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*All required fields must be completed. Please include non-medical questions and correspondence only. If this is an emergency referral, please contact our office directly, Jacksonville 800.237.3846, Daytona Beach 800.555.6590, Lake Mary 877.357.3846. Our regular office hours are 8AM to 5PM Monday through Friday.
Jaya B Kumar, Karen M Wai, Justin P Ehlers, Rishi P Singh, Aleksandra V Rachitskaya. British Journal of Ophthalmology, BMH Journals. 2018/3/12
Aims To investigate the relationship between subfoveal choroidal thickness (SFCT), visual acuity (VA), optical coherence tomography (OCT) features and total anti-vascular endothelial growth factor (VEGF) treatments to determine whether SFCT serves as a prognostic factor in age-related macular degeneration (AMD).
Methods This is a retrospective case series of 62 consecutive treatment-naive patients with exudative AMD followed for 1 year and treated with treat-and-extend or pro re nata anti-VEGF protocols. SFCT was measured at three locations using Cirrus HD-OCT (the foveal centre and 500 um nasal and temporal to the fovea) at presentation, 3, 6 and 12 months. Demographic characteristics, OCT imaging biomarkers and VA were recorded.
Results. Mean SFCT at baseline was 187 µm (range: 70–361 µm). There was a trend of decreasing SFCT at 1 year (173 µm) compared with 3 months (175 µm) and baseline (188 µm) (p=0.2). There was no correlation between baseline SFCT and presence of subretinal fluid (p=0.2), intraretinal fluid (p=0.6) or subretinal hyper-reflective material (p=0.4) at baseline. The mean number of injections at 1 year was 6.6 (range: 2–12). Increased SFCT at baseline showed statistically significant correlation with a higher number of intravitreal injections at 1 year (p=0.004). Eyes with SFCT 1 SD above the mean required 50% more injections compared with others. There was no association between SFCT on presentation with baseline and 1 year VA (p=0.7 and p=0.2).
Conclusions SFCT in naïve patients with exudative AMD may be an important prognostic tool in determining treatment burden. Patients with thicker subfoveal choroid may require increased intravitreal injections.
Jaya B. Kumar, MD, Justis P. Ehlers, MD, Sumit Sharma, MD, Sunil K. Srivastava, MD, Cole Eye Institute, Cleveland Clinic Foundation, Cleveland, Ohio. 2018/10
To evaluate the feasibility and usefulness of intraoperative OCT (iOCT) for uveitis-related vitreoretinal surgeries.
Prospective consecutive case series.
Seventy-three consecutive patients (74 eyes) with a uveitis-related diagnosis.
Eyes undergoing surgery for a uveitis-related diagnosis in the prospective Determination of Feasibility of Intraoperative Spectral Domain Microscope Combined/Integrated OCT Visualization During En Face Retinal and Ophthalmic Surgery (DISCOVER) iOCT study. Intraoperative OCT was performed at various surgical milestones. Clinical details and evaluation of the role of iOCT were assessed. A standardized surgeon survey was completed to evaluate the usefulness of iOCT during surgery.
Percentage of patients in whom iOCT provided valuable feedback and altered surgical decision making.
Seventy-four consecutive eyes with a uveitis-related diagnosis were enrolled in the DISCOVER study. Successful imaging was obtained in 72 of 73 eyes (98.6%). Intraoperative OCT provided valuable feedback for fluocinolone acetonide implant placement in 11 of 13 eyes (84.6%), for chorioretinal biopsies in 13 of 16 eyes (81.2%), and for retinal detachment (RD) repairs in 20 of 27 eyes (74.1%). In subretinal and chorioretinal biopsies, iOCT altered surgical decision making in 38% of patients. In uveitis-related RD repairs, iOCT resulted in alterations in the surgical procedure in 48% of patients, predominantly related to additional membrane peeling.
Intraoperative OCT during uveitis-related vitreoretinal surgery seems to provide valuable additional information that can impact surgical decision making and may enhance outcomes.
DISCOVER (Determination of Feasibility of Intraoperative Spectral Domain Microscope Combined/Integrated OCT Visualization during En Face Retinal and Ophthalmic Surgery), ERM (epiretinal membrane), iOCT (intraoperative OCT), RD (retinal detachment)
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Journal of VitreoRetinal Diseases. Full-Thickness Macular Hole Formation After Repair of Rhegmatogenous and Tractional Retinal Detachment.
Matthew A. Cunningham, MD, Samantha Fink, BS, Jaya B. Kumar, MD, Elias C. Mavrofrides, MD, S.K. Steven Houston, III, MD, Abdallah M. Jeroudi, MD, Thomas A. Barnard, MD
Thomas A. Barnard. Accepted 2019.
