The Experts below are selected from a list of 9675 Experts worldwide ranked by ideXlab platform
Deborah S. Jacobs - One of the best experts on this subject based on the ideXlab platform.
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Therapeutic Contact Lenses in the Management of Corneal and Ocular Surface Disease
Foundations of Corneal Disease, 2020Co-Authors: Deborah S. Jacobs, Joshua S. AgranatAbstract:Contact lenses serve an important function in the management and treatment of corneal and Ocular Surface Disease. Corneal specialists should have an appreciation of the history and role of contact lenses in the management of corneal Disease. Therapeutic contact lenses can improve quality of life for those with corneal Disease, eliminate the need for cornea transplantation or tarsorrhaphy, and contribute to the success of the Boston KPro in the treatment of corneal blindness.
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Therapeutic Contact Lenses in the Management of Corneal and Ocular Surface Disease
Foundations of Corneal Disease, 2019Co-Authors: Deborah S. Jacobs, Joshua S. AgranatAbstract:Contact lenses serve an important function in the management and treatment of corneal and Ocular Surface Disease. Corneal specialists should have an appreciation of the history and role of contact lenses in the management of corneal Disease. Therapeutic contact lenses can improve quality of life for those with corneal Disease, eliminate the need for cornea transplantation or tarsorrhaphy, and contribute to the success of the Boston KPro in the treatment of corneal blindness.
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Improvement of chronic corneal opacity in Ocular Surface Disease with prosthetic replacement of the Ocular Surface ecosystem (PROSE) treatment
Elsevier, 2018Co-Authors: Anna Cressey, Deborah S. Jacobs, Crystal Remington, Karen G. CarrasquilloAbstract:Purpose: To demonstrate clearing of chronic corneal opacities and improvement of visual acuity with the use of BostonSight prosthetic replacement of the Ocular Surface ecosystem (PROSE) treatment in Ocular Surface Disease. Observations: We undertook retrospective analysis of the medical records of a series of patients who underwent PROSE treatment from August 2006 to December 2014. Patients were referred for Ocular Surface Disease of various etiologies. Primary inclusion criterion was corneal opacity that improved with PROSE treatment. Patients were excluded if topical steroids or adjuvant therapy used once PROSE treatment was initiated. Underlying Disease, prior treatment, clinical presentation, and clinical course were extracted from the medical record. Four patients are included in this series. There were three females and one male; median age at time of treatment initiation was 30 years (range = 0.5–58 years). Median duration of PROSE treatment at time of retrospective analysis was 3.5 years (range = 1–8 years). Two cases had corneal opacification in the context of neurotrophic keratopathy: a unilateral case due to presumed herpes simplex keratitis and a bilateral case due to congenital corneal anesthesia associated with familial dysautonomia. One case had corneal opacity from exposure related to seventh nerve palsy, and one had corneal opacification associated with recurrent Surface breakdown, neurotrophic keratopathy, and limbal stem deficiency of uncertain etiology. After consistent wear of prosthetic devices used in PROSE treatment for support of the Ocular Surface, visual acuity improved and clearing of the opacities was observed, without use of topical steroids or adjuvant therapy. Conclusions and importance: These cases demonstrate clearing of chronic corneal opacity with PROSE treatment for Ocular Surface Disease. This clearing can occur with no adjuvant therapy, suggesting that restoration of Ocular Surface function and integrity allows for corneal remodeling. Keywords: PROSE treatment, Ocular Surface Disease, Opacity, Corneal scar, Dry eye syndrome, Scleral lenses, Scleral prosthetic device
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prosthetic replacement of the Ocular Surface ecosystem treatment of Ocular Surface Disease after skull base tumor resection
World Neurosurgery, 2017Co-Authors: Carolyn E Kloek, Karen W Jengmiller, Deborah S. Jacobs, Ian F DunnAbstract:Background Prosthetic replacement of the Ocular Surface ecosystem (PROSE) treatment is an effective, nonsurgical therapeutic option for patients with Ocular Surface Disease related to cranial nerve deficits secondary to skull base tumor resection. Methods This case series describes the impact of PROSE treatment in patients with symptomatic exposure keratopathy or neurotrophic keratitis after skull base tumor surgery. Results All patients improved symptomatically and functionally with PROSE treatment, and have had sustained improvement for as long as 3 years. Conclusions In postneurosurgical cases in which neurologic function may recover, PROSE treatment offers a safe, nonsurgical treatment option to support the Ocular Surface during the period of observation awaiting neurologic recovery.
