Steven Sanislo, MD

All Publications

• Barriers to Follow-Up and Strategies to Improve Adherence to Appointments for Care of Chronic Eye Diseases. Investigative ophthalmology & visual science Thompson, A. C., Thompson, M. O., Young, D. L., Lin, R. C., Sanislo, S. R., Moshfeghi, D. M., Singh, K. 2015; 56 (8): 4324-4331

  Abstract

  To understand factors associated with poor attendance of follow-up appointments for care of glaucoma (GL), AMD, and diabetic retinopathy (DR) in a tertiary referral center, and to identify strategies to improve adherence.Cross-sectional study of 240 adults attending follow-up appointments for GL, AMD, or DR. Cases (N = 102) were patients with poor follow-up who missed and failed to reschedule an appointment within 1 month of the recommended follow-up date during the preceding year. Controls (N = 138) were patients who completed the assigned follow-up. Data regarding the factors impacting adherence to appointments were collected via an orally administered questionnaire. Multivariate logistic regression was performed to determine factors associated with poor follow-up.In a multivariate logistic regression model, independent factors significantly associated with poor follow-up included incorrectly answering more than 50% of questions about eye disease (adjusted odds ratio [OR] = 3.24, P = 0.001), legal blindness (adjusted OR 2.64, P = 0.013), the presence of glaucomatous versus retinal disease (adjusted OR 2.06, P = 0.013), and difficulty for the study subject and/or escort taking time away from work for the appointments (adjusted OR 1.80, P = 0.049). Subjects identified the following strategies to improve follow-up: contact with others having the same eye condition (41.3%), greater education regarding eye disease (40.8%), and improved transportation services to the clinic (44.6%).Low disease knowledge scores, legal blindness, and difficulty getting time away from work for appointments adversely impacted follow-up independent of eye disease diagnosis. Improvements in patient education, transportation services, and clinic efficiency may increase adherence to recommended appointment intervals.

  View details for DOI 10.1167/iovs.15-16444

  View details for PubMedID 26176869

• Ocular toxoplasmosis in the United States: recent and remote infections. Clinical infectious diseases Jones, J. L., Bonetti, V., Holland, G. N., Press, C., Sanislo, S. R., Khurana, R. N., Montoya, J. G. 2015; 60 (2): 271-273

  Abstract

  We tested all samples from patients with ocular toxoplasmosis sent to the Palo Alto Medical Foundation Toxoplasma Reference Laboratory from June 2004 through August 2010 for serologic evidence of recent Toxoplasma gondii infection. Of 205 patients aged 10-96 years, 11.7% had recent infection. Many people develop ocular disease soon after T. gondii infection.

  View details for DOI 10.1093/cid/ciu793

  View details for PubMedID 25301214

• Prefoveal vitreous condensation in chronic inflammation. Ophthalmic surgery, lasers & imaging retina Paulus, Y. M., Wong, I. G., Sanislo, S., Moshfeghi, D. M. 2014; 45 (5): 447-450

  Abstract

  Uveitis can produce a host of signs throughout the eye. Cylinders, snowballs, condensations, and snowbanks in the vitreous have been described. The authors report two cases of chronic ocular inflammation with a novel sign of a prefoveal white vitreous condensation. One patient is a 6-year-old child with intermediate uveitis and positive results for PPD, and the second is a 65-year-old woman with bilateral recurrent intraocular lymphoma. Both cases responded well to vitrectomy and treatment of the inflammation.

  View details for DOI 10.3928/23258160-20140806-03

  View details for PubMedID 25153658

• Prefoveal Vitreous Condensation in Chronic Inflammation OPHTHALMIC SURGERY LASERS & IMAGING RETINA Paulus, Y. M., Wong, I. G., Sanislo, S., Moshfeghi, D. M. 2014; 45 (5): 447-450

  View details for DOI 10.3928/23258160-20140806-03

  View details for Web of Science ID 000347297300014

  View details for PubMedID 25153658

• 16 and 24 Gy low-voltage X-ray irradiation with ranibizumab therapy for neovascular age-related macular degeneration: 12-month outcomes. American journal of ophthalmology Morales-Canton, V., Quiroz-Mercado, H., Velez-Montoya, R., Zavala-Ayala, A., Moshfeghi, A. A., Shusterman, E. M., Kaiser, P. K., Sanislo, S. R., Gertner, M., Moshfeghi, D. M. 2013; 155 (6): 1000-1008 e2

