Stevens Johnson Syndrome
Description
Stevens-Johnson syndrome and toxic epidermal necrolysis (SJS/TEN) are potentially life-threatening, immune-mediated typically drug-induced cutaneous adverse reactions with a high burden to individuals, their families and society that has an annual incidence of 1-5/1,000,000. It is characterized by widespread erythema, epidermal necrosis, and bullous detachment of the skin. The global clinical and financial burden of SJS/TEN is considerable (total cost of $128 million annually in the US), resulting in prolonged hospital stays, mortality of up to 50% in the elderly and considerable long-term multi-system physical and mental health morbidity that is still poorly understood qualitatively and quantitatively.
Research has advanced our understanding of the epidemiology, etiology, genetic risk factors, immunopathogenesis, and acute and chronic management. Although it is a rare disease there are still many research gaps across the multiple disciplines required to manage as well as prevent SJS/TEN (e.g. dermatology, immunology, clinical pharmacology, ophthalmology, gynecology). Our research team is working on the immunopathogenesis of the acute and chronic phases of the disease which includes characterizing the ocular surface microbiome.
Efforts to grow and develop functional international collaborations and a multidisciplinary interactive network focusing on SJS/TEN as an uncommon but high burden disease will be necessary to improve efforts in prevention, early diagnosis and improved acute and long-term management. Loyola will also participate in an NIH clinical trial (NATINS Study, see below) to evaluate the efficacy of systemic cyclosporine, etanercept and supportive therapy for the acute management.
Research Team
Publications
2023
- Brahmbhatt P, Khanna S, Griffin S, Bouchard CS. A Retrospective Analysis of Tear Film and Blink Parameters in Patients With Ocular Surface Disease. Eye Contact Lens. 2023 May 11. doi: 10.1097/ICL.0000000000000994. Epub ahead of print. PMID: 37167586.
- Ueta M, Inoue C, Nakata M, Sotozono C, Kim MK, Wakamatsu T, Jongkhajornpong P, Saeed H, Rauz S, Ma D, Yoon KC, Puansricharern V, Bouchard CS, Ahmad S, Seo KY, Joo CK, Gomes JA, Kinoshita JC, Teramukai S. Severe Ocular Complications of SJS/TEN and associations between pre-onset, acute and chronic factors: a report from the International Ophthalmology Collaborative Group. Frontier Medicine. 2023; 10. doi: 10.3389/fmed.2023.1189140.
- Zhang N, Su T, Yan J, Zhang M, Zhao S, Liu C, Chen T. Case report: Successful immunomodulators combined with electromagnetic field therapy in a patient with methazolamide-induced Steven Johnson syndrome/toxic epidermal necrolysis overlap. Frontier Medicine. 2023 May; 10. doi.org/10.3389/fmed.2023.1192920.
2022
- Phillips EJ, Bouchard CS, Divito SJ. Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis-Coordinating Research Priorities to Move the Field Forward. JAMA Dermatol. 2022 March 30. doi: 10.1001/jamadermatol.2022.0484. Epub ahead of print. PMID: 35353140.
- Abtahi, M., Adams, W., Agarwal, A., Agranat, JS., Ajlan, RS., Akhlaq, A. ... Zhu, I. “Noninfectious Keratitis”, in Ophthalmology, Yanoff M, Duker J, eds., Mosby-Year Book, Inc. St. Louis, MO, 2022.
- Iqbal O, El Khateeb H, Lewis J, Bouchard CS. Immune-mediated pathogenesis of Stevens Johnson Syndrome/Toxic Epidermal Necrolysis - An imminent need for stricter and more effective pharmacovigilance strategies. Journal of Dermatology and Dermatologic Diseases. 2022 December 05-06. 9:33.
2021
- Metcalfe D, Iqbal O, Chodosh J, Bouchard CS, Saeed H. Acute and Chronic Management of Ocular Disease in Stevens Johnson Syndrome/Toxic Epidermal Necrolysis. Frontiers in Medicine. 2021 July; 8:662897. doi: 10.3389/fmed.2021.662897.
- Bouchard CS. A Burning Issue. The Ophthalmologist. 2021 June; 20-25.
