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  1. Article ; Online: Demographic Characteristics, Clinical Presentations, and Risk Factors Impacting Visual Outcomes in Peripheral Ulcerative Keratitis.

    Singh, Rohan Bir / Atta, Sarah / Srikumaran, Divya / Jhanji, Vishal

    Cornea

    2024  

    Abstract: Purpose: To assess the demographic characteristics, ophthalmic and systemic presentations, and risk factors impacting the outcomes in patients diagnosed with peripheral ulcerative keratitis (PUK).: Methods: This retrospective study includes patients ... ...

    Abstract Purpose: To assess the demographic characteristics, ophthalmic and systemic presentations, and risk factors impacting the outcomes in patients diagnosed with peripheral ulcerative keratitis (PUK).
    Methods: This retrospective study includes patients diagnosed with PUK at a tertiary care center over 13 years. A descriptive analysis of the demographics, clinical history, and presentation was performed. A reverse risk analysis was performed to assess the PUK resolution in patients with underlying autoimmune and non-autoimmune etiologies. Finally, we evaluated the correlation between treatment duration and final best corrected visual acuity (BCVA) and continuous and categorical variables.
    Results: A total of 58 eyes of 51 patients with a mean age of 59.67 ± 13.41 years diagnosed with PUK were included in the study; 58.82% were female. The resolution duration was significantly shorter in patients with autoimmune etiologies (vs. non-autoimmune etiologies, P = 0.028) and female patients (vs. male patients, P = 0.008). The BCVA worsened in patients with non-autoimmune etiologies after treatment (P = 0.17). Despite worse BCVA at presentation in patients with underlying autoimmune etiologies, significantly better final vision outcomes were observed (P = 0.04). Linear regression analysis showed that longer treatment duration (P = 0.001; R2 = 0.1704) and worse vision (P = 0.002; R2 = 0.1502) at presentation were the primary risk factors of poor vision outcomes. Similarly, the treatment duration was significantly longer in male compared with female patients (P < 0.001; R2 = 0.2027).
    Conclusions: The clinical outcomes in PUK with underlying autoimmune disorders were observed to be better than non-autoimmune etiologies, which may be attributed to the early detection of the PUK-related changes and aggressive medical management. A delayed diagnosis of PUK leads to poor vision outcomes.
    Language English
    Publishing date 2024-03-14
    Publishing country United States
    Document type Journal Article
    ZDB-ID 604826-2
    ISSN 1536-4798 ; 0277-3740
    ISSN (online) 1536-4798
    ISSN 0277-3740
    DOI 10.1097/ICO.0000000000003541
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  2. Article ; Online: Fungal Keratitis: Clinical Features, Risk Factors, Treatment, and Outcomes.

    Atta, Sarah / Perera, Chandrashan / Kowalski, Regis P / Jhanji, Vishal

    Journal of fungi (Basel, Switzerland)

    2022  Volume 8, Issue 9

    Abstract: Fungal keratitis (FK) can be challenging to diagnose and treat. In this retrospective case series, FK cases presenting at the University of Pittsburgh Medical Center, Pennsylvania, USA, from 2015 to 2021 were reviewed for ocular risk factors, clinical ... ...