  Abstract

  To describe the 12-month safety and efficacy outcomes of 16 or 24 Gy radiation using low-voltage x-ray irradiation in conjunction with intravitreal ranibizumab for neovascular age-related macular degeneration (AMD).Prospective, phase I, open-label, nonrandomized uncontrolled safety study.setting: Institutional. study population: Neovascular AMD patients. intervention: One x-ray irradiation treatment at 16 or 24 Gy was administered externally through 3 locations in the inferior pars plana. After 2 initial monthly loading doses of ranibizumab, subsequent ranibizumab was administered according to predetermined criteria. main outcome measures: Visual acuity, number of ranibizumab injections, safety and efficacy metrics at 12 months.Forty-seven eyes of 47 patients were enrolled and completed 12 months of follow-up: 16 Gy (n = 28) and 24 Gy (n = 19). There was no evidence of radiation retinopathy, optic neuropathy, or cataract. The mean visual acuity improved in both groups: +8.4 ± 11.9 letters and +7.8 ± 12 letters for 16 and 24 Gy, respectively. In both groups, 100% of subjects lost <15 letters, with 76% and 79% gaining ≥0 letters in the 16 Gy and 24 Gy groups, respectively. Patients received a mean of 1.0 additional injection over 12 months. The mean change in optical coherence tomography central subfield thickness from baseline to month 12 was -107 and -87 μm for the 16 Gy and 24 Gy groups, respectively.One treatment of 16 or 24 Gy low-voltage x-ray therapy with as-needed ranibizumab appears safe in subjects with neovascular AMD at 12 months. An overall improvement in visual acuity was observed. No radiation-related adverse effects were reported.

  View details for DOI 10.1016/j.ajo.2013.01.015

  View details for PubMedID 23497847

• 16 and 24 Gy Low-voltage X-ray Irradiation With Ranibizumab Therapy for Neovascular Age-Related Macular Degeneration: 12-Month Outcomes. American journal of ophthalmology Morales-Canton, V., Quiroz-Mercado, H., Velez-Montoya, R., Zavala-Ayala, A., Moshfeghi, A. A., Shusterman, E. M., Kaiser, P. K., Sanislo, S. R., Gertner, M., Moshfeghi, D. M. 2013; 155 (6): 1000-1008 e2

  View details for DOI 10.1016/j.ajo.2013.01.015

  View details for PubMedID 23497847

• Herpes simplex virus type 2 mediated acute retinal necrosis in a pediatric population: case series and review GRAEFES ARCHIVE FOR CLINICAL AND EXPERIMENTAL OPHTHALMOLOGY Silva, R. A., Berrocal, A. M., Moshfeghi, D. M., Blumenkranz, M. S., Sanislo, S., Davis, J. L. 2013; 251 (2): 559-566

  Abstract

  We report 15 eyes with herpes simples virus type 2 (HSV-2) mediated acute retinal necrosis (ARN) in order to better characterize pathogenesis, clinical course, diagnosis, and outcomes of the disease.Retrospective observational case series of 14 patients (15 eyes) all aged 21 years or younger with acute retinal necrosis resulting from HSV-2 and examined between 1995 and 2009. Patients were diagnosed by various techniques, including polymerase chain reaction (PCR) of aqueous, vitreous, and serum, antibody determination of serum and intraocular fluids, fundoscopic exam, a therapeutic trial of antivirals active against HSV-2, or a combination thereof.Mean age of presentation was 11.7 years (range, newborn to 21.0 years) with a standard deviation of 7.0 years. Mean initial vision was 20/200 (median, 20/400; range, 20/20 to LP). Eleven patients (73.3 %) had received oral, injectable, or topical corticosteroids, and 14 (93.3 %) had received antiviral therapy. All patients were diagnosed based on evaluation of intraocular fluids and tissue by antibody determinations, culture, PCR, histopathologic examination, or a combination thereof. Mean final visual acuity was 20/400 (median, CF; range, 20/25 to LP) with worsened visual acuity in five eyes (33.3 %). Anatomically, 14 of 15 eyes had healed or improved retinal appearance.In a pediatric population with acute retinal necrosis, HSV-2 should be considered as the prime candidate virus. Diagnosis of HSV-2 acute retinal necrosis is accomplished mainly by PCR of ocular specimens. Prompt diagnosis may lead to appropriate anti-viral therapy.

  View details for DOI 10.1007/s00417-012-2164-8

  View details for Web of Science ID 000314683200020

  View details for PubMedID 23052715

• 16 Gy low-voltage x-ray irradiation followed by as needed ranibizumab therapy for age-related macular degeneration: 12 month outcomes of a 'radiation-first' strategy BRITISH JOURNAL OF OPHTHALMOLOGY Moshfeghi, A. A., Morales-Canton, V., Quiroz-Mercado, H., Velez-Montoya, R., Zavala-Ayala, A., Shusterman, E. M., Kaiser, P. K., Sanislo, S. R., Gertner, M., Moshfeghi, D. M. 2012; 96 (10): 1320-1324

  Abstract

  To describe 'radiation-first' combination treatment with a non-invasive, low-voltage x-ray irradiation system followed by as needed ranibizumab for neovascular age-related macular degeneration (AMD).Phase I study of non-invasive, low-voltage 16 Gy x-ray irradiation delivered in three beams via the inferior pars plana in patients with active neovascular AMD. Ranibizumab was administered as needed per protocol. Patients were followed monthly for safety and efficacy over 12 months.13 patients were enrolled and completed 12 months follow-up. Safety was good with no serious ocular/non-ocular adverse events or radiation-related ocular complications. 11 patients lost <15 Early Treatment of Diabetic Retinopathy Study (ETDRS) letters, seven gained ≥0 ETDRS letters and 0 gained ≥15 ETDRS letters. Patients received a total of 31 subsequent ranibizumab injections (of possible 156) over the 12 months following x-ray irradiation. Mean time to first injection was 3.9 months. One patient received no ranibizumab injections, three patients received one injection, four patients received two injections, and five patients received three or more injections.After 12 months, non-invasive, low-voltage x-ray irradiation with as needed ranibizumab rescue therapy demonstrated good safety with a visual acuity stabilising effect and reduction in retinal thickness in patients with neovascular AMD.

