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Li JX, Wei JCC, Wang YH, Bair H, Hsu SB, Lin CJ. RETINAL VASCULAR OCCLUSION AND COVID-19 DIAGNOSIS: A Multicenter Population-Based Study. Retina 2024; 44:345-352. [PMID: 37824812 DOI: 10.1097/iae.0000000000003952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2023]
Abstract
BACKGROUND Several ocular diseases have been reported in patients with coronavirus disease 2019 (COVID-19), especially retinal vascular occlusion. This study aimed to examine the risk of retinal vascular occlusion after COVID-19 diagnosis. METHODS This retrospective cohort study was based on 46 health care organizations in the United States using the TriNetX network. Individuals who had laboratory confirmation of COVID-19 from January 1, 2020, to December 31, 2021, were included. Multivariate analysis was adjusted on age, sex, race, and comorbidities, and hazard ratio was calculated using the Cox proportional hazard regression model. RESULTS A total of 1,460,634 paired individuals were enrolled for analysis. Patients with COVID-19 had a significantly higher risk of branch retinal vein occlusion (hazard ratio 1.27, 95% confidence interval [CI] 1.04-1.52) than those without COVID-19. The cumulative incidence rate of branch retinal vein occlusion was also significantly higher in patients with COVID-19 compared with those without COVID-19 (log-rank P = 0.014). Within 12 weeks after COVID-19 diagnosis, the transient effect of central retinal vein occlusion (hazard ratio 1.59, 95% confidence interval 1.15-2.17) and branch retinal vein occlusion (hazard ratio 2.11, 95% confidence interval 1.51-2.95) were observed. CONCLUSION This large-scale multicenter study demonstrated that retinal vein occlusion may be associated with COVID-19.
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Affiliation(s)
- Jing-Xing Li
- Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, China Medical University, Taichung, Taiwan
- Graduate Institute of Clinical Laboratory Sciences and Medical Biotechnology, National Taiwan University, Taipei, Taiwan
| | - James Cheng-Chung Wei
- Department of Medical Research, Chung Shan Medical University Hospital, Taichung, Taiwan
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Department of Allergy, Immunology & Rheumatology, Chung Shan Medical University Hospital, Taichung, Taiwan
- Institute of Integrated Medicine, China Medical University, Taichung, Taiwan
| | - Yu-Hsun Wang
- Department of Medical Research, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Henry Bair
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung, Taiwan
- Byers Eye Institute, Stanford University School of Medicine, Stanford, California, USA
| | - Shu-Bai Hsu
- College of Medicine, China Medical University, Taichung, Taiwan
- Department of Nursing, China Medical University Hospital, Taichung, Taiwan; and
| | - Chun-Ju Lin
- School of Medicine, China Medical University, Taichung, Taiwan
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung, Taiwan
- Department of Optometry, Asia University, Taichung, Taiwan
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Hsia NY, Bair H, Lin CY, Lin CJ, Lai CT, Chang CM, Lin JM, Tsai YY. Epstein-Barr Virus Uveitis Confirmed via Aqueous Humor Polymerase Chain Reaction and Metagenomics-A Case Report. Medicina (Kaunas) 2024; 60:97. [PMID: 38256358 PMCID: PMC10819169 DOI: 10.3390/medicina60010097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Revised: 12/03/2023] [Accepted: 12/11/2023] [Indexed: 01/24/2024]
Abstract
This is a case report of Epstein-Barr virus (EBV) uveitis confirmed via aqueous humor polymerase chain reaction (PCR) and metagenomics. This 72-year-old male with a history of diabetes and herpes zoster complained of redness and blurred vision in his right eye for eight months. Mild conjunctival injection, anterior chamber cells, mutton-fat keratic precipitates, and vitreous haze were noted. Fluorescein angiography revealed dye leakage from retinal vessels without retinal ischemic changes. Only the serum anti-cytomegalovirus (CMV) IgG was positive while the aqueous humor PCR for VZV (Varicella-zoster virus), HSV (Herpes simplex viruses), CMV, and EBV was initially negative. Inflammation recurred and vitreous haze worsened after discontinuing nine-month topical ganciclovir and oral prednisolone. the aqueous humor PCR was repeated due to persistent low-grade inflammation. The EBV PCR turned out to be positive. Shotgun metagenomics revealed 1459 classified sequences (1.62%) and confirmed the EBV infection. Topical ganciclovir and methylprednisolone treatment was resumed. Conjunctival injection improved while pigmented keratic precipitates lessened. Elderly patients with diabetes or under immunosuppression may be susceptible to chronic uveitis associated with subsequent EBV infection. Repeated aqueous humor PCR and shotgun metagenomics are important tools in the diagnosis of this case of chronic indolent panuveitis.
