Alexander Aizman, M.D.

Qualitative spectral OCT/SLO analysis of drusen change in dry age-related macular degeneration patients treated with Copaxone
Landa, Gennady; Rosen, Richard B; Patel, Amar; Lima, Veronica Castro; Tai, Katy W; Perez, Violete R; Aizman, Alexander; Garcia, Patricia M T
2011 Feb;27(1):77-82, Journal of ocular pharmacology & therapeutics
PURPOSE: High-resolution spectral domain OCT/SLO (SD-OCT) has become an increasingly useful tool for differentiating drusen morphologic parameters such as shape, internal reflectivity, homogeneity, and presence of overlying hyperreflective foci. Our purpose was to evaluate which types of drusen may respond to Copaxone (glatiramer acetate) treatment of dry age-related macular degeneration (AMD) patients by shrinking or disappearing. METHODS: A prospective and interventional clinical trial of patients with dry AMD who received subcutaneous treatment with Copaxone or sham injections was conducted. SD-OCT images were used for analysis of drusen ultrastructure. Morphologic characteristics for specific drusen within the macular region were assessed with serial studies. Pre- and posttreatment statuses of drusen were compared. Main outcome measure was a change of drusen morphologic parameters in Copaxone-treated and sham-treated dry AMD patients between baseline and 12 weeks of treatment. RESULTS: Three hundred eleven drusen from 26 eyes of 14 dry AMD patients were evaluated. One hundred seventy-two drusen from 14 eyes (7 patients) of Copaxone-treated and 139 drusen from 12 eyes sham-treated (7 patients) were included. Overall, between baseline and 12-week visit, the percentage of drusen that disappeared/shrank in the Copaxone-treated group was 19.2% versus 6.5% in the sham-treated group (P = 0.13). The percentage of convex drusen that shrank or disappeared after 12 weeks of treatment was significantly higher in the Copaxone-treated group (27.8%) in comparison with the sham-treated group (6.8%) (P = 0.008). The difference between the groups was found to be statistically significant for drusen with low and medium internal reflectivity (P = 0.019 and P = 0.036, respectively). CONCLUSIONS: Convex shape and low/medium internal reflectivity were found to be favorable parameters in prediction of drusen reduction in the Copaxone-treated patients. This study represents a preliminary attempt to identify SD-OCT features of drusen that may predict susceptibility to Copaxone treatment and therefore help clinicians decide which patients to treat
— id: 134168, year: 2011, vol: 27, page: 77, stat: Journal Article,

Treatment of acute retinal necrosis syndrome with oral antiviral medications
Aizman, Alexander; Johnson, Mark W; Elner, Susan G
2007 Feb;114(2):307-312, Ophthalmology
OBJECTIVE: Acute retinal necrosis (ARN) is a distinct ocular viral syndrome traditionally treated with intravenous acyclovir followed by oral acyclovir. We investigated the use of the oral antiviral medications valacyclovir and famciclovir as the sole treatment for patients with newly diagnosed ARN syndrome. DESIGN: Retrospective, uncontrolled, interventional case series. PARTICIPANTS: Eight consecutive patients with newly diagnosed ARN treated solely with oral antiviral medications. INTERVENTION: All patients received famciclovir or valacyclovir without antecedent intravenous therapy. One patient with bilateral ARN treated with famciclovir received a single intravitreal injection of foscarnet in the more severely involved eye. MAIN OUTCOME MEASURES: Clinically and photographically documented complete resolution of retinitis and best-corrected visual acuity on final follow-up. RESULTS: Active retinitis resolved completely in 10/10 (100%) affected eyes. Initial response to treatment was seen as early as 4 days (in 5 eyes), with a median time to complete resolution of 14 days. At the last examination, visual acuity was improved (> or = 2 Snellen lines) in 6 (60%) eyes, stable in 2 (20%) eyes, and worse in 2 (20%) eyes. Over a mean follow-up of 36 weeks (range, 7-72 weeks), 3 eyes developed rhegmatogenous retinal detachment that was successfully repaired with 1 vitrectomy surgery. No patient with initially unilateral involvement developed disease in the contralateral eye. CONCLUSIONS: In this pilot study, the use of the oral drugs valacyclovir and famciclovir resulted in complete regression of herpetic necrotizing retinitis. Additional studies are necessary to evaluate the role of these antiherpetic medications in the treatment of the ARN syndrome
— id: 106478, year: 2007, vol: 114, page: 307, stat: Journal Article,

