Prithvi Mruthyunjaya

Overview:

Dr. Mruthyunjaya specializes in the diagnosis, treatment, and surveillance of patients with ocular cancers and advanced retinal diseases.  He is fellowship trained in both Vitreoretinal surgery and Ocular Oncology.  He is skilled at performing complex retinal surgical procedures including repair of retinal detachments, epiretinal membrane peeling, macular hole surgery, and surgery for diabetic retinopathy.  He has extensive expertise in small-gauge vitrectomy and is adept at using the latest technologies to optimize surgical outcomes.  He cares for patients with diabetic retinopathy, macular degeneration, ocular inflammation, and macular holes.

As the Ocular Oncologist for the Duke Eye Center, Dr. Mruthyunjaya serves patients from across the 5 state region and across the country.  He provides compassionate and individualized care for patients with suspected or confirmed ocular cancers involving the conjunctiva, iris, vitreous, retina, and choroid--in adults and children.  Many of his patients are treated for ocular melanoma, lymphoma, retinoblastoma, and metastatic lesions found in the eye.  He performs complex diagnostic procedures including biopsies of small ocular tumors and surgeries to treat malignant cancers including vitrectomy, retinal injections of chemotherapy, plaque radiation therapy, and lesion excision surgeries.  He is a member of the Duke Cancer Institute which gives him unprecedented access to experts in oncology at Duke for collaborative care for his patients. 

His research interests are in translational therapies in ocular oncology in particular use of targeted drug therapy in ocular melanomas and retinoblastomas. He is interested in the use of predictive modelling to define survival characteristics in ocular cancers. He has focused on identifying novel patterns in health care delivery and in new techniques for vitreoretinal surgery and ocular imaging to diagnose complex retinal conditions. 

He is a member of numerous societies including the American Academy of Ophthalmology, the Retina Society (elected member), American Society of Retina Specialists, International Society of Ocular Oncology, and the North Carolina Retina Club among others.  He has been award the Achievement Award by the American Academy of Ophthalmology along with other honors including the Heed and AOS Knapp fellowships, the Edward K Isby Jr. Award for excellence in residency training, the Hornaday Fellow Award, and the Ronald G. Michels Foundation Fellowship. 

He is actively involved in numerous Ophthalmology Organizations and has been an invited speaker and moderator at state, national and international meetings in both Ocular Oncology and Vitreoretinal diseases.  He is an examiner for the American Board of Ophthalmology and has been invited to design future curriculum for Board eligibility.  He has been named one of the Best Doctors in America since 2012.

Dr. Mruthyunjaya is dedicated to teaching the next generation of outstanding ophthalmologists and retinal specialists at Duke.   He works closely with Ocular Pathologists to enhance training across specialities.  He is also director of Medical Education to help improve the quality of care by eye care specialists across the region. 

Positions:

Adjunct Associate Professor in the Department of Ophthalmology

Ophthalmology, Vitreoretinal Diseases & Surgery
School of Medicine

Member of the Duke Cancer Institute

Duke Cancer Institute
School of Medicine

Education:

M.D. 1996

Albany Medical College

Publications:

Considerations for the Management and Triage of Ocular Oncology Cases during the COVID-19 Pandemic.

Authors
Skalet, AH; Allen, RC; Shields, CL; Wilson, MW; Mruthyunjaya, P; Gombos, DS
MLA Citation
Skalet, Alison H., et al. “Considerations for the Management and Triage of Ocular Oncology Cases during the COVID-19 Pandemic.Ocul Oncol Pathol, vol. 6, no. 3, Apr. 2020, pp. 1–4. Pubmed, doi:10.1159/000507734.
URI
https://scholars.duke.edu/individual/pub1439944
PMID
32411697
Source
pubmed
Published In
Ocular Oncology and Pathology
Volume
6
Published Date
Start Page
1
End Page
4
DOI
10.1159/000507734

Anti-Vascular Endothelial Growth Factor Therapy for Radiation Retinopathy.

