Browsing by Author "Boente, Charline S."

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    Comparing reactivation and retreatment of three doses of bevacizumab in type 1 retinopathy of prematurity
    (Elsevier, 2024-04) Chopra, Jay; Haider, Kathryn M.; Boente, Charline S.; Ophthalmology, School of Medicine
    Purpose To determine timing and rates of reactivation and retreatment of type 1 retinopathy of prematurity (ROP) after treatment with either 0.125 mg, 0.250 mg, or 0.500 mg of intravitreal bevacizumab (IVB). Methods Retrospective data, including demographic information, past medical history, and ROP characteristics were analyzed for babies with type 1 ROP treated with IVB at Riley Hospital for Children for the period 2014-2021. Results A total of 84 patients met inclusion criteria: 29 patients received 0.125 mg of IVB; 39, 0.250 mg; and 16, 0.500 mg. Of the 84, 67 (80%) had additional laser treatment because of late reactivation (n = 52) or persistent avascular retina (PAR) (n = 15). Subsequent laser treatment was more common with lower doses: 0.125 mg (n = 27 [93%]); 0.250 mg (n = 31 [80%]); 0.500 mg (n = 9 [57%]) (P = 0.012). There was no difference between groups with regard to reason for subsequent laser treatment (reactivation vs PAR). The 0.125 mg group required retreatment because of reactivation 3.8 weeks sooner than the other dosing groups (P = 0.047). Conclusions The outcomes comparing three doses of IVB for severe ROP showed a difference in the timing of secondary treatment, with the lower dosing group requiring laser for reactivation earlier.
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    Corneal Nerve Assessment by Aesthesiometry: History, Advancements, and Future Directions
    (MDPI, 2024-05-12) Crabtree, Jordan R.; Tannir, Shadia; Tran, Khoa; Boente, Charline S.; Ali, Asim; Borschel, Gregory H.; Surgery, School of Medicine
    The measurement of corneal sensation allows clinicians to assess the status of corneal innervation and serves as a crucial indicator of corneal disease and eye health. Many devices are available to assess corneal sensation, including the Cochet–Bonnet aesthesiometer, the Belmonte Aesthesiometer, the Swiss Liquid Jet Aesthesiometer, and the newly introduced Corneal Esthesiometer Brill. Increasing the clinical use of in vivo confocal microscopy and optical coherence tomography will allow for greater insight into the diagnosis, classification, and monitoring of ocular surface diseases such as neurotrophic keratopathy; however, formal esthesiometric measurement remains necessary to assess the functional status of corneal nerves. These aesthesiometers vary widely in their mode of corneal stimulus generation and their relative accessibility, precision, and ease of clinical use. The development of future devices to optimize these characteristics, as well as further comparative studies between device types should enable more accurate and precise diagnosis and treatment of corneal innervation deficits. The purpose of this narrative review is to describe the advancements in the use of aesthesiometers since their introduction to clinical practice, compare currently available devices for assessing corneal innervation and their relative limitations, and discuss how the assessment of corneal innervation is crucial to understanding and treating pathologies of the ocular surface.
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    The Impact of Away Rotations on the Ophthalmology Residency Match
    (Thieme, 2021-01) Tso, Hanna L.; Young, Jason; Boente, Charline S.; Yung, Chi Wah; Ophthalmology, School of Medicine
    Background The ophthalmology residency match is highly competitive, and fourth-year medical students frequently complete away rotations at other institutions hoping to increase their chances of matching. Objective The study aimed to determine the impact of away rotations on the ophthalmology residency selection process and to provide recommendations to faculty for counseling fourth-year medical students as they prepare for the ophthalmology match. Methods A survey was sent in June 2020 to program directors (PDs), medical student educators (MSEs), and residents at 119 accredited ophthalmology residency programs via the Association of University Professors of Ophthalmology e-mail listserv. The 43 PDs and 38 MSEs who responded were asked questions about their views regarding away rotations and visiting students during the residency selection process. The 83 resident respondents were asked about their interview and match success after completing away rotations. Categorical variables were analyzed by Chi-square test. Results The majority of PDs and MSEs typically recommend that fourth-year medical students complete away rotations (p = 0.022 and p = 0.194, respectively). The majority believe that an away rotation will increase the chance of the applicant matching with the host institution (p = 0.004 and p = 0.001, respectively). The vast majority of PDs were more likely to offer an interview to a visiting student compared with another equally qualified applicant (p < 0.001). However, only one-third of PDs were typically more likely to rank an away rotator higher on their rank list (p = 0.047). Two-thirds of residents completed at least one away rotation in medical school (mean = 1.7 rotations). The majority received interview invitations from at least some of their host institutions (p < 0.001). Approximately one-fifth ultimately matched at a host residency program (p < 0.001). Conclusion The majority of ophthalmology PDs and MSEs surveyed recommend that fourth-year medical students complete away rotations and believe that these rotations will increase the chance of the applicant matching at a host institution. The PDs are more likely to offer an interview to a visiting student compared with another equally qualified applicant. For some programs, visiting students may also receive special consideration by being ranked higher on a program's rank list and being more likely to match.