Treatment of acute retinal necrosis syndrome
Aizman, Alexander
2006 Aug;42(8):545-551, Drugs of today (Barcelona, Spain : 1998)
Acute retinal necrosis is a distinct ocular viral syndrome with a potentially devastating visual outcome, traditionally treated with intravenous acyclovir followed by oral acyclovir. The goals of therapy include accelerating the resolution of the infection in the affected eye and prevention of contralateral involvement. Recently, several small case series and case reports have described the use of newer oral antivirals such as valacyclovir, famciclovir or valganciclovir, alone or in combination with adjunctive intravitreal foscarnet or ganciclovir injections for the treatment of acute retinal necrosis (1-4). The purpose of this article is to describe various therapies available to practitioners who may treat patients with acute retinal necrosis
— id: 106477, year: 2006, vol: 42, page: 545, stat: Journal Article,

Diagnostic and therapeutic challenges. High grade fever and bronchitis
Aizman, Alexander; Johnson, Mark W; Olsen, Timothy W; Ho, Allen C; Davis, Janet L
2006 Mar;26(3):345-351, Retina
— id: 106474, year: 2006, vol: 26, page: 345, stat: Journal Article,

Nature and risk of neovascularization in the fellow eye of patients with unilateral retinal angiomatous proliferation
Gross, Nicole E; Aizman, Alexander; Brucker, Allison; Klancnik, James M Jr; Yannuzzi, Lawrence A
2005 Sep;25(6):713-718, Retina
PURPOSE: To determine the nature and risk of neovascularization in the fellow eyes of patients with unilateral retinal angiomatous proliferation (RAP), a neovascular form of age-related macular degeneration (AMD). METHODS: A consecutive series of 52 patients diagnosed with unilateral RAP were studied retrospectively. Clinical biomicroscopic examination, fluorescein angiography, and indocyanine green angiography were used to evaluate all patients for the development of neovascular manifestations in the fellow eye. RESULTS: Neovascularization developed in the fellow eye in 52 patients over the follow-up period (range, 2-36 months). All patients developed neovascular manifestations of RAP in the fellow eye. Twenty-one patients (40%) developed a RAP lesion within 1 year; 29 (56%), within 2 years; and 52 (100%), within 3 years. At the time of diagnosis of neovascularization in the fellow eye, 8 patients (15%) had a stage I RAP lesion, 36 (70%) had a stage II RAP lesion, and 8 (15%) had a stage III RAP lesion. Other characteristic findings in these patients included the presence of preretinal, intraretinal, and subretinal hemorrhages in 49 patients (94%) and pigment epithelial detachments in 41 patients (79%). CONCLUSIONS: In patients diagnosed with unilateral RAP lesions, the form of neovascularization that develops in the fellow eye is virtually always RAP. The annual and accumulative risk of neovascularization in the fellow eye is higher in patients with RAP than in those with other forms of neovascular AMD. These new findings enhance our understanding of the clinical spectrum of RAP in terms of its natural course and visual prognosis and may possibly offer useful information to establish future treatment options
— id: 66042, year: 2005, vol: 25, page: 713, stat: Journal Article,

Palladium 103 (103Pd) plaque radiation therapy for circumscribed choroidal hemangioma with retinal detachment
Aizman, Alexander; Finger, Paul T; Shabto, Uri; Szechter, Andrzej; Berson, Anthony
2004 Nov;122(11):1652-1656, Archives of ophthalmology
OBJECTIVE: To describe clinical experience with palladium 103 ((103)Pd) ophthalmic plaque radiotherapy for choroidal hemangioma. METHODS: One course of (103)Pd ophthalmic plaque radiotherapy was used in each of 5 patients with circumscribed choroidal hemangioma who had progressive loss of vision due to subretinal exudation. A mean apex dose of 2900 cGy (2900 rad) was delivered. Functional tests of outcome included best-corrected visual acuity. Anatomic results included changes in tumor height and subretinal fluid documented by ophthalmoscopy, fluorescein angiography, and ultrasonography. RESULTS: All patients had complete resolution of subretinal fluid with reattachment of the retina. All tumors decreased in height (mean, 50%) after treatment. Three patients (60%) demonstrated improvement in visual acuity at the last follow-up, and in 1 patient vision remained stable with resolution of metamorphopsia. Twenty-four months after treatment, 1 patient whose visual acuity had recovered from 20/160 to 20/32 had a loss of vision to 20/160 because of radiation maculopathy. For all patients, a mean visual acuity improvement of 2 lines was documented (95% confidence interval, 0.23-0.88). Mean follow-up was 18.6 months (range, 6-29 months). CONCLUSIONS: A single (103)Pd plaque radiation treatment was effective in decreasing tumor height, eliminating subretinal fluid, and improving visual acuity in patients with symptomatic circumscribed choroidal hemangiomas
— id: 47825, year: 2004, vol: 122, page: 1652, stat: Journal Article,