BACKGROUND AND OBJECTIVE: The purpose of this article is to review the role of anti-vascular endothelial growth factor (VEGF) therapy in treating patients with radiation retinopathy (RR). PATIENTS AND METHODS: RR can be associated with a significant decrease in visual acuity (VA) related to the development of cystoid macular edema, macular ischemia, and proliferative retinopathy leading to neovascular glaucoma. RESULTS: Anti-VEGF therapy is effective at stabilizing VA in around 80% of patients and achieving reductions in central macular thickness when it is administered using a constant algorithm. Furthermore, consistent prophylactic anti-VEGF therapy reduces the risk of development of RR, neovascularization of the iris, and neovascularization glaucoma. CONCLUSION: Future studies are needed to determine the optimal regimen for anti-VEGF therapy according to patient risk factors and likelihood of developing RR. [Ophthalmic Surg Lasers Imaging Retina. 2020;51:S44-S49.].
Authors
Rayess, N; Mruthyunjaya, P
MLA Citation
Rayess, Nadim, and Prithvi Mruthyunjaya. “Anti-Vascular Endothelial Growth Factor Therapy for Radiation Retinopathy.Ophthalmic Surg Lasers Imaging Retina, vol. 51, no. 4, Apr. 2020, pp. S44–49. Pubmed, doi:10.3928/23258160-20200401-06.
URI
https://scholars.duke.edu/individual/pub1440391
PMID
32348534
Source
pubmed
Published In
Ophthalmic Surg Lasers Imaging Retina
Volume
51
Published Date
Start Page
S44
End Page
S49
DOI
10.3928/23258160-20200401-06

Pseudoprogression of Metastatic Melanoma to the Orbit With Pembrolizumab.

The management of metastatic melanoma to the orbit may involve a variety of therapeutic modalities including external-beam radiation, chemotherapy, and varying degrees of surgical resection or debulking. Pembrolizumab is an immunotherapeutic agent that has demonstrated efficacy in the treatment of metastatic melanoma. The authors present a case of metastatic melanoma to the orbit demonstrating profound pseudoprogression within hours of beginning pembrolizumab therapy, with associated mass effect and vision loss. Systemic corticosteroids, orbital external-beam radiation therapy, and a brief interruption in pembrolizumab halted expansion of the orbital lesion and vision loss. This case illustrates that rapid increase in orbital melanoma size, due to acute inflammatory response, may occur after initiation of systemic pembrolizumab therapy. Clinicians should be aware of this pseudoprogression mechanism as a potential cause of vision compromise in metastatic orbital melanoma. Prompt recognition and treatment may be needed to prevent permanent vision loss.
Authors
Garcia, GA; Topping, KL; Mruthyunjaya, P; Kossler, AL
MLA Citation
Garcia, Giancarlo A., et al. “Pseudoprogression of Metastatic Melanoma to the Orbit With Pembrolizumab.Ophthalmic Plast Reconstr Surg, vol. 36, no. 2, pp. e36–40. Pubmed, doi:10.1097/IOP.0000000000001543.
URI
https://scholars.duke.edu/individual/pub1434118
PMID
32134764
Source
pubmed
Published In
Ophthalmic Plastic and Reconstructive Surgery
Volume
36
Start Page
e36
End Page
e40
DOI
10.1097/IOP.0000000000001543

CORRELATION OF GENE EXPRESSION PROFILE STATUS AND AMERICAN JOINT COMMISSION ON CANCER STAGE IN UVEAL MELANOMA.

