of dietary iron might contribute in the pathogenesis of type II diabetes mellitus and its complications. However, previous studies had methodological problems including design, lack of matched controls and unspecified inclusion criteria. The aim of the study was to evaluate the relationship between diabetic retinopathy and serum ferritin levels in well-defined diabetic patients and controls. The study population comprised of 3 groups: patients with type II diabetes mellitus and severe diabetic retinopathy, diabetic patients without retinopathy, and non-diabetic, non-retinopathy patients. The groups were well matched by age, gender and hemoglobin levels, whereas diabetes characteristics and treatment differed. Serum iron, transferrin and ferritin levels were compared between the patients' groups. Twenty-two patients had diabetes and retinopathy, 29 patients had diabetes without retinopathy and 40 were non-diabetic, non-retinopathy patients. Serum iron or ferritin levels did not differ significantly between the 3 groups. Also, there was no correlation between HbA1c level and serum iron or ferritin levels between the 2 diabetic patients' groups. Our findings suggest that iron does not have a major role in the development of diabetes mellitus or diabetic retinopathy.

Research paper thumbnail of Orbital cellulitis following silicone-sponge scleral buckles

Clinical Ophthalmology, 2013

Background: Acute or chronic infection of the scleral explant is rare. We report seven cases of s... more Background: Acute or chronic infection of the scleral explant is rare. We report seven cases of scleral explant infections that caused orbital cellulitis. Materials and methods: This was a retrospective chart review of oculoplastics at oculoplastics and vitreo-retinal units in a secondary referral hospital. All subjects had orbital cellulitis secondary to scleral buckle in the range of January 1990 to March 2010. Demographics, imaging studies, and pathology specimens were reviewed. Results: A total of 841 silicone-sponge scleral buckle implants for rhegmatogenous retinal detachment were performed. Forty were extracted (4.75%; annual rate of 1.9 cases). Seven (0.83%) had orbital cellulitis. The mean time from implantation to presentation was 5.7 years. There was bacterial growth in all specimens, with Staphylococcus aureus in four. Conclusions: Patients who are operated on with silicone-sponge scleral buckling for rhegmatogenous retinal detachment sometimes require removal of the implant because of infection. However, the infection rate is low. Patients should be followed in the long term for possible complications.