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Dive into the research topics where Carolyn Shih is active.

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Featured researches published by Carolyn Shih.


Cornea | 2014

Clinical characteristics of Acanthamoeba keratitis infections in 28 states, 2008 to 2011.

Jonathan Ross; Sharon L. Roy; William D. Mathers; David C. Ritterband; Jonathan S. Yoder; Tracy Ayers; Rupa D. Shah; Monika E. Samper; Carolyn Shih; Ann Schmitz; Allison C. Brown

Purpose: The aim was to describe a geographically and clinically diverse sample of cases of Acanthamoeba keratitis (AK) and establish the risk factors for poor outcomes among patients with this disease. Methods: We conducted a retrospective, population-based case series of 116 patients with AK identified through a national surveillance network. Data were collected via a medical record review by diagnosing ophthalmologists and by phone interviews with patients. Exact logistic regression modeling was used to determine risk factors for poor visual outcomes. Results: Among patients with data available on contact lens use, it was found that 93.3% wore contact lenses. The median time from symptom onset to care seeking was 2 days, whereas the median time from symptom onset to diagnosis was 27 days. Keratoplasty was performed in 27 of 81 patients with available outcome data and was more likely in patients >40 years old [odds ratio (OR) 5.25, 95% confidence interval (CI) 1.49–21.92]. When adjusted for age, the risk factors for keratoplasty included the presence of a ring infiltrate (OR 40.00, 95% CI 3.58–447.0) or any sign of stromal invasion (OR 10.48, 95% CI 2.56–55.09). One-third of patients with available data on best-corrected visual acuity had a best-corrected visual acuity <20/200, with the presence of a ring infiltrate as the only significant predictor of this outcome when adjusted for age (aOR 3.45, 95% CI 1.01–12.31). Conclusions: AK remains challenging to diagnose. Consequently, patients with advanced disease are more likely to have poor outcomes, particularly if they are older. The increasing awareness of AK among general eye care providers may shorten referral times and potentially improve outcomes.


American Journal of Ophthalmology | 2010

Spontaneous Reattachment of Descemet Stripping Automated Endothelial Keratoplasty Lenticles: A Case Series of 12 Patients

Daniel D. Hayes; Carolyn Shih; Neda Shamie; Mark A. Terry; Francis W. Price; Marianne O. Price; David C. Ritterband; Sadeer B. Hannush; Mark S. Gorovoy; Robert W. Weisenthal; Robert Ritch; Jeffrey M. Liebmann; Ira J. Udell

PURPOSE To review 12 cases of postoperative detachment and spontaneous reattachment of Descemet stripping automated endothelial keratoplasty (DSAEK) lenticles. DESIGN Retrospective, observational case series. METHODS This was a review of patients undergoing DSAEK at 7 institutions. Patients who had a significant detachment of their DSAEK lenticle during the postoperative period were identified and divided into 2 groups. Significant detachment was defined as either complete central interface fluid with bare peripheral attachment (group 1) or a free-floating lenticle in the anterior chamber (group 2). Patients who subsequently had a spontaneous reattachment of the lenticle were identified, with data regarding surgical technique and intraoperative and postoperative complications collected for analysis. RESULTS Our cohort consisted of 12 eyes of 12 patients who met the definition of significant postoperative detachment with subsequent spontaneous reattachment. Four patients had complete central detachment with peripheral attachment (group 1), whereas 8 patients had a free-floating lenticle (group 2). Ten of the 12 patients had a successful outcome as defined as an attached and clear DSAEK lenticle. In our study, reattachment was seen as early as 5 days and as late as 7 months after surgery, with reattachment in 9 of 12 patients by day 25. CONCLUSIONS Spontaneous reattachment of detached DSAEK lenticles may occur during the postoperative period. The decision of when to bring the patient back for a rebubble ultimately must be made on a case-by-case basis.


Cornea | 2013

Textural interface opacity after descemet stripping automated endothelial keratoplasty: a report of 30 cases and possible etiology.

Samir Vira; Carolyn Shih; Nikola Ragusa; Alan Sheyman; Robert S. Feder; Robert W. Weisenthal; George O. D. Rosenwasser; Sadeer B. Hannush; Ira J. Udell; Charles S. Bouchard