  View details for DOI 10.1136/bjophthalmol-2011-301222

  View details for Web of Science ID 000309215500010

  View details for PubMedID 22895887

• Macular infarction following intravitreal bevacizumab for treatment of central retinal vein occlusion. Ophthalmic surgery, lasers & imaging : the official journal of the International Society for Imaging in the Eye Leung, L. B., Silva, R. A., Blumenkranz, M. S., Flynn, H. W., Sanislo, S. R. 2012; 43: e73-9

  Abstract

  Bevacizumab, a monoclonal antibody against vascular endothelial growth factor (VEGF), is widely used for the treatment of macular edema associated with central retinal vein occlusion (CRVO). The authors present a series of three patients with CRVO who suffered apparent macular infarction within weeks of intravitreal administration of bevacizumab. Of the nearly 200 patients undergoing intravitreal injections of bevacizumab for this indication over a surveillance period of 3 years, this event occurred in three patients. This has not been described in the natural history of the disease and is associated with poor visual outcomes.

  View details for DOI 10.3928/15428877-20120712-05

  View details for PubMedID 22823029

• 24-Gy Low-Voltage X-Ray Irradiation With Ranibizumab Therapy for Neovascular AMD: 6-Month Safety and Functional Outcomes OPHTHALMIC SURGERY LASERS & IMAGING Morales Canton, V., Quiroz-Mercado, H., Velez-Montoya, R., Lopez-Miranda, M. J., Moshfeghi, A. A., Shusterman, E. M., Kaiser, P. K., Sanislo, S. R., Gertner, M., Moshfeghi, D. M. 2012; 43 (1): 20-24

  Abstract

  To describe the 6-month safety and preliminary efficacy outcomes of the use of 24-Gy radiation with intravitreal ranibizumab for patients with neovascular age-related macular degeneration (AMD).A single treatment of a non-invasive, externally delivered low-voltage x-ray irradiation at a dose of 24 Gy was administered in one session through three locations in the inferior pars plana in a consecutive series of patients with neo-vascular AMD (treatment naïve and previously treated). Optical coherence tomography (OCT) and Early Treatment Diabetic Retinopathy Study (ETDRS) visual acuity examinations were performed at 1 week, 1 month, and monthly thereafter with quarterly fluorescein angiography.Nineteen patients completed 6 months of follow-up. There was no evidence of radiation retinopathy, optic neuropathy, or cataract. The mean baseline ETDRS score was 38.3 ± 19.5 letters. At 6 months, the corresponding ETDRS score was 44.7 ± 16.8 letters. At 6 months, the mean change in visual acuity was 6.4 ± 9.8 ETDRS letters. Patients received an average of 0.4 additional ranibizumab injections following the initial two mandated injections.A single treatment of external 24-Gy low-voltage x-ray therapy in conjunction with ranibizumab demonstrated an overall improvement in visual acuity in patients with neovascular AMD at 6 months, with no radiation-related adverse effects.

  View details for DOI 10.3928/15428877-20111129-01

  View details for Web of Science ID 000305342600003

  View details for PubMedID 22251841

• 16-Gy Low-Voltage X-ray Irradiation Followed by As-Needed Ranibizumab Therapy for AMD: 6-Month Outcomes of a "Radiation-First" Strategy OPHTHALMIC SURGERY LASERS & IMAGING Moshfeghi, A. A., Canton, V. M., Quiroz-Mercado, H., Velez-Montoya, R., Lopez-Miranda, M. J., Shusterman, E. M., Kaiser, P. K., Sanislo, S. R., Gertner, M., Moshfeghi, D. M. 2011; 42 (6): 460-467

  Abstract

  To describe the effect of a "radiation-first" combination treatment strategy for neovascular age-related macular degeneration (AMD) with ranibizumab rescue therapy.Non-invasive, externally delivered low-voltage x-ray irradiation at a dose of 16 Gy was given in a single session through three locations in the inferior pars plana in a consecutive series of patients with neovascular AMD. Ranibizumab was administered according to prospectively determined criteria.Thirteen patients completed a 6-month follow-up. All patients lost 15 or fewer ETDRS letters, 7 gained 0 or more ETDRS letters, and 0 gained more than 15 ETDRS letters. Patients received a total of 15 ranibizumab injections following x-ray irradiation at baseline. Two patients received no ranibizumab injections, seven patients received 1 injection, and four patients received 2 injections.Low-voltage x-ray treatment followed by ranibizumab rescue demonstrates an independent visual acuity stabilizing effect for patients with wet AMD.