- Iqbal O. A New Eruptive Fever Associated With Stomatitis and Ophthalmia. International Journal of Ophthalmology & Eye Science (IJOES). 2021 July; 9(1e):1-2.
- Sadek, Michael; Iqbal, Omer; Siddiqui, Fakiha; Till, Sean; Dharan, Adarsh; Mazariegos, Mellisa; Campbell, Edward; Mudaliar, Kumaran ; Speiser, Jodi ; Bontekoe, Emily; Kouta, Ahmed ; Farooqui, Amber ; Daravath, Bharathi ; Qnebi, Dalia; Sadek, Ramy; Hoppensteadt, Debra; Fareed, Jawed; Bouchard, Charles. The Role of IL-13, IL-15 and granulysin in the pathogenesis of Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis. Clinical and Applied Thrombosis/Hemostasis. 2021 February; 27:1076029620950831. doi: 10.1177/1076029620950831. PMID: 33560872.
- Goldstein J, Ben Hadj Tahar M, Iqbal O, Fareed J, Bouchard CS. Stevens Johnson Syndrome/Toxic Epidermal Necrolysis and It’s Interface with Coagulation Activation. International Journal of Ophthalmology & Eye Science. 2021; 9(4): 472-477.
- De Bustros P, Baldea A, Sanford A, Joyce C, Adams W, Bouchard CS. Review of Culprit Drugs Associated with Patients Admitted to the Burn Unit with the Diagnosis of Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis Syndrome. Journal of the International Society for Burn Injuries. 2021 August; S0305-4179(21)00220-5. doi: 10.1016/j.burns.2021.08.009. PMID: 34924230. PMCID: PMC9124451.
2020
- Saeed HN, Bouchard CS, Shieh C, Phillips E, Chodosh J. Highlights from the 2nd Biennial Stevens Johnson Syndrome Symposium 2019: SJS/TEN From Science to Translation. The Ocular Surface. 2020 July; 18(3): 483-486. doi:10.1016/j.jtos.2019.11.012. PMCID: PMC7307450.
- Sadek, Michael; Iqbal, Omer; Siddiqui, Fakiha; Till, Sean; Dharan, Adarsh; Mazariegos, Mellisa; Campbell, Edward; Mudaliar, Kumaran ; Speiser, Jodi ; Bontekoe, Emily; Kouta, Ahmed ; Farooqui, Amber ; Daravath, Bharathi ; Qnebi, Dalia; Sadek, Ramy; Hoppensteadt, Debra; Fareed, Jawed; Bouchard, Charles. The Role of IL-13, IL-15 and granulysin in the pathogenesis of Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis. Clinical and Applied Thrombosis/Hemostasis. 2020 July. (In Press 7-27-2020).
2018
- Till SD, Iqbal O, Dharan A, Campbell E, Bu P, Mudaliar K, Speiser J, Bouchard CS. The Roles of IL-33 and TGF-Β1 in the Pathogenesis of Stevens-Johnson Syndrome/ Toxic Epidermal Necrolysis: Potential Biomarkers for Disease Severity. Journal of Ophthalmology Eye Care. 2018 September; 1(1): 105.
2016
- Kohanim S, Palioura S, Saeed HN, Akpek EK, Amescua G, Basu S, Blomquist PH, Bouchard CS, Dart JK, Gai XW, Gomes JAP, Gregory DG, Iyer G, Jacobs DS, Johnson AJ, Kinoshita S, Mantagos IS, Mehta JS, Perez VL, Pflugfelder SC, Sangwan VS, Sippel KC, Sotozono C, Srinivasan B, Tan DTH, Tandon R, Tseng SCG, Ueta M, Chodosh J. Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis-A comprehensive review and guide to therapy. I Systemic Disease. The Ocular Surface. 2016 January;14(1):2-19. doi: 10.1016/j.jtos.2015.10.002. PMID: 26549248.