This article reports the clinical features, associations, and outcomes of patients with full-thickness macular hole (MH) formation after pars plana vitrectomy for retinal detachment (RD).
A retrospective, interventional case series is presented of consecutive patients undergoing surgical repair of MH following prior tractional or rhegmatogenous retinal detachment repair from September 2014 to October 2018 at a single vitreoretinal surgery practice. The size of the MH, presence of epiretinal membrane (ERM), rate of MH closure, and visual outcome following repair were evaluated. For more information please click here.
Kumar JB, Han JI, Stinnett S, Jaffe GJ. “Correlation of Subretinal Hyperreflective Material Morphology and Visual Acuity in Neovascular Age Related Macular Degeneration.” Retina. 2019 Jul 10. doi: 10.1097/IAE.0000000000002552
Stultz, R, Conti FF, Kumar JB, Kotabish E, Schachat AP, Ehlers JP, Singh RP. Beta-Thalassemia Minor Manifesting as Proliferative Retinopathy. Ophthalmic Surg Lasers, Imaging Retina. 2018; 49(10) 161-4.
Kumar JB, Ehlers JP, Sharma S, Srivastava SK. Intraoperative Optical Coherence Tomography for Uveitis-related Vitreoretinal Surgery in the DISCOVER Study. Ophthalmology Retina. 2018; 2 (10); 1041-9.
Kumar JB, Kai KM, Ehlers JP, Singh RP, Rachitskaya AV. Subfoveal choroidal thickness as a prognostic factor in exudative age-related macular degeneration. British Journal of Ophthalmology. Published Online First: 27 August 2018. Doi: 10.1136/bjophthalmol-2018-31625
Kumar JB and Sharma S, Kim JE, Thordsen J, Dayani P, Ober M, et al. Pneumatic Displacement of Submacular Hemorrhage with Subretinal Air and Tissue Plasminogen Activator: Initial United States Experience. Ophthalmology Retina. 2018; 2(3):180-6.
Lavine JA, Kumar JB, Rachitskaya AV. Tidal Wave Retinal Detachment. Ophthalmology. 2017;124(8):1217.
Kumar JB, Bosworth HB, Sleath B, Woolson S, Olsen M, Danus S, et al. Quantifying Glaucoma Medication Adherence: The Relationship Between Self-Report, Electronic Monitoring, and Pharmacy Refill. Journal of ocular pharmacology and therapeutics : the official journal of the Association for Ocular Pharmacology and Therapeutics. 2016; 32(6):346-54.
Kumar JB, Proia AD, Mruthyunjaya P, Sharma S. Primary adenocarcinoma of pigmented ciliary epithelium in a phthisical eye. Survey of ophthalmology. 2016;61(4):502-5.
Kumar JB, Silverstein E, Wallace DK. Klebsiella pneumonia: An unusual cause of ophthalmia neonatorum in a healthy newborn. Journal of AAPOS : the official publication of the American Association for Pediatric Ophthalmology and Strabismus / American Association for Pediatric Ophthalmology and Strabismus. 2015;19(6):564-6.
Colon-Acevedo B, Kumar J, Richard MJ, Woodward JA. The Role of Adjunctive Therapies in the Management of Invasive Sino-Orbital Infection. Ophthalmic plastic and reconstructive surgery. 2015;31(5):401-5.
Badhwar J, Karri S, Cass CK, Wunderlich EL, Znosko BM. Thermodynamic characterization of RNA duplexes containing naturally occurring 1 x 2 nucleotide internal loops. Biochemistry. 2007;46(50):14715-24.
Kumar JB, Ehlers, JP. What Vascular Changes may tell us about Macular Edema and Disease Burden. Retina Specialist. 2017:22-5.
Kumar JB, Colon-Acevedo, B, Liss J. Diagnosis and management of superior ophthalmic vein thrombosis. Eye Net Magazine. 2015;May.
Kumar JB, Nallasamy N, Zhang W, Challa P. Review of “Nepafenac 0.1% plus dexamethasone 0.1% versus dexamethasone alone and effect on macular swelling after cataract surgery.”Eye World Journal Club. 2014; September.
Kothary PC, Badhwar J, Weng C, Del Monte MA. Impaired intracellular signaling may allow up-regulation of CTGF-synthesis and secondary peri-retinal fibrosis in human retinal pigment epithelial cells from patients with age-related macular degeneration. Retinal Degenerative Diseases. Advances in experimental medicine and biology. 2010;664:419-28.
Kumar JB, Ehlers JP. “Choroidal Folds.” The Retina Illustrated. In press.
Kumar JB, Sharma S. “Diagnostic Biopsy in Uveitis.” Current Trends in Uveitis. In press.