  View details for DOI 10.3928/15428877-20110804-03

  View details for Web of Science ID 000305342500003

  View details for PubMedID 21830745

• 16-Gy Low-Voltage X-ray Irradiation With Ranibizumab Therapy for AMD: 6-Month Safety and Functional Outcomes OPHTHALMIC SURGERY LASERS & IMAGING Canton, V. M., Quiroz-Mercado, H., Velez-Montoya, R., Lopez-Miranda, M. J., Moshfeghi, A. A., Shusterman, E. M., Kaiser, P. K., Sanislo, S. R., Gertner, M., Moshfeghi, D. M. 2011; 42 (6): 468-473

  Abstract

  To describe the 6-month safety and preliminary efficacy outcomes of the use of 16-Gy radiation with intravitreal ranibizumab for patients with neovascular age-related macular degeneration (AMD).A single treatment of a non-invasive, externally delivered low-voltage 16-Gy x-ray irradiation was administered in one session through three locations in the inferior pars plana. Optical coherence tomography (OCT) and Early Treatment Diabetic Retinopathy Study (ETDRS) visual acuity (VA) examinations were performed at 1 week, 1 month, and monthly thereafter, with quarterly fluorescein angiography (FA). After the two initial ranibizumab injections, subsequent injections were administered according to the following criteria: VA decline of 10 ETDRS letters compared with baseline, increase of 100-μm central foveal thickness on OCT compared with baseline, the development of new submacular hemorrhage, and the development of a new area of classic choroidal neovascularization on FA.Twenty-six patients completed a 6-month follow-up. There was no evidence of radiation retinopathy, optic neuropathy, or cataract. The mean baseline ETDRS score was 46.6 letters (range: 5 to 80; standard deviation [SD]: 21.5). At 6 months, the corresponding ETDRS score was 55.6 letters (range: 25 to 80; SD: 18.9) and the mean change in VA was 9.5 ETDRS letters (SD: 10.3). On responder analysis, 96% lost 15 or fewer ETDRS letters, 81% gained 0 or more ETDRS letters, and 50% gained 15 or more ETDRS letters. Patients received a total of 13 ranibizumab injections following two initial injections. At 6 months, patients received an average of 0.5 additional injections following the initial two mandated injections.A single treatment of externally applied, non-invasive 16-Gy low-voltage x-ray therapy in conjunction with ranibizumab demonstrated an overall improvement of VA in patients with neovascular AMD at 6 months with no radiation-related adverse effects.

  View details for DOI 10.3928/15428877-20110804-01

  View details for Web of Science ID 000305342500004

  View details for PubMedID 21830747

• Photodynamic therapy rescue for subretinal fluid exacerbation after focal laser treatment in idiopathic central serous chorioretinopathy. The open ophthalmology journal Leng, T., Sanislo, S. R., Jack, R. L. 2011; 5: 6-9

  Abstract

  To report a case of subretinal leakage after focal laser treatment for idiopathic central serous chorioretinopathy (ICSC). This rare complication was successfully treated with photodynamic therapy (PDT).Interventional case report.A 36-year-old male presented with ICSC in his right eye. After a period of observation without resolution, he was treated with focal laser. That treatment resulted in a massive exacerbation of his subretinal fluid. PDT was successfully used to treat the severe exacerbation with rapid resolution of the subretinal fluid, improvement in visual acuity, decreased leakage on fluorescein angiography, and reduction of subretinal fluid on ophthalmoscopic exam and by optical coherence tomography.Ophthalmologists should consider the use of PDT in cases where focal laser causes an exacerbation of subretinal fluid in ICSC.

  View details for DOI 10.2174/1874364101105010006

  View details for PubMedID 21399767

• Antibiotic Susceptibility Patterns of Ocular Bacterial Flora in Patients Undergoing Intravitreal Injections OPHTHALMOLOGY Moss, J. M., Sanislo, S. R., Ta, C. N. 2010; 117 (11): 2141-2145

  Abstract

  To determine the antibiotic susceptibility patterns of conjunctival flora in patients undergoing intravitreal (IVT) injection.Prospective, observational study.Patients (n = 85) scheduled to undergo 136 IVT injections at California Vitreoretinal Center at Stanford University.Conjunctival cultures were obtained on the day of the IVT injection from the injection site bulbar conjunctiva before the application of povidone-iodine or antibiotics.Bacterial isolates were identified and tested for antibiotic susceptibility using either the Kirby-Bauer disc-diffusion technique or MicroScan-WalkAway system.Our analysis included 136 samples collected from 90 eyes of 85 patients. Of those with positive cultures (n = 65), the most common bacterial isolates were coagulase-negative staphylococci (CNS), comprising 59 (83%) of the 71 bacterial strains. Among the CNS, all were susceptible to vancomycin and >80% were susceptible to gentamicin, chloramphenicol, tetracycline, and imipenem. Between 60% and 80% of the CNS were susceptible to the cephalosporins and newer generation fluoroquinolones. Fewer than 60% were susceptible to the penicillin analogs, erythromycin, and the earlier generation fluoroquinolones. Nearly half of the CNS (47%) were resistant to oxacillin/methicillin.Bacteria isolated from the injection site of patients undergoing IVT injections were mostly CNS. Most are sensitive to vancomycin, gentamicin, and chloramphenicol.Proprietary or commercial disclosure may be found after the references.

