About

Dr. Michael Altaweel is a Professor of Ophthalmology and Visual Sciences at the University of Wisconsin–Madison. He serves as the Retina Service Chief, Vitreoretinal Surgery Fellowship Director, and Co-Director of the Wisconsin Reading Center. His subspecialty focuses on retina, macula, and vitreous diseases, as well as ocular oncology. His medical and surgical interests include diabetic retinopathy, dislocated intraocular lenses, epiretinal membranes, macular degeneration, macular holes, ocular tumors and melanoma, ocular trauma, retinal detachment, and vascular occlusive disease. Dr. Altaweel's research interests encompass retina imaging, diabetic retinopathy, uveitis, macular edema, diseases of the retina, and ocular melanoma. Notable contributions include collaborative research on the effectiveness of intravitreous fluocinolone acetonide implants versus systemic corticosteroid therapy in uveitis, and the analysis of pegaptanib's effect on neovascular age-related macular degeneration, demonstrating reduced vision loss and progression to legal blindness. He has also pioneered a novel technique for silicone oil infusion using the pressurized air infusion line of the constellation vitrectomy machine, which avoids common complications related to pressure control. Dr. Altaweel's educational background includes a fellowship at the University of Wisconsin Hospital and Clinics, a residency at Dalhousie University, and an internship at Ottawa Civic Hospital. He completed his medical degree at Dalhousie University.

Research topics

• Medicine
• Ophthalmology
• Surgery
• Internal medicine

Selected publications

• Intraocular Pressure Control and Long-Term Outcomes With the Reservoir Technique: The Wisconsin Silicone Oil Study (Report 2)

  Journal of VitreoRetinal Diseases · 2025-09-25 · 1 citations

  articleOpen accessSenior authorCorresponding

  Purpose: To evaluate the long-term outcomes of silicone oil (SO) tamponade using the reservoir technique vs standard oil fill technique for complex vitreoretinal surgery. Methods: This retrospective comparative case series evaluated 313 SO tamponade surgeries (230 eyes). In the reservoir technique, the posterior segment is filled with SO. The infusion line is temporarily opened to atmosphere, allowing SO to egress into the line, creating the reservoir. The pressurized air infusion is then reset to 15 mm Hg to maintain a complete SO fill during sclerotomy closure. In the palpation method, SO is introduced without creating a reservoir or moderating infusion pressure, and digital palpation of the globe determines adequate fill. Results: Moderately severe ocular hypertension (intraocular pressure [IOP] ≥30 mm Hg) occurred less frequently in the reservoir group (1.6%) compared with the palpation group (9.3%; P = .005). Prolonged ocular hypertension (IOP ≥25 mm Hg for ≥2 visits) was also less frequent in the reservoir group (2.9% vs 9.1%; P = .02). SO emulsification was less frequent in the reservoir group (2.7% vs 9.4%; P = .04). Eyes in the reservoir group required fewer SO placement surgeries (1.2 vs 1.5 surgeries per eye; P = .01), while final anatomic success rates were similar (reservoir: 80.4%, palpation: 78.2%; P = .5). Visual outcomes were comparable between groups. Conclusions: The reservoir technique for SO tamponade placement reduces the risk of IOP elevation, minimizes the need for reoperation, and decreases SO complications. These findings support the reservoir technique as a reliable and consistent method for SO placement in complex vitreoretinal surgeries.

  PublisherOA PDFDOI

• Corrigendum to Evidence and Consensus-Based Imaging Guidelines in Multifocal Choroiditis With Panuveitis and Punctate Inner Choroiditis-Multimodal Imaging in Uveitis (MUV) Taskforce Report 5. Am J Ophthalmol. 2025;276:272-285

  American Journal of Ophthalmology · 2025-08-01

  erratumOpen access
  PublisherOA PDFDOI

• Early genetic evolution of driver mutations in uveal melanoma

  Nature Communications · 2025-12-12 · 2 citations

  articleOpen access

  Uveal melanoma (UM) is an aggressive eye cancer that frequently results in metastatic death despite successful primary tumor treatment. Subclinical micrometastasis is thought to occur early, when tumors are small and difficult to distinguish from benign nevi. However, the early genetic evolution of UM is poorly understood, and biomarkers for malignant transformation are lacking. Here, we perform integrated genetic profiling of 1140 primary UMs, including 131 small tumors. A clinically available 15-gene expression profile (15-GEP) prospectively validated by our group is more accurate than driver mutations for predicting patient survival. Small tumors are significantly more likely to be in earlier stages of genetic evolution than larger tumors. Further, the 15-GEP support vector machine discriminant score predicts small tumors undergoing transformation from low-risk Class 1 to high-risk Class 2 profile. These results shed light on the early genetic evolution of UM and move us closer to a molecular definition of malignant transformation in this cancer type.