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Affiliation(s)
- Ning-Yi Hsia
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung 40402, Taiwan; (N.-Y.H.); (H.B.); (C.-Y.L.); (C.-T.L.); (J.-M.L.)
- Department of Optometry, Asia University, Taichung 40447, Taiwan
| | - Henry Bair
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung 40402, Taiwan; (N.-Y.H.); (H.B.); (C.-Y.L.); (C.-T.L.); (J.-M.L.)
- Byers Eye Institute, School of Medicine, Stanford University, Stanford, CA 94303, USA
| | - Chih-Ying Lin
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung 40402, Taiwan; (N.-Y.H.); (H.B.); (C.-Y.L.); (C.-T.L.); (J.-M.L.)
| | - Chun-Ju Lin
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung 40402, Taiwan; (N.-Y.H.); (H.B.); (C.-Y.L.); (C.-T.L.); (J.-M.L.)
- Department of Optometry, Asia University, Taichung 40447, Taiwan
- School of Medicine, College of Medicine, China Medical University, Taichung 404327, Taiwan
| | - Chun-Ting Lai
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung 40402, Taiwan; (N.-Y.H.); (H.B.); (C.-Y.L.); (C.-T.L.); (J.-M.L.)
- Department of Optometry, Asia University, Taichung 40447, Taiwan
| | - Chieh-Min Chang
- Precision Medical Center, China Medical University, Taichung 404327, Taiwan;
| | - Jane-Ming Lin
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung 40402, Taiwan; (N.-Y.H.); (H.B.); (C.-Y.L.); (C.-T.L.); (J.-M.L.)
| | - Yi-Yu Tsai
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung 40402, Taiwan; (N.-Y.H.); (H.B.); (C.-Y.L.); (C.-T.L.); (J.-M.L.)
- Department of Optometry, Asia University, Taichung 40447, Taiwan
- School of Medicine, College of Medicine, China Medical University, Taichung 404327, Taiwan
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Li JX, Hung YT, Bair H, Hsu SB, Hsu CY, Lin CJ. Sodium-glucose co-transporter 2 inhibitor add-on therapy for metformin delays diabetic retinopathy progression in diabetes patients: a population-based cohort study. Sci Rep 2023; 13:17049. [PMID: 37816862 PMCID: PMC10564914 DOI: 10.1038/s41598-023-43893-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 09/29/2023] [Indexed: 10/12/2023] Open
Abstract
To investigate how sodium-glucose co-transporter 2 inhibitors (SGLT2is) add-on therapy for metformin affects diabetic retinopathy (DR) progression in patients with type 2 diabetes mellitus (T2DM). This nationwide population-based study conducted from January 1, 2016, to December 31, 2018 involved 3,432,911 adults with T2DM in Taiwan. To adjust for potential confounders, data on sex, age, income, comorbidities, diabetes complication severity index score, staging of kidney disease, anti-diabetic medications, and index year were included. The outcome was DR progression, determined by procedure codes or the addition of ICD-9-CM or ICD-10-CM codes to the medical records of the patients during the study. Sensitivity analyses were performed to validate the findings. The adjusted hazard ratio (aHR) of DR progression was 0.89 for the SGLT2is add-on group, relative to the control group [95% confidence interval (CI) 0.81-0.99, P = 0.026]. The Kaplan-Meier curve of the cumulative incidence rate showed that the cumulative incidence of DR progression was considerably decreased in the SGLT2is cohort (log-rank P = 0.0261). The use of SGLT2is for less than 1 year and 1-2 years were associated with a significant increase in the risk of DR progression (aHR 1.56 and 1.88, respectively); however, the risk markedly reduced if the SGLT2is regimen was used for more than 2 years (aHR 0.41, 95% Cl 0.35-0.48; P < 0.001). The serial sensitivity analysis showed consistent findings. The aHR of DR progression was 0.82 for the SGLT2is cohort relative to the non-SGLT2is cohort based on the fundoscopy or indirect ophthalmoscopy findings within 1 year before the outcome date (95% Cl 0.71-0.95; P = 0.009). Co-administration of metformin and SGLT2is may reduce the risk of DR progression. Short-term use of SGLT2is may markedly increase the risk of DR, whereas prolonged use SGLT2is may significantly decrease it.