  View details for DOI 10.1016/j.ophtha.2010.02.030

  View details for Web of Science ID 000283264200016

  View details for PubMedID 20561687

• An extensive case of acute posterior multifocal placoid pigment epitheliopathy. Retinal cases & brief reports Chan, A., Blumenkranz, M. S., Sanislo, S. R. 2010; 4 (4): 336-338

  Abstract

  To report a case of extensive acute posterior multifocal placoid pigment epitheliopathy (APMPPE).Case report.An 18-year-old girl was admitted and treated with intravenous acyclovir and intravitreal gancyclovir for presumed acute retinal necrosis. As the lesions faded and vision improved, the findings became more consistent with an extensive form of APMPPE.Acute posterior multifocal placoid pigment epitheliopathy can present very aggressively early in its course. Despite macular involvement, as in this patient, vision can improve significantly.

  View details for DOI 10.1097/ICB.0b013e3181aff47e

  View details for PubMedID 25390912

• Photodynamic Therapy With and Without Adjunctive Intravitreal Triamcinolone Acetonide: A Retrospective Comparative Study OPHTHALMIC SURGERY LASERS & IMAGING Chan, A., Blumenkranz, M. S., Wu, K. H., Wang, G., Berker, N., Parast, L. M., Sanislo, S. R. 2009; 40 (6): 561-569

  Abstract

  To compare photodynamic therapy (PDT) with and without adjunctive intravitreal triamcinolone acetonide (IVTA) in the treatment of choroidal neovascularization secondary to age-related macular degeneration.Sixty-six eyes received PDT with IVTA and 73 eyes received PDT only. Outcome measures included changes in visual acuity and greatest linear dimension (GLD), the presence of angiographic leakage, the re-treatment rate, and adverse events.Patients treated with PDT with IVTA had reduced mean GLD compared to patients treated with PDT only at all study time points (3 [P = .0049], 6 [P = .003], and 12 [P = .05] months). Forty-four percent of patients in the PDT with IVTA group and 22% of patients in the PDT only group achieved angiographic closure at 3 months (P = .027). There were no significant differences in the final visual acuity outcome or the re-treatment rate between the two groups.PDT with IVTA therapy has a favorable outcome on GLD. There is a modest improvement in visual acuity with PDT with IVTA therapy, which diminishes over time.

  View details for DOI 10.3928/15428877-20091030-05

  View details for Web of Science ID 000272510500006

  View details for PubMedID 19928721

• A Prospective Randomized Evaluation of Topical Gatifloxacin on Conjunctival Flora in Patients Undergoing Intravitreal Injections OPHTHALMOLOGY Moss, J. M., Sanislo, S. R., Ta, C. N. 2009; 116 (8): 1498-1501

  Abstract

  We sought to assess the efficacy of 3-day topical gatifloxacin use in combination with povidone-iodine (PVI) versus PVI alone in eliminating conjunctival bacterial flora in patients scheduled to undergo intravitreal (IVT) injection.Prospective, randomized single-blind clinical trial.We included 129 patients scheduled to undergo 273 IVT injections at California Vitreoretinal Center at Stanford University.Study patients were randomized to self-administration of gatifloxacin drops for 3 days before injection, or no pretreatment antibiotics. Cultures were collected from the bulbar conjunctiva at the injection site and at the corresponding location in the fellow eye before PVI preparation. After topical PVI treatment and immediately before injection, a third culture was obtained at the injection site. Additionally, the injection needle was also cultured after the procedure.Incidence of positive bacterial samples collected from injection site conjunctiva and injection needles.Three-day gatifloxacin use resulted in a significantly lower rate of SeptiChek (Becton Dickinson, Franklin Lakes, NJ) positive cultures compared with untreated controls (21% vs 48% respectively, P = 0.005). After topical PVI, the rate of positive bacterial cultures in gatifloxacin-treated and control eyes were similar (8% and 4%, respectively; P = 0.324).Although 3-day topical gatifloxacin use is effective in reducing the frequency of conjunctival bacterial growth relative to untreated eyes, antibiotic use confers no additional benefit in combination with PVI than eyes receiving PVI alone. This supports that topical PVI is an effective preinjection monotherapy for infection prophylaxis in the setting of IVT injections.