    Abstract Fungal keratitis (FK) can be challenging to diagnose and treat. In this retrospective case series, FK cases presenting at the University of Pittsburgh Medical Center, Pennsylvania, USA, from 2015 to 2021 were reviewed for ocular risk factors, clinical presentation, management, and outcomes. Twenty-eight cases of FK were included. The median presenting age was 58.5 (18.5) years, and the median symptom duration prior to presentation was 10 (35.8) days. Predisposing ocular risk factors included contact lens use (67.9%), recent ocular trauma/abrasion (42.9%), and history of ocular surgery (42.9%). The median presenting visual acuity (VA) was 1.35 (1.72) LogMAR. About half presented with a central ulcer (42.9%), large infiltrate (6.7 (6.3) mm2), corneal thinning (50.0%), and hypopyon (32.1%). The majority of isolated fungal species were filamentous (75.0%). Most common antifungal medications included topical voriconazole (71.4%) and natamycin (53.6%) drops and oral voriconazole (64.3%). Surgical management was necessary in 32.1% of cases and enucleation in one case. Defect resolution occurred in 42.5 (47.0) days, and median final VA was 0.5 (1.84) LogMAR. Features associated with poor final visual outcomes included poor initial VA (p < 0.001) and larger defect size (p = 0.002). In conclusion, unlike prior studies in the northeast region of the USA, FK was commonly caused by filamentous fungi, and antifungal management most often consisted of topical and oral voriconazole.
    Language English
    Publishing date 2022-09-15
    Publishing country Switzerland
    Document type Journal Article
    ZDB-ID 2784229-0
    ISSN 2309-608X ; 2309-608X
    ISSN (online) 2309-608X
    ISSN 2309-608X
    DOI 10.3390/jof8090962
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  3. Article ; Online: Effect of a Patient Portal Reminder Message After No-Show on Appointment Reattendance in Ophthalmology: A Randomized Clinical Trial.

    Atta, Sarah / Brown, Richard B / Wasser, Lauren M / Mayer, Natasha / Cassidy, Julie / Liu, Peggy J / Williams, Andrew M

    American journal of ophthalmology

    2024  Volume 263, Page(s) 93–98

    Abstract: Purpose: To assess the efficacy of electronic health record (EHR) messaging for re-engaging patients with ophthalmology care after a missed appointment.: Design: Prospective, randomized clinical trial.: Methods: The study setting was an academic ... ...

    Abstract Purpose: To assess the efficacy of electronic health record (EHR) messaging for re-engaging patients with ophthalmology care after a missed appointment.
    Design: Prospective, randomized clinical trial.
    Methods: The study setting was an academic ophthalmology department. The patient population comprised of return patients age 18 years or older with an appointment "no show," or missed appointment. Over 2 phases of recruitment, 362 patients with an active patient portal in the EHR were selected consecutively each business day. Patients were randomized using a web-based tool to receive a reminder to reschedule via a standard mailed letter only (control) or the mailed letter plus an electronic message through the EHR within 1 business day of the missed appointment (intervention). Reengagement with eye care was defined as attendance of a rescheduled appointment within 30 days of the no-show visit. Patient charts were reviewed for demographic and clinical data.
    Results: The average age of recruited patients was 59.9 years, just under half of the sample was male (42.5%, 154/362), and most patients were White (56.9%, 206/362) or Black (36.2%, 131/362). Patients were most commonly recruited from the retina service (39.2%, 142/362) followed by the glaucoma service (29.3%, 106/362). Many patients in this study had previous no-show appointments, with an average no-show rate of 18.8% out of all scheduled visits across our health system. In total, 22.2% (42/189) of patients in the intervention group attended a follow-up appointment within 30 days of their no-show visit compared to 11.6% (20/173) of the control group (OR, 2.186; 95% CI, 1.225-3.898; P = .008). When including only the 74 patients in the intervention group who read the intervention message in the patient portal, 28.4% (21/74) attended a follow-up compared to 11.6% (20/173) of the control group (P = .001).
    Conclusions: EHR-based reminder messages sent within a business day of a missed appointment may promote re-engagement in ophthalmology care after appointment no-show.
    Language English
    Publishing date 2024-02-23
    Publishing country United States
    Document type Journal Article
    ZDB-ID 80030-2
    ISSN 1879-1891 ; 0002-9394
    ISSN (online) 1879-1891
    ISSN 0002-9394
    DOI 10.1016/j.ajo.2024.02.026
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  4. Article ; Online: The Use of Mobile Messaging for Telecommunications with Patients in Ophthalmology: A Systematic Review.

    Atta, Sarah / Omar, Mahmoud / Kaleem, Syed Z / Waxman, Evan L

    Telemedicine journal and e-health : the official journal of the American Telemedicine Association

    2021  Volume 28, Issue 2, Page(s) 125–137

    Abstract: Introduction: ...