Purpose: Descemet stripping automated endothelial keratoplasty (DSAEK) has its own set of complications including interface abnormalities. This case series presents the largest number of patients who developed textural interface opacity (TIO) at the graft–host interface after DSAEK. Methods: This is a retrospective multicenter case series of 30 patients from 7 institutions with the finding of TIO. Clinical information collected included donor preparation details, recipient information, and surgical technique. Clinical outcomes included best-corrected visual acuity and status of TIO appearance at the last follow-up visit. Slit-lamp photographs were analyzed and compared. Results: The majority of the patients (73%) had a best-corrected visual acuity of 20/40 or better. Four of the donor tissues were prepared with a microkeratome blade with the same lot number. Six patients had a central interface space between host and donor stromal surfaces—presumed interface fluid but potentially viscoelastic. A slight majority (57%) of patients had improvement in the severity of TIO, with 20% noted to have a complete resolution of TIO (mean follow-up of 11.9 months). Two clinical types of TIO were seen: an elongated type and a punctate type. Conclusions: Most patients with TIO after DSAEK obtain good visual outcomes. TIO spontaneously improves or even resolves during follow-up without intervention. The etiology of this condition is unknown, but we propose 2 different mechanisms. The elongated type could be secondary to an irregular cut of the donor with the microkeratome blade. The punctate type may be secondary to retained viscoelastic.


Ophthalmology | 2015

Paraproteinemic Keratopathy: The Expanding Diversity of Clinical and Pathologic Manifestations.

Tatyana Milman; Andrew Allen Kao; David S. Chu; Matthew Gorski; Annie Steiner; Carrie Zaslow Simon; Carolyn Shih; Anthony J. Aldave; Ralph C. Eagle; Frederick A. Jakobiec; I. J. Udell

PURPOSE To describe 7 patients with paraproteinemic keratopathy and to highlight the clinical and pathologic diversity of this rare entity and the importance of timely, systemic evaluation. DESIGN Retrospective, multicenter collaborative case series. PARTICIPANTS Seven patients with paraproteinemic keratopathy. METHODS Clinical and pathologic records were reviewed to identify patients with well-documented corneal immunoglobulin deposits. Detailed ophthalmologic and medical histories were assembled. In 6 patients, corneal tissue was evaluated histochemically and immunohistochemically; in selected cases, corneal tissue was evaluated by in situ hybridization and ultrastructurally. MAIN OUTCOME MEASURES Visual acuity and anterior segment examination at presentation and follow-up; local therapy; systemic diagnosis and management; and histopathologic, immunohistochemical, in situ hybridization, and ultrastructural findings. RESULTS Seven patients were identified with corneal immunoglobulin deposition. In addition to previously reported crystalline, nummular, patch-like, and lattice-like corneal opacities, prominent corneal vascularization was present in 2 patients mimicking interstitial keratitis and limbal stem cell deficiency. All patients had evidence of paraproteinemia in a setting of monoclonal gammopathy of undetermined significance, smoldering plasma cell myeloma, or Waldenström macroglobulinemia. Corneal findings were the first manifestation of systemic disease in 4 patients, and the diagnosis was not suspected in 3 of these patients. Pathologic evaluation of biopsied corneal and conjunctival tissues demonstrated immunoglobulin deposits. Previously unreported ultrastructural patterns in the cornea were noted: large scroll-like immunotactoid deposits, immune complex-like deposits, and randomly arranged fibrils morphologically intermediate between amyloid and immunotactoid deposits. Surgical intervention to improve vision was performed in 4 patients, with recurrence of deposits in 3 patients. Three patients underwent systemic therapy with diminution of the deposits and improvement in vision in 1 patient. CONCLUSIONS The clinical and pathologic expressions of corneal immunoglobulin deposits are protean and present a diagnostic challenge. Early recognition of this rare entity is important to address the potentially serious associated systemic disease.


Cornea | 2014

Descemet stripping endothelial keratoplasty for the treatment of combined fuchs corneal endothelial dystrophy and keratoconus.

Samir Vira; Usiwoma Abugo; Carolyn Shih; Ira J. Udell; Brian J. Sperling; Sadeer B. Hannush; Surendra Basti; Charles S. Bouchard

Purpose: To report the first case series of patients with Fuchs corneal endothelial dystrophy (FCD) and keratoconus (KCN) who underwent Descemet stripping endothelial keratoplasty (DSEK). Methods: This is a retrospective case series of 6 eyes of 4 patients with combined FCD and KCN who underwent DSEK at 3 different centers. Clinical information collected included corneal topography measurements, central corneal thickness, and endothelial cell count. Visual outcomes and change in keratometric measurements were evaluated. Results: The follow-up for patients ranged from 10 to 72 months. The best-corrected visual acuity was 20/40 or better in all 6 eyes. The mean keratometric measurements decreased in all cases (range of 0.5–5.8 diopters); however, topography still demonstrated an inferior steepening in each case. Conclusions: Patients with FCD and KCN have been previously reported as being managed with penetrating keratoplasty. We present 6 eyes of 4 patients who were managed with DSEK for the FCD. Topographically, the characteristic inferior steepening of KCN did not change; however, all patients with DSEK had flatter postoperative keratometric measurements with improved visual acuity. If a DSEK is performed for FCD before apical corneal scarring from KCN, a good visual outcome may be achieved.