  View details for DOI 10.1016/j.ophtha.2009.02.024

  View details for Web of Science ID 000268710200013

  View details for PubMedID 19501409

• TRIAMCINOLONE ACETONIDE PREPARATIONS Impact of Crystal Size on In Vitro Behavior RETINA-THE JOURNAL OF RETINAL AND VITREOUS DISEASES Moshfeghi, A. A., Nugent, A. K., Nomoto, H., Sanislo, S. R., Kitchens, J. W., Moshfeghi, D. M. 2009; 29 (5): 689-698

  Abstract

  To characterize the in vitro behavior of three preparations of triamcinolone acetonide (TA).Three preparations of TA were mixed with Balanced Salt Solution Plus: commercially available TA (Kenalog 40, Bristol-Myers Squibb, Princeton, NJ), compounded preservative-free triamcinolone acetonide (PFTA, New England Compounding Center, Framingham, MA), and triamcinolone acetonide injectable suspension (TAIS, TRIESENCE, Alcon, Inc., Fort Worth, TX). We determined the mean number of crystalline aggregates per high-power deconvolution microscopy field, largest aggregate area, and spectroscopic photometric absorption.Preservative-free triamcinolone acetonide had larger mean number of aggregates compared with TA (time 0 P = 0.002, 10 minutes P < 0.001) and TAIS (time 0 P < 0.001, 10 minutes P = 0.003). Aggregate size varied at both 0 and 10 minutes: TAIS > TA > PFTA. Spectroscopic photometric absorption decreased in direct correlation to aggregate size over time for all three preparations.In vitro, PFTA in Balanced Salt Solution Plus had more aggregates of smaller size than either TA or TAIS. By contrast, TAIS had much larger aggregate size than both PFTA and TA, and this increased over time. These findings correlate with the clinical observations that PFTA and TA tend to disperse throughout the vitreous, whereas TAIS tends to conglomerate and gravitate toward the most dependent portion of the eye in a globular fashion.

  View details for Web of Science ID 000266059000019

  View details for PubMedID 19373129

• Surveillance for potential adverse events associated with the use of intravitreal bevacizumab for retinal and choroidal vascular disease RETINA-THE JOURNAL OF RETINAL AND VITREOUS DISEASES Wong, L. J., Desai, R. U., Jain, A., Feliciano, D., Moshfeghi, D. M., Sanislo, S. R., Blumenkranz, M. S. 2008; 28 (8): 1151-1158

  Abstract

  To systematically study potential adverse events associated with the use of intraocular bevacizumab at a single medical center.Retrospective study of all consecutive patients receiving intraocular bevacizumab injections at the Stanford University Department of Ophthalmology between November 15, 2005 and July 14, 2006. Bevacizumab was given for exudative age-related macular degeneration, retinal vascular occlusion, diabetic macular edema, neovascular glaucoma, and five other indications.We analyzed medical records of 186 subjects (203 eyes) who received a total of 578 injections of 1.25 mg of bevacizumab. The average follow-up was approximately 6 months. Five eyes with exudative age-related macular degeneration developed retinal pigment epithelial (RPE) tears, all with preexisting RPE detachments. These five eyes represented 2.9% of all age-related macular degeneration eyes treated and 7% of the age-related macular degeneration eyes with preexisting RPE detachments at initiation of treatment. Other adverse events were rare and included retinal ischemia, subretinal hemorrhage, vitreous hemorrhage, ocular irritation or pain, worsened hypertension, and headache. No death or thromboembolic events were observed.Intraocular bevacizumab appears to be well tolerated for the treatment of a variety of retinal and choroidal vascular diseases. RPE tears may occur when treating choroidal neovascularization, particularly in patients with preexisting RPE detachment.

  View details for Web of Science ID 000259329100018

  View details for PubMedID 18685542

• Bacterial contamination of ocular surface and needles in patients undergoing intravitreal injections 109th Annual Meeting of the American-Academy-of-Ophthalmology De Caro, J. J., Ta, C. N., Ho, H. V., Cabael, L., Hu, N., Sanislo, S. R., Blumenkranz, M. S., Moshfeghi, D. M., Jack, R., de Kaspar, H. M. LIPPINCOTT WILLIAMS & WILKINS. 2008: 877–83

  Abstract

  To evaluate potential sources of bacterial contamination during intravitreal (IVT) injection procedures.Patients scheduled for IVT injection were asked to enroll in the study at the California Vitreoretinal Center (Menlo Park, CA) and the Vantage Eye Center (Salinas, CA) between October 2004 and April 2005. A total of 104 patients participated in the study, with a total of 118 IVT injection procedures performed on 107 eyes. Standard microbiological techniques were used to culture, identify, and quantify bacterial contamination of injection needles and the bulbar conjunctiva at the injection site in patients undergoing IVT injections. The main outcomes measured were type and quantity of bacterial isolates.Two (2%) of 114 needles collected were contaminated with bacteria. The prevalence of bacterial contamination of the injection site on the bulbar conjunctiva was 43% before prophylaxis on the day of the injection with topical antibiotics and povidone-iodine, with a statistically significant reduction to 13% after prophylaxis (P < 0.0001). Coagulase-negative Staphylococcus, the most common bacterium isolated from the ocular surface, was isolated from both culture-positive needles.IVT injection needles became contaminated with bacteria during the injection procedure. Although the contamination rate was low, this supports a mechanism of postinjection endophthalmitis in which there is direct inoculation of ocular surface flora into the vitreous cavity by the injection needle.