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prosthetic replacement of the Ocular Surface ecosystem as treatment for Ocular Surface Disease in patients with a history of stevens johnson syndrome toxic epidermal necrolysis
Ophthalmology, 2015Co-Authors: Thanos D Papakostas, Deborah S. Jacobs, James ChodoshAbstract:Purpose To report the visual outcomes of prosthetic replacement of the Ocular Surface ecosystem (PROSE) treatment in patients with Ocular Surface Disease related to Stevens–Johnson syndrome/toxic epidermal necrolysis (SJS/TEN). Design Retrospective cohort study. Subjects We included 86 patients (167 eyes) with history of SJS/TEN who underwent PROSE treatment from January 1, 2006, to January 1, 2011. Methods Etiology, previous interventions, change in visual acuity, change in visual function, and duration of follow-up are reported. Paired t test and Friedman test with Dunn's post hoc test for multiple comparisons were used for statistical analysis. Main Outcome Measures Visual acuity at last follow-up and visual function based on the National Eye Institute 25-item Visual Functioning Questionnaire (NEI VFQ-25) at 6 months. Results We treated 35 males and 51 females with a history of SJS/TENS; median age was 36 years. The most common reported etiologies for SJS/TENS were antibiotics (n = 25), ibuprofen (n = 15), and lamotrigine (n = 11). The median visual acuity at the initial visit was 20/60 (range, 20/400–20/25; 0.48 logarithm of the minimum angle of resolution [logMAR]), and the visual acuity at completion of customization was 20/25 (range, 20/200–20/20; 0.096 logMAR; P P P Conclusions In a large cohort of patients with chronic Ocular Surface Disease related to SJS/TEN, PROSE treatment offers sustained and significant large improvement in visual function and acuity.
Muriel Schornack - One of the best experts on this subject based on the ideXlab platform.
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Scleral Lenses in the Management of Corneal Irregularity and Ocular Surface Disease.
Eye & contact lens, 2018Co-Authors: Ellen Shorter, Jennifer S Harthan, Cherie B Nau, Amy C. Nau, Joseph T. Barr, David O. Hodge, Muriel SchornackAbstract:Purpose To describe current practice patterns regarding the use of scleral lens therapy in the management of corneal irregularity and Ocular Surface Disease among eye care providers who fit scleral lenses. Methods The Scleral Lenses in Current Ophthalmic Practice: an Evaluation (SCOPE) study group conducted an electronic survey of eye care providers from January 15 to March 31, 2015. Respondents ranked management options for corneal irregularity in the order in which they would generally consider their use. Respondents also ranked options for the management of Ocular Surface Disease in the order in which they would use each of the treatments. Results for each option were analyzed as percentage first-place ranking; percentage first-, second-, or third-place ranking; and mean rank score. Results Survey responses were obtained from 723 providers who had fit 5 or more scleral lenses. Of these respondents, 629 ranked options for management of corneal irregularity and 612 ranked options for management of Ocular Surface Disease. Corneal rigid gas-permeable lenses were the first option for management of corneal irregularity for 44% of respondents, and scleral lenses were the first option for 34% of respondents. Lubricant drops were the first therapeutic recommendation for Ocular Surface Disease for 84% of respondents, and scleral lenses were ranked first by 6% of respondents. Conclusion Scleral lenses rank second only to corneal rigid gas-permeable lenses for management of corneal irregularity. Scleral lenses are generally considered after other medical intervention and before surgery for the management of Ocular Surface Disease.