- Kohanim S, Palioura S, Saeed HN, Akpek EK, Amescua G, Basu S, Blomquist PH, Bouchard CS, Dart JK, Gai XW, Gomes JAP, Gregory DG, Iyer G, Jacobs DS, Johnson AJ, Kinoshita S, Mantagos IS, Mehta JS, Perez VL, Pflugfelder SC, Sangwan VS, Sippel KC, Sotozono C, Srinivasan B, Tan DTH, Tandon R, Tseng SCG, Ueta M, Chodosh J. Acute and Chronic Ophthalmic Involvement in Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis - A Comprehensive Review and Guide to Therapy. II. Ophthalmic Disease. The Ocular Surface. 2016 April. 14(2): 168-188. doi: 10.1016/j.jtos.2016.02.001. PMID: 26882981.
2015
- Syed D, Iqbal O, Mosier M, Mitchell R, Hoppensteadt D, Bouchard CS, Fareed J, Gamelli R. Elevated endocan levels and its association with clinical severity in Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis. International Angiology. 2015; 34(5): 483-8. PMID: 25394955.
2012
- Hsu M, Jayarum A, Verner R, Lin A, Bouchard CS. Indications and Outcomes of Amniotic Membrane Transplantation in the Management of Acute Stevens–Johnson Syndrome and Toxic Epidermal Necrolysis: A Case–Control Study. Cornea. 2012 December; 31(12): 1394-1402. doi: 10.1097/ICO.0b013e31823d02a8. PMID: 23135531.
2010
- Fu Y, Gregory DG, Sippel KC, Bouchard CS, Scheffer C, Tseng G. The ophthalmologist's role in the management of acute Stevens - Johnson syndrome and toxic epidermal necrolysis. The Ocular Surface 2010;8:4-11. doi: 10.1016/s1542-0124(12)70234-3. PMID: 20964982
Ocular Microbiome
Description
We are studying the ocular microbiome and its role in floppy eyelid disease (FES), Steven’s Johnson Syndrome (SJS), graph vs. host disease (GVHD) and dry eye disease (DED). The eye contains few bacteria compared to other parts of the body, but we have developed robust methods to interrogate the microbiome in this body site. We have found that half of individuals have the same microbiome in each eye and the other half have different microbiomes in each eye. We have also found that patients with SJS have much more Staphylococcus than other patients or healthy eyes, while GVHD patients look similar to healthy individuals and FES and DED are dominated by Corynebacterium. Healthy eyes and patients with GVHD have more diverse microbiomes than patients with SJS, FES and DED. We are currently studying the viability and stability of these microbiomes longitudinally.
Research Team
Publication
2021
- Herrnreiter C, Li XL, Luck M, Zilliox M, Choudhry M. Integrated Analysis of Dysregulated microRNA and mRNA Expression in Intestinal Epithelial Cells following Ethanol Intoxication and Burn Injury. Scientific Reports, 2021 July.
2020
- Zilliox MJ, Gange WS, Kuffel G, Mores CR, Joyce C, De Bustros P, Bouchard CS. Assessing the Ocular Surface Microbiome in Severe Ocular Surface Diseases. The Ocular Surface. 2020 July. doi: 10.1016/j.jtos.2020.07.007. PMID: 32717380.
Ocular Graft VS Host Disease
Description
We are studying ocular surface disease in patients who have undergone bone marrow transplant and suffer from graft versus host disease. Specifically, we are investigating the structural and functional changes of the Meibomian oil glands on the eyelids of these patients using meibography and learning how these changes contribute to their dry eye symptoms. We are also investigating the effectiveness of a new dry eye treatment called Lipiflow Thermal Pulsation System in this patient population as an early treatment to prevent the late states of their ocular surface disease.
Research Team
Publications
2023
- Brahmbhatt P, Khanna S, Griffin S, Bouchard CS. A Retrospective Analysis of Tear Film and Blink Parameters in Patients With Ocular Surface Disease. Eye Contact Lens. 2023 May 11. doi: 10.1097/ICL.0000000000000994. Epub ahead of print. PMID: 37167586.
2021
- Zhang CY, Farooq AV, Harocopos GJ, Sollenberger EL, Hou JH, Bouchard CS, Shieh C, Tran UL, Lubniewski AJ, Huang AJ, Paley GL. Corneal perforation in ocular graft-versus-host disease. American Journal of Ophthalmology Case Reports. 2021 December; 24. https://doi.org/10.1016/j.ajoc.2021.101224.