PURPOSE: To study the relationship between gene expression profile (GEP) subclass and American Joint Committee on Cancer (AJCC) stage in patients with uveal melanoma (UM). METHODS: A retrospective, multicenter study was undertaken with patients entered from nine major ocular oncology centers from across the United States. Three hundred sixty eligible patients had UM and underwent I-125 plaque brachytherapy with concurrent tumor biopsy with GEP testing between January 1, 2010, and October 28, 2014. Patient demographics and UM features were analyzed by both GEP and AJCC status. RESULTS: Gene expression profile class divided the cohort into three groups: Class 1a (n = 186), Class 1b (n = 77), and Class 2 (n = 113). When classified using AJCC staging criteria, we found the following: Stage I in 91 cases (25.3%), Stage IIA in 143 cases (39.7%), Stage IIB in 89 cases (24.7%), Stage IIIA in 36 cases (10%), and Stage IIIB in 1 case (0.3%). There were no Stage IV cases, as lymph node and metastatic data were not collected as a part of this study. Among Stage I tumors, both high tumor height and high largest basal diameter were associated with a higher frequency of Class 2 status (P < 0.05). As UMs progress to a larger AJCC tumor group (T1-T4), the odds ratio of having a worse prognosis based on GEP class was 1.75 (95% CI, 1.36-2.25; P < 0.001). Similarly, as UMs progress to a higher AJCC stage, the odds ratio of having a worse prognosis based on GEP class was 1.69 (95% CI, 1.36-2.10; P < 0.001). CONCLUSION: This report details the differences in clinical features between GEP subclasses and how they are distributed among the AJCC stages. When the tumors were grouped by AJCC staging criteria, both larger AJCC tumor (T) group and worsening AJCC stage were associated with worsening predicted prognosis, based on GEP subclass.
Authors
Berry, DE; Schefler, AC; Seider, MI; Materin, M; Stinnett, S; Mruthyunjaya, P; Ocular Oncology Study Consortium,
MLA Citation
Berry, Duncan E., et al. “CORRELATION OF GENE EXPRESSION PROFILE STATUS AND AMERICAN JOINT COMMISSION ON CANCER STAGE IN UVEAL MELANOMA.Retina, vol. 40, no. 2, Feb. 2020, pp. 214–24. Pubmed, doi:10.1097/IAE.0000000000002385.
URI
https://scholars.duke.edu/individual/pub1428415
PMID
31972790
Source
pubmed
Published In
Retina
Volume
40
Published Date
Start Page
214
End Page
224
DOI
10.1097/IAE.0000000000002385

Association of Rhegmatogenous Retinal Detachment and Outcomes With the Day of the Week That Patients Undergo a Repair or Receive a Diagnosis.

Importance: Because variation in care on weekends has been reported in many surgical fields, it is of interest if variations were noted for care patterns of rhegmatogenous retinal detachments (RRDs). Objective: To assess the association between modality of RRD repair and day of the week that patients receive a diagnosis or undergo RRD repair. Design, Setting, and Participants: A retrospective claims-based cohort analysis was performed of primary RRD surgery for 38 144 commercially insured patients in the United States who received a diagnosis of incident RRD between January 1, 2008, and December 31, 2016, and underwent repair within 14 days of diagnosis. Multinomial regression models were used to assess patients' likelihood of repair with different modalities, logistic regression models were used to assess patients' likelihood of reoperation, and linear regression models were used to assess time from diagnosis to repair. Data analysis was performed from March 9 to September 5, 2019. Exposures: Day of the week that the patient received a diagnosis of RRD or underwent RRD repair. Main Outcome and Measures: Modality of repair, time from diagnosis to repair, and 30-day reoperation rate. Results: Among the 38 144 patients in the study (23 031 men [60.4%]; mean [SD] age at diagnosis, 56.8 [13.4] years), pneumatic retinopexy (PR) was more likely to occur when patients received a diagnosis of RRD on Friday (relative risk ratio [RRR], 1.37; 95% CI, 1.17-1.60), Saturday (RRR, 1.73; 95% CI, 1.36-2.20), or Sunday (RRR, 1.53; 95% CI, 1.08-2.17) compared with Wednesday. Pneumatic retinopexy was more likely to be used for surgical procedures on Friday (RRR, 1.55; 95% CI, 1.33-1.80), Saturday (RRR, 2.03; 95% CI, 1.61-2.56), Sunday (RRR, 2.28; 95% CI, 1.55-3.35), or Monday (RRR, 1.70; 95% CI, 1.46-1.98). Patients undergoing PR on Sundays were more likely to receive another procedure (PR, scleral buckle, or pars plana vitrectomy) within 30 days (odds ratio, 1.62; 95% CI, 1.07-2.45). An association between the need for reoperation for repairs performed via scleral buckle or pars plana vitrectomy and the day of the week of the initial repair was not identified. Patients who received a diagnosis on a Friday waited a mean of 0.28 days (95% CI, 0.20-0.36 days) longer for repair than patients who received a diagnosis on a Wednesday. Conclusions and Relevance: These findings suggest that management of RRD varies according to the day of the week that diagnosis and repair occurs, with PR disproportionately likely to be used to repair RRDs during the weekend. Ophthalmologists should be aware that these results suggest that patients undergoing PR on Sundays may be more likely to require reoperation within 30 days.
Authors
Vail, D; Pan, C; Pershing, S; Mruthyunjaya, P
MLA Citation
Vail, Daniel, et al. “Association of Rhegmatogenous Retinal Detachment and Outcomes With the Day of the Week That Patients Undergo a Repair or Receive a Diagnosis.Jama Ophthalmol, Dec. 2019. Pubmed, doi:10.1001/jamaophthalmol.2019.5253.
URI
https://scholars.duke.edu/individual/pub1424884
PMID
31855233
Source
pubmed
Published In
Jama Ophthalmology
Published Date
DOI
10.1001/jamaophthalmol.2019.5253