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Affiliation(s)
- Jing-Xing Li
- Department of Internal Medicine, Taipei Veteran General Hospital, Taipei, Taiwan
- School of Medicine, China Medical University, Taichung, Taiwan
- Graduate Institute of Clinical Laboratory Sciences and Medical Biotechnology, National Taiwan University, Taipei, Taiwan
| | - Yu-Tung Hung
- Institute of Public Health, China Medical University Hospital, Taichung, Taiwan
| | - Henry Bair
- Department of Ophthalmology, China Medical University Hospital, Taichung, Taiwan
- Byers Eye Institute, Stanford University School of Medicine, Stanford, CA, USA
| | - Shu-Bai Hsu
- Department of Nursing, China Medical University Hospital, Taichung, Taiwan
- School of Nursing, China Medical University, Taichung, Taiwan
| | - Chung-Yi Hsu
- Graduate Institute of Biomedical Sciences, China Medical University, Taichung, Taiwan
| | - Chun-Ju Lin
- School of Medicine, China Medical University, Taichung, Taiwan.
- Department of Ophthalmology, China Medical University Hospital, Taichung, Taiwan.
- Department of Optometry, Asia University, Taichung, Taiwan.
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Affiliation(s)
- Henry Bair
- School of Medicine, Stanford University, Stanford, CA, USA
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Affiliation(s)
- Henry Bair
- Fourth-year medical student, Stanford University School of Medicine, Stanford, California; ; ORCID: https://orcid.org/0000-0002-3422-0373
| | - Justin Norden
- Adjunct professor, Center for Biomedical Informatics Research, Stanford University School of Medicine, Stanford, California
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Li JX, Wang YH, Bair H, Hsu SB, Chen C, Wei JCC, Lin CJ. Risk assessment of retinal vascular occlusion after COVID-19 vaccination. NPJ Vaccines 2023; 8:64. [PMID: 37130882 PMCID: PMC10153772 DOI: 10.1038/s41541-023-00661-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 04/11/2023] [Indexed: 05/04/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19) vaccines are associated with several ocular manifestations. Emerging evidence has been reported; however, the causality between the two is debatable. We aimed to investigate the risk of retinal vascular occlusion after COVID-19 vaccination. This retrospective cohort study used the TriNetX global network and included individuals vaccinated with COVID-19 vaccines between January 2020 and December 2022. We excluded individuals with a history of retinal vascular occlusion or those who used any systemic medication that could potentially affect blood coagulation prior to vaccination. To compare the risk of retinal vascular occlusion, we employed multivariable-adjusted Cox proportional hazards models after performing a 1:1 propensity score matching between the vaccinated and unvaccinated cohorts. Individuals with COVID-19 vaccination had a higher risk of all forms of retinal vascular occlusion in 2 years after vaccination, with an overall hazard ratio of 2.19 (95% confidence interval 2.00-2.39). The cumulative incidence of retinal vascular occlusion was significantly higher in the vaccinated cohort compared to the unvaccinated cohort, 2 years and 12 weeks after vaccination. The risk of retinal vascular occlusion significantly increased during the first 2 weeks after vaccination and persisted for 12 weeks. Additionally, individuals with first and second dose of BNT162b2 and mRNA-1273 had significantly increased risk of retinal vascular occlusion 2 years following vaccination, while no disparity was detected between brand and dose of vaccines. This large multicenter study strengthens the findings of previous cases. Retinal vascular occlusion may not be a coincidental finding after COVID-19 vaccination.
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Affiliation(s)
- Jing-Xing Li
- Department of General Medicine, China Medical University Hospital, Taichung, Taiwan
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
- Graduate Institute of Clinical Laboratory Sciences and Medical Biotechnology, National Taiwan University, Taipei, Taiwan
| | - Yu-Hsun Wang
- Department of Medical Research, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Henry Bair
- Department of Ophthalmology, China Medical University Hospital, Taichung, Taiwan
- Byers Eye Institute, Stanford University School of Medicine, Stanford, CA, USA
| | - Shu-Bai Hsu
- College of Medicine, China Medical University, Taichung, Taiwan
- Department of Nursing, China Medical University Hospital, Taichung, Taiwan
| | - Connie Chen
- Department of Optometry, Chung Shan Medical University, Taichung, Taiwan
- Institute of Optometry, Chung Shan Medical University, Taichung, Taiwan
| | - James Cheng-Chung Wei
- Department of Medical Research, Chung Shan Medical University Hospital, Taichung, Taiwan.
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan.