2016
- Sivaraman KR, Jivrajka RV, Soin K, Bouchard CS, Movahedan A, Shorter E, Jain S, Jacobs DS, Djalilian, AR. Superior Limbic Keratoconjunctivitis-like Inflammation in Patients with Chronic Graft-Versus-Host Disease. The Ocular 2016 July; 14(3): 393-400. doi: 10.1016/j.jtos.2016.04.003. PMCID: PMC5554073.
Ocular Manifestation of Sleep Apnea
Description
Obstructive sleep apnea (OSA) is defined as recurrent episodes of upper airway collapse during sleep with oxygen desaturation and fragmented brief arousals causing chronic excessive daytime sleepiness. OSA is highly prevalent in adults, with incidence estimates of 34–49% in men and 17.4–23.4% in women, ages 30–70 years. However, only 2–7% may be symptomatic with daytime somnolence leading to widespread underdiagnosis. OSA has been shown to be a risk factor for systemic disease and associated mortality including hypertension, diabetes, coronary artery disease, arrhythmia, sudden cardiac death, metabolic syndrome, cerebrovascular disease, cognitive decline, and malignancy. OSA has been linked to a variety of anterior and posterior segment ocular disease. Anterior segment diseases include lax eyelid syndrome (LES), ptosis, ectropion, entropion, infectious keratitis, corneal changes including thinning/perforation and abnormal biomechanics (hysteresis). Posterior segment diseases include glaucoma, ischemic optic neuropathy, and retinal vascular occlusion.
During the episodes of airway collapse, the intermittent hypoxia that results activates the production of systemic inflammatory cytokines including matrix metalloproteinase-9 (MMP-9).
In LES there is histopathological evidence of elevation of MMP-9 associated with elastin deficiency. Tear film MMP-9 is also elevated in patients with OSA. A decrease in the biomechanics (hysteresis) of the cornea has been documented by the Ocular Response Analyzer (ORA) in OSA, FES, KCN, and glaucoma. This may be related to matrix metalloproteinase (MMP) upregulation. Hypoxia–reperfusion injury, leptin resistance, and mechanical forces all may lead to increased MMP activity, contributing to elastin breakdown in the tarsus and other tissues throughout the body in patients with OSA.
Our current research involved defining the relationship between OSA, MMP-9 and ocular manifestations of OSA as it relates to MMP elevation and histopathologic changes in tissue elastin.
Research Team
Publications
2023
- Brahmbhatt P, Khanna S, Griffin S, Bouchard CS. A Retrospective Analysis of Tear Film and Blink Parameters in Patients With Ocular Surface Disease. Eye Contact Lens. 2023 May 11. doi: 10.1097/ICL.0000000000000994. Epub ahead of print. PMID: 37167586.
2018
- Sward M, Kirk C, Stefonowicz C, Kumar S, Nasir N, Adams W, Bouchard CS. Lax Eyelid Syndrome (LES), Obstructive Sleep Apnea (OSA), and Ocular Surface Inflammation. The Ocular Surface. 2018 July; 16(3): 331-336. doi: 10.1016/j.jtos.2018.04.003. PMID: 29729418.
2012
- Saidel MA, Paik JY, Garcia C, Russo P, Cao DC, Bouchard CS. Prevalence of sleep apnea syndrome and high-risk characteristics among keratoconus patients. Cornea. 2012 June; 31(6): 600–603. doi: 10.1097/ICO.0b013e318243e446. PMID: 22495032.
Keratoconus
Description
Keratoconus is defined as a non-inflammatory, bilateral, progressive, often asymmetric primary ectasia associated with irregular astigmatism and decreased visual acuity. While improving vision depends on the severity, mild to moderate cases can be treated with an array of contact lenses such as hard contact lenses, piggyback lenses, hybrid lenses and scleral lenses. Collagen cross-linking (CXL) can increase the corneal biomechanical rigidity and prevent progression of the disease. Acute Corneal Hydrops is a serious complication of keratoconus. Surgical procedures such as Penetrating keratoplasty and deep anterior lamellar keratoplasty (DALK) may be indicated in patients with corneal scarring and advanced disease.