  PublisherOA PDFDOI

• Evidence and Consensus-Based Imaging Guidelines in Multifocal Choroiditis With Panuveitis and Punctate Inner Choroiditis—Multimodal Imaging in Uveitis (MUV) Taskforce Report 5

  American Journal of Ophthalmology · 2025-04-25 · 13 citations

  articleOpen access

  PURPOSE: To develop imaging and consensus-based guidelines on the application of multimodal imaging in noninfectious multifocal choroiditis and panuveitis (MFCPU) and punctate inner choroiditis (PIC). DESIGN: Consensus agreement guided by the review of literature and an expert committee using nominal group technique (NGT). METHODS: An expert committee applied a timed structured nominal group technique (NGT) to achieve consensus-based recommendations on specific disease characteristics, biomarkers of activity, and complications for MFCPU and PIC. Representative cases with noninfectious active and inactive MFCPU and PIC with color fundus photographs (CFP), optical coherence tomography (OCT), fundus fluorescein angiography (FFA), OCT angiography (OCTA), indocyanine angiography (ICGA), and fundus autofluorescence images (FAF) were reviewed. These recommendations were voted upon by the entire task force. RESULTS: The experts agreed that lesions of MFCPU and PIC can be well characterized using CFP. OCT is the preferred modality for detecting active lesions. Both FAF and OCT are effective for monitoring disease recurrence. Late-phase ICGA is most valuable in recurrent disease when the lesions are not visible on FAF and CFP. While OCTA and ICGA can successfully identify lesions and complications such as choroidal neovascularization, no imaging biomarkers were found to reliably distinguish between active and inactive lesions on these two modalities. CONCLUSIONS: Incorporating imaging findings, particularly OCT, into the Standardization of Uveitis Nomenclature (SUN) classification criteria for MFCPU and PIC enables more precise assessment of disease activity. These consensus-based guidelines provide a framework for selecting optimal imaging modalities for diagnosis, monitoring and identification of complications of MFCPU and PIC.

  PublisherDOI

• Adalimumab versus Conventional Immunosuppression for Uveitis (ADVISE) Trial

  Ophthalmology · 2025-10-11 · 3 citations

  articleOpen access
  PublisherOA PDFDOI

• Early Genetic Evolution of Driver Mutations in Uveal Melanoma

  medRxiv · 2025-06-12 · 1 citations

  preprintOpen access

  ABSTRACT Uveal melanoma (UM) is an aggressive cancer of the eye that frequently results in metastatic death. UMs are most likely to metastasize when they are small, at a time when they are difficult to distinguish from benign nevi and often observed without treatment. Unfortunately, little is known about the early genetic evolution of UM or potential biomarkers to indicate small tumors undergoing malignant transformation. Here, we performed targeted next generation sequencing for the 7 canonical UM driver mutations in 1140 primary UMs, including 131 small early-stage tumors. We found that the evolutionary burst of genetic aberrations that determines the archetypal UM subtypes and metastatic propensity has already occurred by the time most small tumors are biopsied, although a significantly larger proportion of small tumors are still evolving compared to larger tumors. We found that the 15-gene expression profile (15-GEP) support vector machine discriminant score was the best indicator of tumors in transition from low-risk Class 1 to high-risk Class 2 signature. While BAP1 , SF3B1 and EIF1AX mutations were associated with poor, intermediate and good prognosis, respectively, mutation analysis was inferior to the prospectively validated 15-GEP + PRAME expression classifier for predicting metastasis-free and overall survival. These results provide a more complete picture of genetic evolution in UM, and they move us closer to a molecular definition of malignant transformation in this cancer type.

  PublisherOA PDFDOI

• The Wisconsin silicone oil study (report #1): anatomical and functional outcomes of repair of retinal detachment with proliferative vitreoretinopathy

  Eye · 2024-05-14 · 1 citations

  articleOpen accessSenior authorCorresponding
  PublisherOA PDFDOI

• 15-Gene Expression Profile and <i>PRAME</i> as Integrated Prognostic Test for Uveal Melanoma: First Report of Collaborative Ocular Oncology Group Study No. 2 (COOG2.1)