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    Low- and Very Low-Dose Bevacizumab for Retinopathy of Prematurity: Reactivations, Additional Treatments, and 12-Month Outcomes
    (Elsevier, 2022) Freedman, Sharon F.; Hercinovic, Amra; Wallace, David K.; Kraker, Raymond T.; Li, Zhuokai; Bhatt, Amit R.; Boente, Charline S.; Crouch, Eric R.; Hubbard, G. Baker; Rogers, David L.; VanderVeen, Deborah; Yang, Michael B.; Cheung, Nathan L.; Cotter, Susan A.; Holmes, Jonathan M.; Pediatric Eye Disease Investigator Group; Ophthalmology, School of Medicine
    Purpose: Low-dose and very low-dose intravitreal bevacizumab (IVB) have been reported to be successful in short-term treatment of type 1 retinopathy of prematurity (ROP), down to an initial dose of 0.004 mg. We now report 12-month outcomes for these infants. Design: Masked, multicenter, dose de-escalation study. Participants: One hundred twenty prematurely born infants with type 1 ROP. Methods: A cohort of 120 infants with type 1 ROP in at least 1 eye from 2 sequential dose de-escalation studies of low-dose IVB (0.25 mg, 0.125 mg, 0.063 mg, and 0.031 mg) or very low-dose IVB (0.016 mg, 0.008 mg, 0.004 mg, and 0.002 mg) to the study eye; the fellow eye (if also type 1) received 1 dose level higher of IVB. After primary success or failure at 4 weeks, clinical management was at investigator discretion, including all additional treatment. Main outcome measures: Reactivation of severe ROP by 6 months corrected age, additional treatments, retinal and other ocular structural outcomes, and refractive error at 12 months corrected age. Results: Sixty-two of 113 study eyes (55%) and 55 of 98 fellow eyes (56%) received additional treatment. Of the study eyes, 31 (27%) received additional ROP treatment, and 31 (27%) received prophylactic laser therapy for persistent avascular retina. No trend toward a higher risk of additional ROP treatment related to initial IVB doses was found. However, time to reactivation among study eyes was shorter in eyes that received very low-dose IVB (mean, 76.4 days) than in those that received low-dose IVB (mean, 85.7 days). At 12 months, poor retinal outcomes and anterior segment abnormalities both were uncommon (3% and 5%, respectively), optic atrophy was noted in 10%, median refraction was mildly myopic (-0.31 diopter), and strabismus was present in 29% of infants. Conclusions: Retinal structural outcomes were very good after low- and very low-dose IVB as initial treatment for type 1 ROP, although many eyes received additional treatment. The rate of reactivation of severe ROP was not associated with dose; however, a post hoc data-driven analysis suggested that reactivation was sooner with very low doses.
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    Plasma Levels of Bevacizumab and Vascular Endothelial Growth Factor After Low-Dose Bevacizumab Treatment for Retinopathy of Prematurity in Infants
    (American Medical Association, 2022) Hartnett, M. Elizabeth; Wallace, David K.; Dean, Trevano W.; Li, Zhuokai; Boente, Charline S.; Dosunmu, Eniolami O.; Freedman, Sharon F.; Golden, Richard P.; Kong, Lingkun; Prakalapakorn, S. Grace; Repka, Michael X.; Smith, Lois E.; Wang, Haibo; Kraker, Raymond T.; Cotter, Susan A.; Holmes, Jonathan M.; Ophthalmology, School of Medicine
    Importance: Intravitreal bevacizumab effectively treats severe retinopathy of prematurity (ROP), but it enters the bloodstream and may reduce serum vascular endothelial growth factor (VEGF), potentially causing detrimental effects on developing organs in the premature infant. Objective: To evaluate the association of intravitreal bevacizumab with plasma bevacizumab and VEGF concentrations at 2 and 4 weeks after predefined, de-escalating doses of intravitreal bevacizumab were administered to infants with severe ROP. Design, setting, and participants: This phase 1 dose de-escalation case series study was conducted at 10 US hospitals of ophthalmology institutions from May 21, 2015, to May 7, 2019. Blood samples were collected 2 and 4 weeks after intravitreal bevacizumab injection. Participants included 83 premature infants with type 1 ROP in 1 or both eyes and no previous ROP treatment. Data were analyzed from April 2017 to August 2021. Interventions: Study eyes received a single bevacizumab injection of 0.250 mg, 0.125 mg, 0.063 mg, 0.031 mg, 0.016 mg, 0.008 mg, 0.004 mg, or 0.002 mg. When the fellow eye required treatment, one dose higher was administered. Total dose administered at baseline was defined as the sum of doses given to each eye within 3 days of initial study-eye injection. Main outcomes and measures: Plasma bevacizumab concentration at 2 and 4 weeks after injection and the percentage change in plasma VEGF concentrations from pretreatment levels. Results: A total of 83 infants (mean [SD] age, 25 [2] weeks; 48 boys [58%]) were included in this study. Higher doses of bevacizumab administered at baseline were associated with higher plasma bevacizumab concentrations at 2 weeks (ρ, 0.53; 95% CI, 0.31-0.70) and 4 weeks (ρ, 0.44; 95% CI, 0.18-0.64). Plasma VEGF concentrations decreased by 50% or more from pretreatment levels in 40 of 66 infants (61%) at 2 weeks and 31 of 61 infants (51%) at 4 weeks, but no association was observed between the total dose of bevacizumab administered at baseline and percentage change in plasma VEGF concentrations 2 weeks (ρ, -0.04; 95% CI, -0.28 to 0.20) or 4 weeks (ρ, -0.17; 95% CI, -0.41 to 0.08) after injection. Conclusions and relevance: Results of this phase 1 dose de-escalation case series study revealed that bevacizumab doses as low as 0.002 mg were associated with reduced plasma VEGF levels for most infants at 2 and 4 weeks after intravitreal administration; however, no association was observed between total bevacizumab dose administered and reductions in plasma VEGF levels from preinjection to 2 weeks or 4 weeks. Additional studies are needed to evaluate the long-term effects of low-dose bevacizumab on neurodevelopment and retinal structure.