But, is keratoconus a non-inflammatory condition?. Our laboratories reported on an increased expression of secreted frizzled-related protein-1 (SFRP-1), SFRP-1 and microtubule-associated protein light chain 3 (LC3) and transforming growth factor-β (TGF-β) signaling pathway activation and increased TGF-β pathway markers in severe keratoconus. TGFβ2 and TNF-α both demonstrated higher expression in the epithelial layer of keratoconic corneas when compared to the normal corneas. NF-κB had similar expression levels in the epithelial and stromal layers of keratoconic corneas when compared to normal corneas. The expression of secreted frizzled-related protein-1 (SFRP-1) and microtubule-associated protein light chain 3 (LC3), an autophagy marker, in keratoconus were earlier reported from our laboratories. Increased expression of SFRP-1 was seen in the epithelium. The LC3 expression in keratoconus tissues occurred at 3 different levels: low, medium, and high. Low expressivity of SFRP1 resulted in low expressivity of LC3 while medium-high expressivity of SFRP1 resulted in medium to high expressivity of LC3. Keratocyte autophagy associated with Keratoconus may play a role in the pathogenesis of Keratoconus. These data indicate a paradigm shift in the understanding of keratoconus from a non-inflammatory to in fact, an inflammatory state. Development of appropriate anti-inflammatory drug may in future become a treatment option.
Keratoconus may be as a result of long-term oxidative stress. Recent reports by Uchida et al highlights the association between oxidative stress and corneal hysteresis in patients with glaucoma prompt interest and further research in this area. Future research may entail determination of increased levels of nitrotyrosine, as a fingerprint of short-lived peroxynitrite, in the pathogenesis of corneal hysteresis in keratoconus.
Research Team
Publication
2013
- Iqbal O, Fisher G, Vira S, Syed D, Sadeghi N, Freeman D, Campbell E, Sugar J, Feder R, Fareed J, Bouchard CS. Increased expression of secreted frizzled-related protein-1 and microtubule-associated protein light chain 3 in keratoconus. Cornea. 2013 May; 32(5):702-707. doi: 10.1097/ICO.0b013e318282987a. PMID: 23449484.
2012
- Saidel MA, Paik JY, Garcia C, Russo P, Cao DC, Bouchard CS. Prevalence of sleep apnea syndrome and high-risk characteristics among keratoconus patients. Cornea. 2012 June; 31(6): 600–603. doi: 10.1097/ICO.0b013e318243e446. PMID: 22495032.
Dry Eye Disease
Description
Dry Eye Disease (DED) is a common, multifactorial inflammatory disorder that affects over 16 million people in the United States and results in irritation, blurred vision, and tear film instability with damage to the ocular surface, including the cornea and conjunctiva. Although symptom relief can be provided by using topically applied hypo-osmotic or iso-osmotic artificial lubricants, these treatments are palliative and often do not prevent disease progression. In more severe cases, FDA-approved anti-inflammatory agents have been shown to reduce some of the signs and symptoms of the disease, however, limited efficacy and tolerability often cause poor patient satisfaction and compliance. This highlights the need for novel treatment options, especially the development of therapeutic strategies that can effectively inhibit key pathophysiological pathways.
The extramurally-funded research in Dr. Kaja's laboratory focuses on increasing our mechanistic understanding of the pathophysiology of dry eye disease and to develop novel therapeutics that address the urgent unmet clinical need for ocular surface disease. Specifically, their laboratory investigates the pathological role of generation of Reactive Oxygen Species (ROS) in the cornea in experimental models for dry eye disease. Their research team uses various physiologically-relevant triggers, including desiccating stress, chronic alcohol administration and antigens that evoke an autoimmune response to model dry eye disease. This multipronged approach allows the better prediction of therapeutic efficacy of novel drug candidates in the management of different clinical manifestations of ocular surface disease. In collaboration with Dr. Sandeep Jain at University of Illinois at Chicago, the Kaja Laboratory is developing novel formulations of ocular surface immunoglobulins (OSIG) and following the necessary IND-enabling studies to prepare phase trials in humans.