    Abstract Introduction:
    MeSH term(s) Appointments and Schedules ; Cell Phone ; Humans ; Ophthalmology ; Telecommunications ; Text Messaging
    Language English
    Publishing date 2021-03-31
    Publishing country United States
    Document type Journal Article ; Review ; Systematic Review
    ZDB-ID 2035659-6
    ISSN 1556-3669 ; 1530-5627
    ISSN (online) 1556-3669
    ISSN 1530-5627
    DOI 10.1089/tmj.2020.0568
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  5. Article: Clinical Characterization and Outcomes of Culture- and Polymerase Chain Reaction-Negative Cases of Infectious Keratitis.

    Atta, Sarah / Singh, Rohan Bir / Samanthapudi, Keerthana / Perera, Chandrashan / Omar, Mahmoud / Nayyar, Shannon / Kowalski, Regis P / Jhanji, Vishal

    Diagnostics (Basel, Switzerland)

    2023  Volume 13, Issue 15

    Abstract: Purpose: To examine the clinical presentation, management, and outcomes of culture and polymerase chain reaction (PCR) negative cases of infectious keratitis.: Methods: In this retrospective case series, we evaluated the laboratory and medical ... ...

    Abstract Purpose: To examine the clinical presentation, management, and outcomes of culture and polymerase chain reaction (PCR) negative cases of infectious keratitis.
    Methods: In this retrospective case series, we evaluated the laboratory and medical records of culture- and PCR-negative cases (2016-2020) reported to a tertiary care center, which were presumed to be infectious keratitis on the basis of clinical history and presentation.
    Results: A total of 121 cases with culture-negative keratitis were included in this study. The mean age of the patients was 48.42 ± 1.89 years, and 53.72% were female. At presentation, the presumed etiology was viral in 38.01%, bacterial in 27.27%, fungal in 8.26%, Acanthamoeba in 6.61%, and unlisted in 28.92% of cases. The most common risk factors were a previous history of ocular surface diseases (96.69%) and contact lens use (37.19%). In total, 61.98% of the patients were already on antimicrobial medication at presentation. The initial management was altered in 79 cases (65.29%) during the treatment course. Average presenting and final (post-treatment) visual acuities (VA) were 0.98 ± 0.04 (LogMAR) and 0.42 ± 0.03 (LogMAR), respectively. A significantly higher frequency of patients with a final VA worse than 20/40 (Snellen) had worse VA at initial presentation (
    Conclusions: We observed a distinct difference in clinical features among patients with culture-negative and PCR-negative keratitis managed for presumed viral and bacterial infections. Although there was significant variability in presentation and management duration in this cohort, the visual outcomes were generally favorable.
    Language English
    Publishing date 2023-07-29
    Publishing country Switzerland
    Document type Journal Article
    ZDB-ID 2662336-5
    ISSN 2075-4418
    ISSN 2075-4418
    DOI 10.3390/diagnostics13152528
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  6. Article ; Online: An 18-Year Overview of Serratia marcescens Ocular Infection.

    Atta, Sarah / Perera, Chandrashan / Nayyar, Shannon / Kowalski, Regis P / Jhanji, Vishal

    Eye & contact lens

    2021  Volume 47, Issue 8, Page(s) 471–475

    Abstract: Purpose: Serratia marcescens is a frequent ocular bacterial pathogen implicated in keratitis, endophthalmitis, and conjunctivitis. We evaluated the risk factors and treatment outcomes of ocular infections due to S. marcescens.: Methods: In this ... ...