Ophthalmic Plastic and Reconstructive Surgery | 2016

The Association of Demodex with Chalazia: A Histopathologic Study of the Eyelid.

Matthew J. Schear; Tatyana Milman; Tehilla Steiner; Carolyn Shih; Ira J. Udell; Anne Steiner

Purpose: To investigate the association of Demodex with chalazia and to describe the associated histopathologic changes in the eyelid tissue. Methods: In a retrospective histopathologic case–control study, 78 ectropion/entropion repair eyelid wedge resections were examined. Serial sections were obtained on formalin-fixed, paraffin-embedded tissues, stained with hematoxylin-eosin and studied by light microscopy. Thirty-eight patient specimens had evidence of chalazia and 40 did not. The main outcome measures included quantification of total eyelid hair follicles, meibomian glands, Demodex folliculorum and Demodex brevis; determining the presence of lipogranulomatous and non-lipogranulomatous inflammation, hair follicle and meibomian gland duct dilatation and hyperkeratinization, and meibomian gland acinar dilation, keratinization, and atrophy. Results: There was a significantly greater mean number of D. folliculorum in biopsies with chalazia, when compared with biopsies without chalazia (5.55 vs. 2.68, p = 0.044). The presence of D. folliculorum was strongly associated with hair follicle duct dilatation and hyperkeratinization and with perifollicular nongranulomatous inflammation (p = 0.00). Hair follicle duct dilatation, hyperkeratinization, and perifollicular inflammation were also independently associated with chalazia (p = 0.040 and 0.031, respectively). D. brevis was observed only in meibomian glands with chalazia (mean = 0.342), but this finding did not reach statistical significance; p= 0.068. Conclusion: While the authors cannot establish causality between Demodex and chalazia, these findings suggest that D. folliculorum indirectly may be involved in the pathogenesis of chalazia via its effect on the anterior eyelid margin.


Cornea | 2016

Spontaneous Descemet Membrane Detachment 20 Years After Penetrating Keratoplasty for Keratoconus.

Matthew Gorski; Carolyn Shih; Brian Savoie; I. J. Udell

Purpose: To report 2 cases of spontaneous Descemet membrane (DM) detachment 20 years after penetrating keratoplasty for keratoconus. Methods: A retrospective chart review of 2 patients was performed. Results: Two male patients—ages 59 and 50—presented 21 and 25 years, respectively, after uncomplicated penetrating keratoplasty for keratoconus, complaining of foreign body sensation. Best-corrected vision was 20/40 and 20/30, respectively. For both patients, slit-lamp examination revealed peripheral corneal thinning and steepening and temporal peripheral microcystic edema of the graft without any sign of rejection. Subsequent anterior segment optical coherence tomography demonstrated a DM detachment localized to the area of the corneal edema. One patients DM failed to reattach after anterior chamber air injection and he then underwent successful Descemet stripping automated endothelial keratoplasty with resultant best-corrected vision of 20/20. The other patient failed mechanical incision at the graft–host interface with air injection for possible retrocorneal membrane and then successfully underwent a sequential cataract and Descemet stripping automated endothelial keratoplasty with visual acuity of 20/30. Conclusions: Spontaneous DM detachment more than 2 decades after uncomplicated penetrating keratoplasty for keratoconus is a previously unrecognized entity. Novel imaging modalities such as anterior segment optical coherence tomography should be used to identify this clinically difficult to detect etiology of microcystic corneal edema. The cause of DM detachment is unclear, but it may be because of mechanical forces from a retrocorneal membrane or from progressive keratoconus leading to peripheral host corneal steepening and thinning.


Ophthalmology | 2012

Bilateral corneal ulceration in keratoconus.

Carolyn Shih; Angela Bosjolie; Matt Qiao; Ira J. Udell


Journal of Glaucoma | 2018

Comparison of Disposable Goldmann Applanation Tonometer, ICare ic100 and Tono-pen XL to Standards of Care Goldmann Nondisposable Applanation Tonometer for Measuring Intraocular Pressure

Benny Wong; Deep Parikh; Lisa Rosen; Matthew Gorski; Allison Angelilli; Carolyn Shih


Investigative Ophthalmology & Visual Science | 2017

Symptomatic improvement with surgical intervention in conjunctivochalasis

Alexander Weiss; Anne Steiner; Carolyn Shih; Jules Winokur; Ira J. Udell

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I. J. Udell

North Shore-LIJ Health System

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Ira J. Udell

Long Island Jewish Medical Center

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Matthew Gorski

North Shore-LIJ Health System

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Allison Angelilli

North Shore-LIJ Health System

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Anne Steiner

North Shore-LIJ Health System

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N. Ragusa

North Shore-LIJ Health System

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Tatyana Milman

New York Eye and Ear Infirmary

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