The Bu Laboratory is exploring the mechanism and novel treatment of Lactobacillus for dry eye disease. Their results show that the human corneal epithelial cells produce large amounts of proinflammatory cytokine IL-6 significantly in response to TLR5 agonist ligation and that the bacterial metabolites of Lactobacillus successfully suppressed TLR5 agonist-induced IL-6 production. These results suggest these metabolites may have protective and possibly therapeutic effects through its anti-inflammatory nature.
Research Team
Thomas John M.D.
Publications
2023
- Brahmbhatt P, Khanna S, Griffin S, Bouchard CS. A Retrospective Analysis of Tear Film and Blink Parameters in Patients With Ocular Surface Disease. Eye Contact Lens. 2023 May 11. doi: 10.1097/ICL.0000000000000994. Epub ahead of print. PMID: 37167586.
2022
- Abtahi, M., Adams, W., Agarwal, A., Agranat, JS., Ajlan, RS., Akhlaq, A. ... Zhu, I. “Noninfectious Keratitis”, in Ophthalmology, Yanoff M, Duker J, eds., Mosby-Year Book, Inc. St. Louis, MO, 2022.
- Ghosh AK, Bacellar-Galdino M, Iqbal S, Pappenhagen NE, Kaja S. Topical Porphyrin Antioxidant Protects Against Ocular Surface Pathology in a Novel Rabbit Model for Particulate Matter-Induced Dry Eye Disease. J Ocul Pharmacol Ther. 2022 May;38(4):294-304. doi: 10.1089/jop.2021.0131. Epub 2022 Apr 4. PMID: 35384749; PMCID: PMC9125571.
2021
- Ghosh AK, Thapa R, Hariani HN, Volyanyuk M, Ogle SD, Orloff KA, Ankireddy S, Lai K, Žiniauskaitė A, Stubbs EB Jr., Kalesnykas G, Hakkarainen JJ, Langert KA, Kaja S. Poly(lactic-co-glycolic acid) Nanoparticles Encapsulating the Prenylated Flavonoid, Xanthohumol, Protect Corneal Epithelial Cells from Dry Eye Disease-Associated Oxidative Stress. Pharmaceutics. 2021 August; 13(9):1362. doi.org/10.3390/pharmaceutics13091362. PMID: 34575438. PMCID: PMC8471707.
2020
- Liu H, Gambino Jr F, Algenio CS, Wu C, Gao YC, Bouchard CS, Qiao L, Bu P, Zhao SZ. Inflammation and Oxidative Stress Induced by Lipid Peroxidation Metabolite 4-Hydroxynonenal in Human Corneal Epithelial Cells. Graefe's Archive for Clinical and Experimental Ophthalmology. 2020 May; 258: 1717-1725. doi: 10.1007/s00417-020-04647-2. PMID: 32445015.
- Ripa M, Jabbehdari S, Yazdanpanah G, Lukacs E, Karcher B, Iqbal O, Bouchard CS. The Role of Multisystem Disease in Composition of Autologous Serum Tears and ocular surface symptom improvement. The Ocular Surface. 2020 July; 18(3):499-504. doi: 10.1016/j.jtos.2020.02.011. PMID: 32126284.
2019
- Ziniauskaite A, Ragauskas S, Ghosh AK, Thapa R, Roessler AE, Koulen P, Kalesnykas G, Hakkarainen JJ, Kaja S. Manganese (III) Tetrakis (1-Methyl-4Pyridyl) Porphyrin, a Superoxide Dismutase Mimetic, Reduces Disease Severity in In Vitro and In Vivo Models for Dry-Eye Disease. The Ocular Surface. 2019 April; 17(2): 257-264. doi: 10.1016/j.jtos.2019.02.006. PMCID: PMC6570415.
2018
- Liu H, Gambino Jr F, Algenio CS, Bouchard CS, Qiao L, Bu P, Zhao SZ. Zidovudine Protects Hyperosmolarity-Stressed Human Corneal Epithelial Cells via Antioxidant Pathway. Biochemical and Biophysical Research Communications. 2018 May; 499(2): 177-181. doi: 10.1016/j.bbrc.2018.03.112. PMID: 29555477.