    Abstract Purpose: Serratia marcescens is a frequent ocular bacterial pathogen implicated in keratitis, endophthalmitis, and conjunctivitis. We evaluated the risk factors and treatment outcomes of ocular infections due to S. marcescens.
    Methods: In this retrospective observational study, all S. marcescens-positive cases between February 2002 and February 2020 were reviewed for ocular risk factors that included log of minimal angle of resolution visual acuity (VA), medical management, and time to epithelial defect closure.
    Results: Fifty-one patients were identified (72.5% females, 46.8±23.3 years). Forty-six patients had complete medical records, and 5 had microbiology data available. The most prevalent ocular risk factors were, contact lens (CL) use (68.6%), corneal disease (52.9%), and history of ocular surgery (41.2%). Mean presenting VA was 1.3±1.0. About half of the patients presented with a central ulcer (49%, 25), large infiltrate (20.4±31.8 mm2 mean), and hypopyon (43.1%, 22). All cases were reported to be susceptible to ciprofloxacin. Defect closure occurred in 52.3±117.1 days and final VA was 0.86±0.88. Adjunctive treatments were required in 14 cases (27.5%). One patient underwent surgical intervention. Features associated with poor VA outcomes included, history of glaucoma (P=0.038), older age at presentation (P<0.001), presence of hypopyon (0.045), poor VA at presentation (0.0086), time to epithelial defect closure (0.0196), and large infiltrate size (P=0.0345).
    Conclusions: S. marcescens keratitis and conjunctivitis is associated with CL use and history of ocular surface disease. Worse outcomes were associated with older age, infiltrate size, presence of hypopyon, worse initial VA, longer time to epithelial defect closure, and history of glaucoma.
    MeSH term(s) Aged ; Anti-Bacterial Agents/therapeutic use ; Endophthalmitis/epidemiology ; Endophthalmitis/etiology ; Endophthalmitis/therapy ; Eye Infections/drug therapy ; Eye Infections, Bacterial/diagnosis ; Eye Infections, Bacterial/drug therapy ; Eye Infections, Bacterial/epidemiology ; Female ; Humans ; Male ; Retrospective Studies ; Risk Factors ; Serratia marcescens
    Chemical Substances Anti-Bacterial Agents
    Language English
    Publishing date 2021-05-27
    Publishing country United States
    Document type Journal Article ; Observational Study
    ZDB-ID 2103049-2
    ISSN 1542-233X ; 1542-2321
    ISSN (online) 1542-233X
    ISSN 1542-2321
    DOI 10.1097/ICL.0000000000000803
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  7. Article ; Online: Microbiological evaluation of corneal and contact lens cultures in contact lens-associated bacterial keratitis.

    Mukhtar, Sabrina / Atta, Sarah / Durrani, Asad / Perera, Chandrashan / Kowalski, Regis / Jhanji, Vishal

    The British journal of ophthalmology

    2020  Volume 106, Issue 5, Page(s) 600–604

    Abstract: Purpose: To determine the degree of microbiological agreement between corneal scrapings and contact lens cultures in cases of contact lens-associated keratitis.: Methods: Electronic medical records of all cases of contact lens-associated keratitis at ...

    Abstract Purpose: To determine the degree of microbiological agreement between corneal scrapings and contact lens cultures in cases of contact lens-associated keratitis.
    Methods: Electronic medical records of all cases of contact lens-associated keratitis at a single institution from April 2006 to May 2019 were reviewed. Cases where both corneal scrapings and contact lens cultures were obtained were included in the study. Group 1 demonstrated agreement between corneal scrapings and contact lens cultures. Group 2 demonstrated growth on both cultures, but disagreement in isolated organism. Group 3 demonstrated negative corneal cultures but growth on contact lens cultures and the diagnostic yield of contact lens microbiological cultures and agreement between corneal and contact lens cultures.
    Results: A total of 80 eyes of 72 patients were included in the study. 135 total incidences of microbiological results were included for data analysis. Group 1 contained nine incidences (6.7%), group 2 contained 60 incidences (44.4%) and group 3 contained 66 incidences (49%). In group 3, 50% of the cases were treated based on contact lens culture data. There was no statistically significant difference between all three groups in terms of baseline characteristics, presenting vision, vision at last follow-up, number of antibiotics used or complications from keratitis.
    Conclusions: Although there was a disagreement in the microbiological yield between contact lens and corneal cultures, contact lens cultures were useful in management of patients while achieving similar outcomes.
    MeSH term(s) Contact Lenses/adverse effects ; Cornea/microbiology ; Corneal Ulcer/diagnosis ; Corneal Ulcer/epidemiology ; Corneal Ulcer/microbiology ; Eye Infections, Bacterial/microbiology ; Humans ; Keratitis/diagnosis ; Keratitis/epidemiology ; Keratitis/microbiology ; Retrospective Studies
    Language English
    Publishing date 2020-12-23
    Publishing country England
    Document type Journal Article
    ZDB-ID 80078-8
    ISSN 1468-2079 ; 0007-1161
    ISSN (online) 1468-2079
    ISSN 0007-1161
    DOI 10.1136/bjophthalmol-2020-317832
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  8. Article ; Online: Dose-dependent effects of netarsudil, a Rho-kinase inhibitor, on the distal outflow tract.