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Scleral Lenses in the Management of Ocular Surface Disease
Ophthalmology, 2014Co-Authors: Muriel Schornack, Jeff Pyle, Sanjay V. PatelAbstract:Purpose To describe the management of Ocular Surface Disease with commercially available scleral lenses. Design Retrospective case series at a tertiary referral center. Participants A total of 212 patients (346 eyes) who were evaluated for scleral lens therapy for the management of Ocular Surface Disease between June 1, 2006, and November 30, 2011. Methods Retrospective review of medical records and analysis of a survey mailed to all patients who completed the scleral lens fitting process to evaluate the long-term success of scleral lens therapy in the management of Ocular Surface Disease. Main Outcome Measures Therapeutic outcome of scleral lens therapy, improvement in visual acuity with scleral lenses, indications for scleral lens wear, and efficiency of fitting process. Results Of the 212 subjects, 115 (188 eyes) successfully completed the scleral lens fitting process, and therapeutic goals (improved comfort, Ocular Surface protection, or resolution of keratopathy) were achieved in all but 2 of these subjects. Visual acuity improved with scleral lens wear, from 0.32±0.37 logarithm of the minimal angle of resolution (logMAR) (mean ± standard deviation; Snellen equivalent, 20/42) with habitual correction to 0.12±0.19 logMAR (Snellen equivalent, 20/26) with scleral lenses ( P 0.001). The most common indications for scleral lens therapy were undifferentiated Ocular Surface Disease, exposure keratopathy, and neurotrophic keratopathy. Subjects had attempted an average of 3.2 (range, 0–8) other forms of intervention before scleral lens wear. Scleral lens fitting was completed in an average of 3 visits (range, 2–6), with an average of 1.4 lenses/eye (range, 1–4). Three patients experienced complications during scleral lens wear that resolved without loss of visual acuity, enabling resumption of scleral lens wear. Conclusions Commercially available scleral lenses can be successfully used in the management of moderate to severe Ocular Surface Disease. The scleral lens fitting process can be completed efficiently for most eyes by using diagnostic trial lenses. In addition to protecting the Ocular Surface, scleral lenses improve visual acuity in patients whose Surface Disease has compromised vision.
Stephen C Foster - One of the best experts on this subject based on the ideXlab platform.
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gas permeable scleral contact lens therapy in Ocular Surface Disease
American Journal of Ophthalmology, 2000Co-Authors: Tatiana Romerorangel, Panagiota Stavrou, Janis Cotter, Perry Rosenthal, Stefanos Baltatzis, Stephen C FosterAbstract:Abstract PURPOSE: To describe the therapeutic benefits of nonfenestrated gas-permeable scleral contact lenses in the management of patients with Ocular Surface Disease. METHODS: The charts of 49 consecutive patients (76 eyes) with Ocular Surface Disease whose management included the use of gas-permeable scleral contact lenses were reviewed. We also developed a questionnaire to assess the impact of lens wear on subjective aspects of activities of daily living. RESULTS: The mean age of the 49 patients was 44.6 years (range, 3 to 87 years); 31 patients were female and 18 were male. The most common indication for fitting of the lenses was Stevens-Johnson syndrome (54 [71%] of the 76 eyes). Other indications included Ocular cicatricial pemphigoid, exposure keratitis, toxic epidermal necrolysis, postherpetic keratitis, congenital deficiency of meibomian glands, superior limbal keratoconjunctivitis, Sjogren syndrome, and inflammatory corneal degeneration. The mean follow-up was 33.6 months (range, 2 to 144 months). Improvement in best-corrected visual acuity (defined as a gain of 2 or more Snellen lines) was observed in 40 (53%) of the eyes. In eight (53%) of the 15 eyes with active corneal epithelial defects at the time of lens fitting, the defects healed, whereas in the remaining seven eyes the corneal epithelial defects remained unchanged. Forty-five (92%) of the 49 patients reported improvement in their quality of life as a result of reduction of photophobia and discomfort. The mean wearing time of the gas-permeable scleral contact lenses was 13.7 hours per day (range, 4 to 18 hours). Many patients had preparatory surgical procedures before lens fitting (for example, punctal occlusion or mucous membrane grafting), and some had visual rehabilitation surgical procedures (for example, keratoplasty and/or cataract surgery) after lens fitting. CONCLUSIONS: Gas-permeable scleral contact lens wear provides an additional effective strategy in the Surface management and visual rehabilitation of patients with severe Ocular Surface Disease.
Sanjay V. Patel - One of the best experts on this subject based on the ideXlab platform.