2017
- John T, Tighe S, Sheha H, Hamrah P, Salem ZM, Cheng AS, Wang MX, Rock ND. Corneal Nerve Regeneration after Self-Retained Cyropreserved Amniotic Membrane in Dry Eye Disease. 2017 August; 2017: 6404918. doi: 10.1155/2017/6404918. PMCID: PMC5574308.
- Gange WS, Kirchner ID, Thompson JA, Hill J, Ibrahim T, Leonetti JP, Anderson DE, Bouchard CS. Ophthalmic complications following acoustic neuroma resection. Operative 2018 January; 14(1): 58-65. doi: 10.1093/ons/opx071. PMID: 29253289.
2014
- Tibrewal S, Ivanir Y, Sarkar J, Nayeb-Hashemi N, Bouchard CS, Kim E, Jain S. Hyperosmolar Stress Induces Neutrophil Extracellular Trap Formation: Implications for Dry Eye Disease. Investigative Ophthalmology & Visual Science. 2014 November; 55(12); 7961-7969. doi: 10.1167/iovs.14-15332. PMCID: PMC4263134.
Meibomian Gland Dysfunction
Description
Our research team is focusing on the structural and functional changes that occur in the eyelid Meibomian glands, particularly in our ocular graft versus host disease patients. We are using Lipiview meibography to quantitate these changes over time. We are also investigating the efficacy of early treatment with Lipiview Thermal Pulsation System in these patients to reduce Meibomian gland dysfunction and ocular surface disease, improve their dry eye symptoms, and prevent late stages of the disease.
Research Team
Publication
2023
- Brahmbhatt P, Khanna S, Griffin S, Bouchard CS. A Retrospective Analysis of Tear Film and Blink Parameters in Patients With Ocular Surface Disease. Eye Contact Lens. 2023 May 11. doi: 10.1097/ICL.0000000000000994. Epub ahead of print. PMID: 37167586.
2022
- Bouchard CS. Diagnosis and Management of Blepharitis. Review of Ophthalmology. 2022 September.
Book Chapter
2020
- Kirk C, Vasaiwala, R. Bouchard CS, “Diagnostic Tools”, in Blepharitis: A Comprehensive Clinical Guide, Asim Farooq and James Reidy, eds, Springer Nature, New York, NY 2020.
Corneal Surgery
Description
Corneal transplantation procedures are performed to restore vision in patients with corneal scarring, opacification, or edema (swelling of the cornea). Many different techniques of corneal transplantation exist, but they can broadly be grouped into full thickness transplantation of the cornea or selective replacement of the diseased layers of the cornea. Most cases of corneal edema are caused by failure of the corneal endothelium, which is the innermost layer of the cornea, and current practice favors selective transplantation of the corneal endothelium (endothelial keratoplasty) in these cases.
Endothelial keratoplasty has been a major focus of the research on corneal surgery performed at Loyola University. Recent highlights include a 2019 study of infections that occurred in the interface between the patient’s native cornea and the transplanted corneal tissue and a 2018 study of the outcomes in patients who required repeat endothelial keratoplasty due to failure of the first transplant.
The goal of our cornea transplantation research is to better understand the management and outcomes of corneal transplants in complex cases. We aim to use this knowledge to improve our surgical techniques and post-operative management so that we can achieve even greater success with our corneal transplantation patients.
Research Team
Thomas John M.D.
Publications
2022
- Hakim R, Patel N, Veryovkin I, Gaynes BI. Effect of Age and Viscosity on Duration of Corneal Anesthesia with Topical 2% Lidocaine Administration. J Ocul Pharmacol Ther. 2022 Dec;38(10):709-716. doi: 10.1089/jop.2022.0076. Epub 2022 Nov 14. PMID: 36374966.
2019
- Gao Y, Li CH, Bu P, Zhang LJ, Bouchard CS. Infectious Interface Keratitis (IIK) Following Lamellar Keratoplasty: A Literature Review. The Ocular Surface. 2019 October; 17(4): 635-643. doi: 10.1016/j.jtos.2019.08.001. PMID: 31415815.