The characteristics of neovascularization in the fellow eye of patients with unilateral retinal angiomatous proliferation
Brucker, AJ; Aizman, A; Gross, NE; Yannuzzi, LA
2004 APR ;45(9):U73-U73, Investigative ophthalmology & visual science. IOVS
— id: 48928, year: 2004, vol: 45, page: U73, stat: Journal Article,

A survey of patterns of physician hygiene in ophthalmology clinic patient encounters
Aizman, Alexander; Stein, Joshua D; Stenson, Susan M
2003 Oct;29(4):221-222, Eye & contact lens
PURPOSE: This study examined physician hygiene patterns in the eye clinic of a major medical center to assess compliance with recommended practice patterns to avoid nosocomial infection during patient encounters. METHODS: One hundred ophthalmology resident-patient encounters were observed anonymously by the authors. Examining physicians were evaluated in handwashing between patients, cleaning and disinfecting of tonometer tips after each use, and recapping of diagnostic drop bottles after each use. RESULTS: Physicians washed their hands 74% of the time between patient encounters. The surfaces of tonometer tips were disinfected with an alcohol pad 100% of the time. Diagnostic drop bottles were recapped 57% of the time after each use. CONCLUSIONS: There is ample clinical evidence in the ophthalmic literature that practitioners' hands and tonometer tips can be vectors for transmission of nosocomial infection and that vigorous handwashing and disinfection of instruments can decrease the rates of transmission. Sometimes, however, physicians neglect to follow these simple and effective steps. We suggest posting visual educational materials in examination rooms as a reminder to ophthalmology residents and clinic personnel to adhere to these precautions, benefiting doctors and patients
— id: 94869, year: 2003, vol: 29, page: 221, stat: Journal Article,

PHOTODYNAMIC THERAPY OF RETINAL ANGIOMATOUS PROLIFERATION
Bui, A.; Aizman, A.; Klancnik, J. M., Jr.; Yannuzzi, L. A.; Slakter, J.; Freund, B. K.; Spaide, R. F..; Gross, N. E.
2003 ;2003(6):Abstract No. 1793-Abstract No. 1793, ARVO Annual Meeting Abstract Search & Program Planner
Purpose: A newly recognized and distinct form of exudative age-related macular degeneration called retinal angiomatous proliferation (RAP) was recently described in the literature. At this time, there are no established treatments for this subset of exudative AMD. The purpose of this study was to evaluate the visual outcome of patients with RAP who were treated with photodynamic therapy (PDT). Methods: A retrospective case series reviewed medical records of ninety consecutive patients with AMD treated with photodynamic therapy between June and September 2001. Five patients met criteria for diagnosis of RAP based on clinical examination and angiographic studies. Results: Stable vision ( < 3 lines of loss) was achieved in four out of five eyes. Only one patient lost more than three lines of vision. At the six month follow-up examination an average loss of vision was 1.8 lines. No patient had a loss of six or more lines of vision. Conclusions: No definitive treatment for RAP is currently established. In this study, photodynamic therapy appeared to reduce the risk of visual loss in eyes with retinal angiomatous proliferation. Additional studies are necessary to further delineate safety and efficacy of PDT in retinal angiomatous proliferation
— id: 103627, year: 2003, vol: 2003, page: Abstract No. 1793, stat: Journal Article,

Photodynamic therapy of retinal angiomatous proliferation
Bui, A; Aizman, A; Klancnik, JM; Yannuzzi, LA; Slakter, J; Freund, BK; Spaide, RF; Gross, NE
2003 MAY ;44(3):U416-U416, Investigative ophthalmology & visual science. IOVS
— id: 55420, year: 2003, vol: 44, page: U416, stat: Journal Article,