Research Areas:

Adolescent
Adrenal Cortex Hormones
Adult
Aged
Aged, 80 and over
Algorithms
Angiogenesis Inhibitors
Animals
Antibodies, Monoclonal
Antibodies, Monoclonal, Humanized
Anticoagulants
Aptamers, Nucleotide
Atrophy
Attitude of Health Personnel
Autoantigens
Autoimmune Diseases
Biopsy
Blood Coagulation
Brachytherapy
Case-Control Studies
Child
Choroidal Neovascularization
Chromosomes, Human, Pair 3
Cohort Studies
Coloring Agents
Combined Modality Therapy
Conjunctival Neoplasms
Contrast Media
Corneal Ulcer
Cryotherapy
Current Procedural Terminology
Cysts
Dacarbazine
Dacryocystitis
Databases, Factual
Diabetic Retinopathy
Diagnosis, Differential
Diagnostic Techniques, Ophthalmological
Disease Models, Animal
Disease Progression
Disease-Free Survival
Drug Therapy, Combination
Endophthalmitis
Equipment Contamination
Eye
Eye Diseases
Eye Enucleation
Eye Infections
Eye Infections, Bacterial
Eye Neoplasms
Eye Proteins
Female
Fluorescein Angiography
Follow-Up Studies
Forecasting
Fundus Oculi
Gene Expression Profiling
Gene Expression Regulation, Neoplastic
Glaucoma
Granuloma
Health Care Costs
Health Services
Health Services Research
Hematologic Diseases
Hemoglobins
Humans
Hypertension
Imaging, Three-Dimensional
Immunohistochemistry
Incidence
Insurance Claim Review
International Classification of Diseases
International Normalized Ratio
Intraocular Pressure
Intravitreal Injections
Keratitis
Lacrimal Apparatus Diseases
Lacrimal Duct Obstruction
Laser Coagulation
Laser Therapy
Lasers
Light
Longitudinal Studies
Lymphoma, Large B-Cell, Diffuse
Macular Degeneration
Macular Edema
Male
Medicare Part B
Melanins
Melanoma
Microscopy
Microscopy, Acoustic
Microscopy, Confocal
Microscopy, Fluorescence, Multiphoton
Middle Aged
Monitoring, Intraoperative
Needles
Neoplasm Recurrence, Local
Neoplasm Staging
Neoplasms
Nursing Care
Observer Variation
Office Visits
Oligonucleotide Array Sequence Analysis
Ophthalmologic Surgical Procedures
Ophthalmology
Optic Nerve Diseases
Optical coherence tomography
Paraneoplastic Syndromes, Ocular
Pigment Epithelium of Eye
Pilot Projects
Polymorphism, Single Nucleotide
Postoperative Complications
Prognosis
Proportional Hazards Models
Prospective Studies
Pseudophakia
Quality of Life
Questionnaires
Radiation Injuries
Radiotherapy Dosage
Reading
Real-Time Polymerase Chain Reaction
Recurrence
Reference Values
Reoperation
Reproducibility of Results
Retina
Retinal Artery Occlusion
Retinal Detachment
Retinal Diseases
Retinal Neoplasms
Retinal Neovascularization
Retinal Perforations
Retinal Vein Occlusion
Retinal Vessels
Retinoblastoma
Retrospective Studies
Sclera
Scleral Buckling
Scleritis
Sensitivity and Specificity
Silicone Oils
Skin Neoplasms
Strabismus
Sturge-Weber Syndrome
Surgery, Computer-Assisted
Surveys and Questionnaires
Telemedicine
Thrombosis
Thyroid Neoplasms
Time Factors
Tomography, Optical Coherence
Treatment Outcome
Tumor Markers, Biological
United States
Utilization
Uveal Neoplasms
Uveitis
Vascular Endothelial Growth Factor A
Vision Disorders
Visual Acuity
Visual Fields
Vitrectomy
Vitreoretinal Surgery
Vitreous Hemorrhage
Warfarin
Wet Macular Degeneration
Xanthogranuloma, Juvenile
Young Adult