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Scleral Lenses in the Management of Ocular Surface Disease
Ophthalmology, 2014Co-Authors: Muriel Schornack, Jeff Pyle, Sanjay V. PatelAbstract:Purpose To describe the management of Ocular Surface Disease with commercially available scleral lenses. Design Retrospective case series at a tertiary referral center. Participants A total of 212 patients (346 eyes) who were evaluated for scleral lens therapy for the management of Ocular Surface Disease between June 1, 2006, and November 30, 2011. Methods Retrospective review of medical records and analysis of a survey mailed to all patients who completed the scleral lens fitting process to evaluate the long-term success of scleral lens therapy in the management of Ocular Surface Disease. Main Outcome Measures Therapeutic outcome of scleral lens therapy, improvement in visual acuity with scleral lenses, indications for scleral lens wear, and efficiency of fitting process. Results Of the 212 subjects, 115 (188 eyes) successfully completed the scleral lens fitting process, and therapeutic goals (improved comfort, Ocular Surface protection, or resolution of keratopathy) were achieved in all but 2 of these subjects. Visual acuity improved with scleral lens wear, from 0.32±0.37 logarithm of the minimal angle of resolution (logMAR) (mean ± standard deviation; Snellen equivalent, 20/42) with habitual correction to 0.12±0.19 logMAR (Snellen equivalent, 20/26) with scleral lenses ( P 0.001). The most common indications for scleral lens therapy were undifferentiated Ocular Surface Disease, exposure keratopathy, and neurotrophic keratopathy. Subjects had attempted an average of 3.2 (range, 0–8) other forms of intervention before scleral lens wear. Scleral lens fitting was completed in an average of 3 visits (range, 2–6), with an average of 1.4 lenses/eye (range, 1–4). Three patients experienced complications during scleral lens wear that resolved without loss of visual acuity, enabling resumption of scleral lens wear. Conclusions Commercially available scleral lenses can be successfully used in the management of moderate to severe Ocular Surface Disease. The scleral lens fitting process can be completed efficiently for most eyes by using diagnostic trial lenses. In addition to protecting the Ocular Surface, scleral lenses improve visual acuity in patients whose Surface Disease has compromised vision.
Shigeru Kinoshita - One of the best experts on this subject based on the ideXlab platform.
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Ocular Surface reconstruction using the combination of autologous cultivated oral mucosal epithelial transplantation and eyelid surgery for severe Ocular Surface Disease
American Journal of Ophthalmology, 2011Co-Authors: Kazunori Takeda, Takahiro Nakamura, Tsutomu Inatomi, Chie Sotozono, Akihide Watanabe, Shigeru KinoshitaAbstract:Purpose To assess the surgical combination of autologous cultivated oral mucosal epithelial transplantation and eyelid surgery used to treat patients with severe Ocular Surface Disease and entropion. Design Observational case series. Methods Three patients with severe thermal and chemical injury were treated by the surgical combination of autologous cultivated oral mucosal epithelial transplantation and everting sutures to correct entropion. Their clinical outcomes and the efficacy of this surgical procedure were assessed. Results The Ocular Surfaces were successfully reconstructed with autologous cultivated oral mucosal epithelial sheets and everting sutures without any complications during the operations. In the course of a mean follow-up period of 30 months their clinical outcomes were assessed. Postoperative follow-up showed that the simultaneous everting sutures caused no problems with the cultivated oral mucosal epithelial sheet, and there were no severe complications such as infection or inflammation. During the follow-up period, in 2 of the 3 eyes the Ocular Surface and eyelid remained stable with no recurrence of entropion. Conclusion This case series presents a surgical approach to treat severely scarred Ocular Surfaces using the combination of autologous cultivated oral mucosal epithelial transplantation and everting sutures. Clinical outcomes suggest that this combined surgical procedure is a safe and useful method for the treatment of patients with severe Ocular Surface Disease and entropion.
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autologous serum derived cultivated oral epithelial transplants for severe Ocular Surface Disease
Archives of Ophthalmology, 2006Co-Authors: Leonard P K Ang, Takahiro Nakamura, Tsutomu Inatomi, Chie Sotozono, Noriko Koizumi, Norihiko Yokoi, Shigeru KinoshitaAbstract:Objective To evaluate the use of autologous serum (AS)–derived cultivated oral epithelial transplants for the treatment of severe Ocular Surface Disease. Methods We used AS from 10 patients with severe Ocular Surface Disease and total limbal stem cell deficiency to develop autologous cultivated oral epithelial equivalents. These were compared with epithelial equivalents derived from conventional fetal bovine serum–supplemented medium. Surgery involved removal of the corneal pannus and surrounding Diseased tissue and transplantation of the AS-derived epithelial equivalents. The oral equivalents were analyzed by review of histologic and immunohistochemical findings. Results Oral epithelial sheets cultivated in AS- and fetal bovine serum–supplemented media were similar in morphology, and both formed basement membrane assembly proteins important for maintaining graft integrity. Complete corneal epithelialization was achieved within 2 to 5 days postoperatively. The Ocular Surface remained stable without major complications in all eyes during a mean ± SD follow-up of 12.6 ± 3.9 months. The visual acuity improved by more than 2 lines in 9 of 10 eyes, with transplanted oral epithelium surviving up to 19 months. Conclusion The successful use of an AS-derived oral epithelial equivalent to treat severe Ocular Surface Disease represents an important advance in the pursuit of completely autologous xenobiotic-free bioengineered Ocular equivalents for clinical transplantation.