Indocyanine green angiography-guided photodynamic therapy for treatment of chronic central serous chorioretinopathy: a pilot study
Yannuzzi, Lawrence A; Slakter, Jason S; Gross, Nicole E; Spaide, Richard F; Costa, Danielle L L; Huang, Sheau J; Klancnik, James M Jr; Aizman, Alexander
2003 Jun;23(3):288-298, Retina
BACKGROUND: Most patients with central serous chorioretinopathy (CSC) have spontaneous resolution of exudative macular detachments and a good visual prognosis. Patients with CSC have a primary choroidal hyperpermeability problem evident as multifocal areas of hyperpermeability during indocyanine green (ICG) angiography. A small percentage of patients develop chronic or progressive disease with widespread decompensation of the retinal pigment epithelium and severe vision loss. There is no known treatment for this variant of the disorder. PURPOSE: To study ICG-guided photodynamic therapy (PDT) with verteporfin as a potential treatment for patients with chronic CSC. METHODS: Twenty eyes of 15 patients were studied with fluorescein angiography, optical coherence tomography, and ICG angiography to diagnose the maculopathy, monitor the detachments, and localize the choroidal hyperpermeability of the disorder. PDT with ICG guidance was applied to areas of choroidal hyperpermeability, and the patients were observed to determine the anatomic and functional outcomes. RESULTS: Photodynamic therapy guided by ICG was associated with complete resolution of exudative macular detachments in 12 patients and incomplete resolution in the remaining eight eyes. The vision improved in six eyes and remained unchanged in 14 eyes during a mean follow-up of 6.8 months. Six weeks after treatment, the mean visual acuity improved by 0.55 lines, an amount that was marginally significant. There was a significant inverse correlation between the baseline visual acuity and the amount of improvement in acuity at 6 weeks. No patient had any treatment-related side effects. CONCLUSIONS: Indocyanine green angiography-guided PDT with verteporfin seems to aid in the resolution of exudative detachments in patients with chronic CSC. This treatment was associated with a rapid reduction in subretinal fluid and improvement in visual acuity. Although the follow-up time and number of patients in this pilot study were limited, the encouraging results and lack of complications suggest that further study is indicated
— id: 65991, year: 2003, vol: 23, page: 288, stat: Journal Article,

A photodynamic pathway to apoptosis and necrosis induced by dimethyl tetrahydroxyhelianthrone and hypericin in leukaemic cells: possible relevance to photodynamic therapy
Lavie G; Kaplinsky C; Toren A; Aizman I; Meruelo D; Mazur Y; Mandel M
1999 Feb;79(3-4):423-432, British journal of cancer
The mechanism of cell death induction by dimethyl tetrahydroxyhelianthrone (DTHe), a new second-generation photodynamic sensitizer, is analysed in human leukaemic cell lines in comparison with the structurally related hypericin. DTHe has a broad range of light spectrum absorption that enables effective utilization of polychromatic light. Photosensitization of HL-60 cells with low doses of DTHe (0.65 microM DTHe and 7.2 J cm(-2) light energy) induced rapid apoptosis of > or =90% of the cells. At doses > or =2 microM, dying cells assumed morphological necrosis with perinucleolar condensation of chromatin in HL-60 and K-562 cell lines. Although nuclear fragmentation that is characteristic to apoptosis was prevented, DNA digestion to oligonucleosomes proceeded unhindered. Such incomplete apoptosis was more prevalent with the related analogue hypericin throughout most doses of photosensitization. Despite hypericin being a stronger photosensitizer, DTHe exhibited advantageous phototoxic properties to tumour cells, initiating apoptosis at concentrations about threefold lower than hypericin. Photosensitization of the cells induced dissociation of the nuclear envelope, releasing lamins into the cytosol. DTHe also differed from hypericin in effects exerted on the nuclear lamina, causing release of an 86-kDa lamin protein into the cytosol that was unique to DTHe. Within the nucleus, nuclear envelope lamin B underwent covalent polymerization, which did not affect apoptotic nuclear fragmentation at low doses of DTHe. At higher doses, polymerization may have been extensive enough to prevent nuclear collapse. Hut-78, CD4+ cells were resistant to the photodynamically activated apoptotic pathway. Beyond the tolerated levels of photodynamic damage, these cells died exclusively via necrosis. Hut-78 cells overexpress Bcl-X(L) as well as a truncated Bcl-X(L)tr isoform that could contribute to the observed resistance to apoptosis
— id: 15241, year: 1999, vol: 79, page: 423, stat: Journal Article,