  Journal of Clinical Oncology · 2024-07-25 · 51 citations

  articleOpen access

  PURPOSE Validated and accurate prognostic testing is critical for precision medicine in uveal melanoma (UM). Our aims were to (1) prospectively validate an integrated prognostic classifier combining a 15-gene expression profile (15-GEP) and PRAME RNA expression and (2) identify clinical variables that enhance the prognostic accuracy of the 15-GEP/ PRAME classifier. MATERIALS AND METHODS This study included 1,577 patients with UM of the choroid and/or ciliary body who were enrolled in the Collaborative Ocular Oncology Group Study Number 2 (COOG2) and prospectively monitored across 26 North American centers. Test results for 15-GEP (class 1 or class 2) and PRAME expression status (negative or positive) were available for all patients. The primary end point was metastasis-free survival (MFS). RESULTS 15-GEP was class 1 in 1,082 (68.6%) and class 2 in 495 (31.4%) patients. PRAME status was negative in 1,106 (70.1%) and positive in 471 (29.9%) patients. Five-year MFS was 95.6% (95% CI, 93.9 to 97.4) for class 1/ PRAME (–), 80.6% (95% CI, 73.9 to 87.9) for class 1/ PRAME (+), 58.3% (95% CI, 51.1 to 66.4) for class 2/ PRAME (–), and 44.8% (95% CI, 37.9 to 52.8) for class 2/ PRAME (+). By multivariable Cox proportional hazards analysis, 15-GEP was the most important independent predictor of MFS (hazard ratio [HR], 5.95 [95% CI, 4.43 to 7.99]; P &lt; .001), followed by PRAME status (HR, 1.82 [95% CI, 1.42 to 2.33]; P &lt; .001). The only clinical variable demonstrating additional prognostic value was tumor diameter. CONCLUSION In the largest prospective multicenter prognostic biomarker study performed to date in UM to our knowledge, the COOG2 study validated the superior prognostic accuracy of the integrated 15-GEP/ PRAME classifier over 15-GEP alone and clinical prognostic variables. Tumor diameter was found to be the only clinical variable to provide additional prognostic information. This prognostic classifier provides an advanced resource for risk-adjusted metastatic surveillance and adjuvant trial stratification in patients with UM.

  PublisherDOI

• Macular Edema Ranibizumab versus Intravitreal Anti-inflammatory Therapy Trial

  Ophthalmology · 2024-11-28 · 2 citations

  articleOpen access
  PublisherOA PDFDOI

• SUPPLEMENTAL DEXTROSE IN THE INFUSION FLUID DURING DIABETIC VITRECTOMY

  Retina · 2024-07-05

  articleOpen accessCorresponding

  PURPOSE: Historically, supplemental dextrose to infusion fluid has been used to reduce the need for intraoperative lensectomies to maintain visualization during diabetic vitrectomy. Valved, small-gauge vitrectomy has reduced surgical time and decreased intraoperative fluid flow. Assessment of supplemental dextrose in modern vitrectomy is presented in this study. METHODS: A retrospective cohort study of diabetic patients undergoing vitrectomy was conducted. The dextrose group received supplemental dextrose in the infusion fluid, while the nondextrose group used a standard balanced salt solution (BSS Plus). Group assignment was per surgeons' typical practice patterns. Eyes with tractional retinal detachments were also evaluated as a subgroup. RESULTS: Three hundred thirty phakic eyes were included. Supplemental dextrose was used in 199 eyes (60.3%). One unplanned lensectomy was performed in this series, in the nondextrose group, not statistically different from the dextrose group, with zero lensectomies (P = 0.4). Cataract survival curves overlapped for all eyes and for the tractional retinal detachment subgroup. CONCLUSION: In modern vitrectomy, unplanned lensectomy is rare. No difference was observed in the rate of intraoperative lensectomies or overall postoperative cataract course with or without dextrose supplementation to the infusion fluid. Standard solutions appear to be adequate for infusion, even for diabetics.

  PublisherOA PDFDOI

Recent grants

• MUST Competitive Renewal

  NIH · $2.2M · 2004–2017

• Macular Edema Treatment Trials Associated with MUST (META-MUST)

  NIH · $1.1M · 2014–2023

• ADalimimab Vs conventional ImmunoSupprEssion for uveitis (ADVISE) Trial

  NIH · $1.3M · 2018–2025

Frequent coauthors

• John H. Kempen

  Harvard University

  129 shared

• Jennifer E. Thorne

  Johns Hopkins University

  128 shared

• Douglas A. Jabs

  Bloomberg (United States)

  121 shared

• Sunir J. Garg

  Wills Eye Hospital

  59 shared

• Shree K. Kurup

  University School

  54 shared

• Janet T. Holbrook

  Bloomberg (United States)

  54 shared

• Jedediah McClintic

  Wake Forest University

  49 shared

• Hugo Quiroz–Mercado

  Asociacion Para Evitar la Ceguera en México Hospital Dr. Luis Sánchez Bulnes

  49 shared

Education

• M.D., Ophthalmology

  University of Wisconsin-Madison

  1994

• B.S., Biology

  University of Wisconsin-Madison

  1990

Awards & honors

• Monroe E. Trout Chair in Eye Research