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transplantation of autologous serum derived cultivated corneal epithelial equivalents for the treatment of severe Ocular Surface Disease
Ophthalmology, 2006Co-Authors: Takahiro Nakamura, Leonard P K Ang, Tsutomu Inatomi, Chie Sotozono, Noriko Koizumi, Norihiko Yokoi, Shigeru KinoshitaAbstract:Purpose To evaluate the use of autologous serum (AS)-derived cultivated corneal epithelial transplantation for the treatment of severe Ocular Surface Disease. Design Retrospective noncomparative case series. Participants Nine eyes from 9 patients with total limbal stem cell deficiency were studied. These consisted of 2 eyes with Stevens–Johnson syndrome, 1 with chemical injury, 1 with Ocular cicatricial pemphigoid, 1 with Salzmann corneal dystrophy, 1 with aniridia, 1 with graft-versus-host Disease, and 2 with idiopathic Ocular Surface Disease. Methods Autologous serum obtained from patients was used for cultivating corneal epithelial cells on an amniotic membrane substrate. These AS-derived corneal epithelial equivalents were compared with those derived from fetal bovine serum (FBS)-supplemented medium. At the time of surgery, complete removal of the corneal pannus and conjunctiva up to 3 mm from the limbus was performed. Allogeneic (7 cases) and autologous (2 cases) AS-derived cultivated corneal epithelial equivalents were transplanted onto the Ocular Surface. Postoperative follow-up included serial slit-lamp examinations with fluorescein staining, as well as photographic documentation. Main Outcome Measures Ocular Surface reconstruction with corneal epithelialization, graft integrity, visual acuity, and postoperative complications. Results The corneal epithelial sheets cultivated in AS- and FBS-supplemented media were morphologically similar, and demonstrated the normal expression of tissue-specific keratins and junctional specialization assembly proteins. After transplantation, complete corneal epithelialization was achieved within 2 to 5 days. All eyes demonstrated an improvement in visual acuity by ≥2 lines. During the follow-up period of 14.6±4.36 months, the corneal Surface of all patients remained stable and transparent, without significant complications. Conclusions Transplantation of AS-derived cultivated corneal epithelial equivalents was shown to be a feasible method of treating patients with severe Ocular Surface Disease. The use of AS is of clinical importance in the development of autologous xenobiotic-free bioengineered Ocular Surface equivalents for clinical transplantation.
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Changes in conjunctival clusterin expression in severe Ocular Surface Disease.
Investigative ophthalmology & visual science, 2002Co-Authors: Takahiro Nakamura, Kohji Nishida, Atsuyoshi Dota, Shigeru KinoshitaAbstract:Purpose Clusterin is a unique gene transcript in the human Ocular Surface epithelia and is synthesized by and localized in mucosal epithelia in general. It is not present, however, in keratinized epithelia, such as epidermis. In severe Ocular Surface Disease, pathologic keratinization (squamous metaplasia) of the ordinarily nonkeratinized corneal and conjunctival mucosal epithelia results in severe visual loss. In the current study, the expression of clusterin was examined in conjunctivalized corneas with severe Ocular Surface Disease. Methods We examined conjunctiva covering cornea in eight eyes with Ocular Surface Disease (Stevens-Johnson syndrome and Ocular cicatricial pemphigoid) in which pathologic keratinization was present. Normal conjunctiva from four age-matched individuals served as the control. Semiquantitative RT-PCR was used to investigate expression of the clusterin gene. Immunohistochemistry was used to study the distribution of clusterin protein. Results The level of clusterin mRNA was significantly lower than normal in the Diseased Ocular Surfaces. Clusterin protein was also markedly decreased in keratinized conjunctiva compared with that in normal eyes. Conclusions Clusterin expression is markedly reduced in the pathologic, keratinized Ocular Surface epithelium, suggesting its importance in maintaining the Ocular Surface epithelium as a nonkeratinizing epithelium.