    Chen, Si / Waxman, Susannah / Wang, Chao / Atta, Sarah / Loewen, Ralitsa / Loewen, Nils A

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

    2020  Volume 258, Issue 6, Page(s) 1211–1216

    Abstract: Purpose: To characterize the effects of netarsudil on the aqueous humor outflow tract distal to the trabecular meshwork (TM). We hypothesized that netarsudil increases outflow facility in eyes with and without circumferential ab interno trabeculectomy ( ... ...

    Abstract Purpose: To characterize the effects of netarsudil on the aqueous humor outflow tract distal to the trabecular meshwork (TM). We hypothesized that netarsudil increases outflow facility in eyes with and without circumferential ab interno trabeculectomy (AIT) that removes the TM.
    Methods: Sixty-four porcine anterior segment cultures were randomly assigned to groups with (n = 32) and without circumferential AIT (n = 32). Cultures were exposed to 0.1, 1, and 10 μM netarsudil (N = 8 eyes per concentration). For each concentration, IOP and vessel diameters were compared with their respective pretreatment baselines. Outflow tract vessel diameters were assessed by spectral-domain optical coherence tomography (SDOCT) and rendered in 4D (XYZ time series).
    Results: Netarsudil at 1 μM reduced IOP both in eyes with TM (- 0.60 ± 0.24 mmHg, p = 0.01) and in eyes without TM (- 1.79 ± 0.42 mmHg, p < 0.01). At this concentration, vessels of the distal outflow tract dilated by 72%. However, at 0.1 μM netarsudil elevated IOP in eyes with TM (1.59 ± 0.36 mmHg, p < 0.001) as well as in eyes without TM (0.23 ± 0.32 mmHg, p < 0.001). Vessels of the distal outflow tract constricted by 31%. Similarly, netarsudil at a concentration of 10 μM elevated IOP both in eyes with TM (1.91 ± 0.193, p < 0.001) and in eyes without TM (3.65 ± 0.86 mmHg, p < 0.001). At this concentration, outflow tract vessels constricted by 27%.
    Conclusion: In the porcine anterior segment culture, the dose-dependent IOP changes caused by netarsudil matched the diameter changes of distal outflow tract vessels. Hyper- and hypotensive properties of netarsudil persisted after TM removal.
    MeSH term(s) Animals ; Aqueous Humor/physiology ; Benzoates/administration & dosage ; Dose-Response Relationship, Drug ; Intraocular Pressure/drug effects ; Ocular Physiological Phenomena ; Organ Culture Techniques ; Protein Kinase Inhibitors/administration & dosage ; Sclera/blood supply ; Swine ; Tomography, Optical Coherence ; Tonometry, Ocular ; Trabecular Meshwork/diagnostic imaging ; Trabecular Meshwork/drug effects ; Trabecular Meshwork/surgery ; Trabeculectomy ; Veins/diagnostic imaging ; Veins/physiology ; beta-Alanine/administration & dosage ; beta-Alanine/analogs & derivatives ; rho-Associated Kinases/antagonists & inhibitors
    Chemical Substances Benzoates ; Protein Kinase Inhibitors ; beta-Alanine (11P2JDE17B) ; rho-Associated Kinases (EC 2.7.11.1) ; netarsudil (W6I5QDT7QI)
    Language English
    Publishing date 2020-05-05
    Publishing country Germany
    Document type Journal Article
    ZDB-ID 8435-9
    ISSN 1435-702X ; 0721-832X
    ISSN (online) 1435-702X
    ISSN 0721-832X
    DOI 10.1007/s00417-020-04691-y
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  9. Article: OCT Angiography in Noninfectious Uveitis: A Description of Five Cases and Clinical Applications.

