Browsing by Author "Haque, Waqas"
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Item Complications of Pterygium Excision(2017-01-17) Haque, Waqas; Vuppala, Suchith; Patel, Sagar Y.INTRODUCTION: Several theories (environmental, genetic, and various other factors) exist regarding the etiology of pterygia, a wing-shaped, fibrovascular growth of conjunctiva that advances onto the cornea. The goals of pterygium surgery are to remove the pterygium and avoid possible complications. Indications for surgery include reduced vision due to encroachment and irregular astigmatism, chronic irritation, recurrent inflammation, and ocular motility restriction. Our hypothesis was that MMC used on the bulbar conjunctiva after pterygium excision may be denuding the palpebral conjunctiva, creating two raw edges that become adherent and form a symblepharon. The purpose of our project was to determine if these complications, specifically symblepharon formation, were related to certain surgical techniques involving the use of MMC. METHODS: We performed a retrospective chart review of Parkland patients with a diagnosis of pterygium (1/1/2015-12/31/2015). We looked at 362 primary pterygia excisions from 280 patients. We recorded each patients’ sex, race, age and information regarding the pterygium such as laterality, PGY of primary surgeon, and complications. We included patients that had all their surgeries at Parkland and had at least 3 months post-op follow-up. RESULTS: A comparison of surgeries involving the use of MMC versus those that did not use MMC was statistically significant. Chi-square analysis revealed a statistical difference between surgical approach and development of a complication (p = 0.0009). A post-hoc analysis of the Chi-square revealed a statistically significant association between the use of amniotic membrane tissue and intraoperative mitomycin C with the development of post-operative complications. The post-hoc analysis also revealed that a lower number of complications were seen with the use of both amniotic membrane tissue and conjunctival autograft transplantation without MMC. DISCUSSION: This retrospective study revealed that at a major county hospital where ophthalmology trainees are the primary surgeons, the use of intraoperative MMC was generally associated with a higher rate of complications in comparison to techniques that did not involve its use. The case series revealed that symblepharons were more likely to develop if their surgical excision included the use of intraoperative MMC. The overall study findings suggest that a decrease in the use of intraoperative MMC should lead to a decrease in complications requiring additional intervention in our group of surgeons and given the difficulty in achieving resolution of symblepharon formation.Item More Than Meets the Eye: The Relationship Between Dry Eye Disease and Multisystem Exocrinopathy(2018-01-23) Haque, Waqas; Al-Hashimi, Ibtisam; Robertson, Danielle M.INTRODUCTION: Sjögren's Syndrome, commonly known to be the disease of "dry eyes and dry mouth", is an autoimmune disease that targets the lacrimal and salivary glands. Sjögren's Syndrome primarily affects women with an estimated prevalence of 1.4% in the United States. Its diagnosis is confirmed via presence of anti-Ro/anti-La antibodies, demonstration of reduced salivary and tear production, and a positive lip biopsy. Patients with Sjögren's Syndrome commonly manifest symptoms of a multisystem exocrinopathy. Currently, over 16 million American adults suffer from dry eye disease and do not meet the diagnostic criteria for Sjögren's Syndrome. For many of these patients, current treatment strategies are not sufficient to eradicate or reduce the chronic symptoms of dry eye, thus decreasing overall quality of life. The objective of this study is to establish whether patients with non-Sjögren's dry eye disease also exhibit symptoms of a multisystem exocrinopathy. METHODS: This was a retrospective chart review of 199 randomly chosen patients who were seen between January 2015 and April 2017 in the Department of Ophthalmology at the Aston Ambulatory Care Center. All patients reviewed had a diagnosis of dry eye disease in their medical chart. Using a validated exocrine dysfunction questionnaire as a template, comprehensive data was collected for ophthalmic findings, patient demographics, oral and topical medications, serology, a review of symptoms for all body systems (such as allergies, congestion, and reflux), and all known diagnoses. A univariate analysis was performed to test for differences between dry eye subtypes. A multivariate analysis is currently underway. Results: 31.2% of patients presented with a diagnosis of evaporative dry eye, 57.5% were aqueous-deficient non-Sjögren's dry eye, and 11.3% were aqueous-deficient Sjögren's dry eye. Analysis of the non-Sjögren's cohorts revealed over 25 symptoms consistent with a multisystem exocrinopathy. 35% of dry eye patients had a diagnosis for rheumatoid arthritis. Exocrine manifestations were significantly different among dry eye subtypes for sinusitis (p=0.0283), diarrhea (p=.0059), and hypothyroidism (p=.0291). DISCUSSION: This study is the first to indicate a multisystem exocrinopathy disorder in patients with non-Sjögren's dry eye disease. While results from the multivariate analysis are still pending, the identification of specific exocrine symptoms in patients with distinct subtypes of dry eye may lead to the establishment of new, tailored treatment regimens that will enhance patient response to therapy and improve overall quality of life.