  View details for Web of Science ID 000256714300014

  View details for PubMedID 18536606

• Perspective: Tissue engineering for RPE transplantation in AMD SPEKTRUM DER AUGENHEILKUNDE Stanzel, B. V., Englander, M., Strick, D. J., Sanislo, S. S., Huie, P., Blumenkranz, M. S., Binder, S., Marmor, M. F. 2007; 21 (4): 212-217

  View details for DOI 10.1007/s00717-007-0213-1

  View details for Web of Science ID 000257708800003

• Retinal pigment epithelium tears after intravitreal injection of bevacizumab (Avastin) for neovascular age-related macular degeneration RETINA-THE JOURNAL OF RETINAL AND VITREOUS DISEASES Ronan, S. M., Yoganathan, P., Chien, F. Y., Corcostegui, I. A., Blumenkranz, M. S., Deramo, V. A., Elner, S. G., Fastenberg, D. A., Johnson, M. W., Lopez, M., Mateo, C., Moshfeghi, D. M., Navarro, R., Rosenblatt, B. J., Sanislo, S. R., Saxe, S. J., Zacks, D. N. 2007; 27 (5): 535-540

  Abstract

  Intravitreal bevacizumab (Avastin, Genentech, Inc., South San Francisco, CA) treatment of neovascular age-related macular degeneration (AMD) has become an important part of clinical retinal practice. We describe retinal pigment epithelium (RPE) tears that were noted after intravitreal injection of bevacizumab.In this multimember, retrospective case series, data on eyes that developed RPE tears after intravitreal bevacizumab injection were collected and analyzed. Previous treatments, type of lesion, time to tear, and preinjection and final visual acuities were all compared. The total numbers of bevacizumab injections were available from all four institutions and compiled to estimate the incidence rate.Four retina centers administered a total of 1,455 intravitreal 1.25-mg bevacizumab injections for neovascular AMD during the 9-month study period. Twelve patients presented with RPE tears within 4 days to 8 weeks of injection (mean +/- SD, 24.3 +/- 15.2 days from injection to tear). In each case, the RPE tear was preceded by an RPE detachment, and all had a component of serous sub-RPE fluid. On the basis of our collective data, we estimate an incidence rate of approximately 0.8%.RPE tears can occur after intravitreal injection of bevacizumab. The low incidence of this adverse event should not preclude anti-vascular endothelial growth factor therapy counseling for patients with neovascular AMD, but eyes with serous RPE detachments appear to be most vulnerable to this adverse event.

  View details for Web of Science ID 000247259400002

  View details for PubMedID 17558313

• Candida (amphotericin-sensitive) lens abscess associated with decreasing arterial blood flow in a very low birth weight preterm infant PEDIATRICS Drohan, L., Colby, C. E., Brindle, M. E., Sanislo, S., Ariagno, R. L. 2002; 110 (5)

  Abstract

  In this report, we review the case of a candidal lens abscess in a premature infant girl who was 28 weeks' gestational age at birth. The culture obtained from the lens abscess grew Candida albicans sensitive to amphotericin B but resistant to flucytosine. This case is unique in that the infant developed a fungal lens cataract at 34 weeks' postconceptional age during the last week of a 30-day course of amphotericin B. The embryonic hyaloid artery system, which perfuses the developing lens, regresses between 29 and 32 weeks of gestation; thus, the mechanism for an infection of the lens may be inoculation of the lens by Candida before hyaloid artery system regression, followed by developmental loss of this blood supply, which makes the lens inaccessible to antimicrobial penetration. Candidal endophthalmitis with lens abscess is an uncommon morbidity that requires prompt recognition and surgical intervention for effective management.

  View details for Web of Science ID 000178971800015

  View details for PubMedID 12415071

• Effects of the pulsed electron avalanche knife on retinal tissue ARCHIVES OF OPHTHALMOLOGY Palanker, D. V., Marmor, M. F., Branco, A., Huie, P., MILLER, J. M., Sanislo, S. R., Vankov, A., Blumenkranz, M. S. 2002; 120 (5): 636-640

  Abstract

  To evaluate the precision of retinal tissue dissection by the pulsed electron avalanche knife (PEAK) and to assess possible toxic effects from this device.To demonstrate precision of cutting, bovine retina (in vitro) and rabbit retina (in vivo) were incised with the PEAK. Samples were examined by scanning electron microscopy and histologic examination (light microscopy). To evaluate possible toxic effects in rabbit eyes, 30 000 pulses were delivered into the vitreous 1 cm above the retina. Histologic examinations and electroretinography were performed at intervals up to 1 month after exposure.Cuts in postmortem bovine retina showed extremely sharp edges with no signs of thermal damage. Full-thickness cuts in living attached rabbit retina were similarly sharp and were typically less than 100 microm wide. No signs of retinal toxic effects were detected by histologic examination or electroretinography.The PEAK is capable of precise cutting through retinal tissue, and there are no demonstrable retinal toxic effects from its use. The precision and tractionless nature of PEAK cutting offers advantages over mechanical tools and laser-based instrumentation. We believe this new device will prove useful in a variety of vitreoretinal surgical applications.