    Melachuri, Samyuktha / Dansingani, Kunal K / Wesalo, Joshua / Paez-Escamilla, Manuel / Gagrani, Meghal / Atta, Sarah / Indermill, Chad / Sahel, José-Alain / Nischal, Ken K / Chhablani, Jay / Errera, Marie-Hélène

    Diagnostics (Basel, Switzerland)

    2023  Volume 13, Issue 7

    Abstract: Background: Optical coherence tomography angiography (OCTA) is a noninvasive imaging modality used to analyze the retinochoroidal vasculature and detect vascular flow. The resulting images can be segmented to view each vascular plexus individually. ... ...

    Abstract Background: Optical coherence tomography angiography (OCTA) is a noninvasive imaging modality used to analyze the retinochoroidal vasculature and detect vascular flow. The resulting images can be segmented to view each vascular plexus individually. While fluorescein angiography is still the gold standard for the diagnosis of posterior uveitis, it has limitations, and can be replaced by OCTA in some cases.
    Methods: This case series describes five patients with posterior noninfectious uveitis and their description by OCTA.
    Results: Cases included lupus retinopathy (
    Conclusions: Ophthalmologists can use OCTA to identify inflammatory changes in retinal and choroidal vasculature, aiding in the diagnosis, management, and monitoring of posterior uveitis.
    Language English
    Publishing date 2023-03-30
    Publishing country Switzerland
    Document type Journal Article
    ZDB-ID 2662336-5
    ISSN 2075-4418
    ISSN 2075-4418
    DOI 10.3390/diagnostics13071296
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  10. Article ; Online: A rise in the frequency of

    Shanks, Robert M Q / Atta, Sarah / Stella, Nicholas A / Sundar-Raj, Chollapadi V / Romanowski, John E / Grewal, Arman S / Shanks, Hazel Q / Mumper, Sonya M / Dhaliwal, Deepinder K / Mammen, Alex / Callaghan, Jake D / Calvario, Rachel C / Romanowski, Eric G / Kowalski, Regis P / Zegans, Michael E / Jhanji, Vishal

    Frontiers in cellular and infection microbiology

    2023  Volume 13, Page(s) 1286842

    Abstract: Introduction: Pseudomonas aeruginosa: Methods: Keratitis isolates (n=399) were classified by sheen phenotype. The : Results: A significant increase in sheen positive isolates was observed between 1993 and 2021. Extracellular protease activity was ... ...

    Abstract Introduction: Pseudomonas aeruginosa
    Methods: Keratitis isolates (n=399) were classified by sheen phenotype. The
    Results: A significant increase in sheen positive isolates was observed between 1993 and 2021. Extracellular protease activity was reduced among the sheen positive isolates and a defined
    Discussion: These results indicate an increase in
    MeSH term(s) Humans ; Pseudomonas aeruginosa ; Retrospective Studies ; Keratitis ; Transcription Factors/genetics ; Endopeptidases ; Bacterial Proteins/genetics ; Quorum Sensing/genetics
    Chemical Substances Transcription Factors ; Endopeptidases (EC 3.4.-) ; Bacterial Proteins
    Language English
    Publishing date 2023-10-31
    Publishing country Switzerland
    Document type Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
    ZDB-ID 2619676-1
    ISSN 2235-2988 ; 2235-2988
    ISSN (online) 2235-2988
    ISSN 2235-2988
    DOI 10.3389/fcimb.2023.1286842
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