- Cortina MS, Karas FI, Bouchard CS, Aref AA, Djalilian A, Vajaranant TS. Staged Ocular Fornix Reconstruction for Glaucoma Drainage Device under Neoconjunctiva at the time of Boston type 1 Keratoprosthesis Implantation. The Ocular Surface. 2019 April; 17(2): 336-340. doi: 10.1016/j.jtos.2019.01.010. PMID: 30742989.
- Thompson JM, Truong AH, Stern HD, Djalilian A, Cortina MS, Tu EY, Johnson P, Verdier DD, Rafo L, Lubeck D, Spektor T, Jorgensen C, Rubenstein JB, Majmudar PA, Talati R, Basti S, Feder R, Sugar A, Mian SI, Balasubramanian N, Sandhu J, Gaynes BI, Bouchard CS. A Multicenter Study Evaluating the Risk Factors and Outcomes of Repeat Descemet Stripping Endothelial Keratoplasty. Cornea. 2019 February; 38(2): 177-182. doi: 10.1097/ICO.0000000000001817. PMID: 30615600.
2014
- Vira S, Abugo U, Shih CY, Udell IJ, Sperling B, Hannush SB, Basti S, Bouchard CS. Descemet stripping endothelial keratoplasty for the treatment of combined Fuchs corneal endothelial dystrophy and Keratoconus. Cornea. 2014 January; 33(1);1-5. doi: 10.1097/ICO.0b013e3182a7389c. PMID: 24240488.
2013
- Vira S, Shih CY, Ragusa N, Sheyman A, Feder R, Weisenthal R, Rosenwasser GOD, Hannush SB, Udell IR, Bouchard CS. Textural interface opacity after Descemet stripping automated endothelial keratoplasty (DSAEK): A report of 30 cases and possible etiology. Cornea. 2013 May; 32(5):54-9. doi: 10.1097/ICO.0b013e31826429d5. PMID: 23132442.
2011
- Clements JL, Bouchard CS, Lee BW, Bunn SP, Mannis MJ, Reidy JJ, John T, Hannush SB, Goins KM, Wagoner MD, Adi MA, Rubenstein JB, Udell IJ, Babiuch AS. Retrospective review of graft dislocation rate associated with descemet stripping automated endothelial keratoplasty after primary failed penetrating keratoplasty. Cornea. 2011 April; 30(4):414-418. doi: 10.1097/ICO.0b013e3181f7f163. PMID: 21099405.
2010
- Bouchard, CS, John, T. Simplified surgical technique for harvesting corneal stem cells. Ocul Surg News US Ed 28:4, February 25, 2010.
- Bouchard, CS. A review of surgical techniques for harvesting corneal stem cells from allograft donor tissue. Techniques in Ophthalmology 2010;8:10-14.
- Chamberlain W, Omid N, Lin A, Farid M, Gaster RN, Steinert RF. Comparison of corneal surface higher-order aberrations after endothelial keratoplasty, femtosecond laser-assistant keratoplasty, and conventional penetrating keratoplasty. Cornea. 2012 January; 31(1): 6-13. doi: 10.1097/ICO.0b013e3182151df2. PMID: 21963860.
Clinical ocular pharmacology
Description
Our clinical laboratory is conducting research on the impact of vitreous degeneration on pharmacodynamic of intravitreal injections for treatment of retinal disease. We are examining the how the presence and extent of vitreous liquification and vitreal detachment impact the disposition of intravitreal injections as determined by outcome parameters of foveal thickness. This study includes examination of patients with diabetic macular edema and ag related macular degeneration who require intravitreal pharmacotherapy. Our lab employs appropriate simulation software to generate pharmacokinetic parameters profiling invitreal disposition as a function of vitreal status as well as in patients who have undergone vitrectomy.
Research Team
Publications
- Hakim R, Patel N, Veryovkin I, Gaynes BI. Effect of Age and Viscosity on Duration of Corneal Anesthesia with Topical 2% Lidocaine Administration. J Ocul Pharmacol Ther. 2022 Dec;38(10):709-716. doi: 10.1089/jop.2022.0076. Epub 2022 Nov 14. PMID: 36374966.