  View details for Web of Science ID 000175503400015

  View details for PubMedID 12003616

• Pulsed Electron Avalanche Knife (PEAK) for intraocular surgery INVESTIGATIVE OPHTHALMOLOGY & VISUAL SCIENCE Palanker, D. V., MILLER, J. M., Marmor, M. F., Sanislo, S. R., Huie, P., Blumenkranz, M. S. 2001; 42 (11): 2673-2678

  Abstract

  To develop a better and more economical instrument for precise, tractionless, "cold" cutting during intraocular surgery. The use of highly localized electric fields rather than laser light as the means of tissue dissection was investigated.A high electric field at the tip of a fine wire can, like lasers, initiate plasma formation. Micrometer-length plasma streamers are generated when an insulated 25 micron (microm) wire, exposed to physiological medium at one end, is subjected to nanosecond electrical pulses between 1 and 8 kV in magnitude. The explosive evaporation of water in the vicinity of these streamers cuts soft tissue without heat deposition into surrounding material (cold cutting). Streamers of plasma and the dynamics of water evaporation were imaged using an inverted microscope and fast flash photography. Cutting effectiveness was evaluated on both polyacrylamide gels, on different tissues from excised bovine eyes, and in vivo on rabbit retina. Standard histology techniques were used to examine the tissue.Electric pulses with energies between 150 and 670 microJ produced plasma streamers in saline between 10 and 200 microm in length. Application of electric discharges to dense (10%) polyacrylamide gels resulted in fracturing of the gel without ejection of bulk material. In both dense and softer (6%) gels, layer by layer shaving was possible with pulse energy rather than number of pulses as the determinant of ultimate cutting depth. The instrument made precise partial or full-thickness cuts of retina, iris, lens, and lens capsule without any evidence of thermal damage. Because different tissues require distinct energies for dissection, tissue-selective cutting on complex structures can be performed if the appropriate pulse energies are used; for example, retina can be dissected without damage to the major retinal vessels.This instrument, called the Pulsed Electron Avalanche Knife (PEAK), can quickly and precisely cut intraocular tissues without traction. The small delivery probe and modest cost make it promising for many ophthalmic applications, including retinal, cataract, and glaucoma surgery. In addition, the instrument may be useful in nonophthalmic procedures such as intravascular surgery and neurosurgery.

  View details for Web of Science ID 000171433300037

  View details for PubMedID 11581215

• Dilute topical proparacaine for pain relief after photorefractive keratectomy 100th Annual Meeting of the American-Academy-of-Ophthalmology Shahinian, L., Jain, S., Jager, R. D., LIN, D. T., Sanislo, S. S., Miller, J. F. LIPPINCOTT-RAVEN PUBL. 1997: 1327–32

  Abstract

  The purpose of the study is to determine whether there is a nonanesthetic and nontoxic concentration of topical proparacaine that can be applied repeatedly to the cornea to reduce pain after photorefractive keratectomy (PRK).Part I: To determine a nonanesthetic concentration, the corneal sensitivity of 50 healthy volunteers was assessed using aesthesiometry before and after a drop of either 0.01%, 0.025%, 0.05%, 0.1%, or 0.2% topical proparacaine. Ten volunteers similarly were tested with multiple doses of 0.05% proparacaine. To evaluate toxicity, ten healthy volunteers self-administered 0.05% proparacaine to one eye and placebo to the other eye every 15 minutes for 12 hours on day 1 and every hour for 12 hours on days 2 through 7. Subjects were assessed throughout the week using visual acuity, slitlamp examination, aesthesiometry, and ultrasonic pachometry. Part II: In a prospective, double-masked study, 34 patients who underwent PRK (48 eyes) self-administered either topical 0.05% proparacaine or placebo for 1 week after PRK as needed to reduce pain. Patients recorded their pain score before and after drop use and answered a pain-relief questionnaire.Part I: Proparacaine concentrations greater than or equal to 0.1% eliminated sensation from some corneas; concentrations of less than or equal to 0.05% were never fully anesthetic. No corneal toxicity was observed except for some minimal punctate staining in both treatment and placebo eyes. Part II: Patients in the treatment group had significantly more pain relief (P < 0.001) for a longer period (P < 0.001) than did patients in the control group. Average change in pain score was significantly greater in the treatment group (P < 0.002). No significant difference in the number of days needed to reach complete epithelial healing was found between the two groups (P < 0.18).Dilute (0.05%) topical proparacaine is nonanesthetic and nontoxic, and can be used safely for at least 1 week to reduce pain after PRK.

  View details for Web of Science ID A1997XP84100029

  View details for PubMedID 9261322