- Department of Allergy, Immunology & Rheumatology, Chung Shan Medical University Hospital, Taichung, Taiwan.
- Institute of Integrated Medicine, China Medical University, Taichung, Taiwan.
| | - Chun-Ju Lin
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan.
- Department of Ophthalmology, China Medical University Hospital, Taichung, Taiwan.
- Department of Optometry, Asia University, Taichung, Taiwan.
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Lin CJ, Hsu AY, Tien PT, Chang CH, Lai CT, Hsia NY, Yang YC, Bair H, Chen HS, Chen WL, Tsai YY. Diabetic retinopathy as a potential risk factor for ptosis: A 13-year nationwide population-based cohort study in Taiwan. Front Epidemiol 2023; 3:1093064. [PMID: 38455898 PMCID: PMC10910925 DOI: 10.3389/fepid.2023.1093064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 02/24/2023] [Indexed: 03/09/2024]
Abstract
Purpose To determine the risk of ptosis among diabetic retinopathy (DR) patients. Methods This is a population-based, retrospective, matched-cohort study where DR patients were recruited from the Taiwan National Health Insurance Research Database (NHIRD) to investigate the risk of developing ptosis. Preexisting co-factors of interest included smoking status and medical comorbidities of hyperlipidemia and hypertension. Statistical analysis was performed using T-test, Cox-proportional hazard ratios adjusted for comorbidities (aHR), Wilcoxon rank sum test, Kaplan-Meier estimators, and log rank tests. Results Follow-up data of 9,494 patients with DR and 37,976 matched control cohort (non-DR) from 2000 to 2012 were analyzed. DR patients were found to have significantly increased risk of developing ptosis (adjusted hazard ratio (HR) [95% CI]: 2.76 [1.74-4.38], p < 0.001) when compared to the control cohort. From analysis in different strata, adult age and non-smokers were shown to have higher risk for ptosis development among DR patients. Furthermore, DR patients was also found to have increased risk of developing ptosis when compared to matched controls, regardless of whether they had medical comorbidities of lipid metabolism disorders or hypertension. Conclusions In this large-scale study using real-world data, our results showed that DR patients were found to have increased risk of developing ptosis. Female gender, adult age, and non-smokers were also shown to increase the risk of ptosis among DR patients. This has implications towards the care of diabetic patients, complications such as ptosis should be properly screened for when encountering such patients. Before ptosis surgery, the possibility of underlying diabetes or DR should be also scrutinized and treated properly to avoid undesirable postoperative dissension.
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Affiliation(s)
- Chun-Ju Lin
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung, Taiwan
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
- Department of Optometry, Asia University, Taichung, Taiwan
| | - Alan Y. Hsu
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung, Taiwan
- Department of General Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Peng-Tai Tien
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung, Taiwan
- Graduate Institute of Clinical Medical Science, College of Medicine, China Medical University, Taichung, Taiwan
| | - Cheng-Hsien Chang
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung, Taiwan
- Department of Ophthalmology, Changhua Hospital, Changhua, Taiwan
| | - Chun-Ting Lai
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Ning-Yi Hsia
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Yu-Cih Yang
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
- College of Medicine, China Medical University, Taichung, Taiwan
| | - Henry Bair
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung, Taiwan
- Byers Eye Institute, Stanford University School of Medicine, Stanford, CA, United States
| | - Huan-Sheng Chen
- An-Shin Dialysis Center, NephroCare Ltd., Fresenius Medical Care, Taichung, Taiwan
| | - Wen-Lu Chen
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Yi-Yu Tsai
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung, Taiwan
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
- Department of Optometry, Asia University, Taichung, Taiwan
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Meng PP, Lin CJ, Hsia NY, Lai CT, Bair H, Lin JM, Tsai YY. MULTIMODAL IMAGING OF ACUTE MULTIFOCAL HEMORRHAGIC RETINAL VASCULITIS: A CASE REPORT. Retin Cases Brief Rep 2023; 17:65-69. [PMID: 33290296 DOI: 10.1097/icb.0000000000001105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
PURPOSE To report a case of acute multifocal hemorrhagic retinal vasculitis and demonstrate the multimodal imaging. METHODS Interventional case report. RESULTS A 54-year-old woman without significant past medical history complained of redness and blurred vision in both eyes. Her visual acuity was counting fingers and 20/60. Mild conjunctival injection, anterior chamber cells, and vitreous haze were noted. Fundus showed multifocal intraretinal hemorrhages. Fluorescein angiography revealed vasculitic process with intraretinal hemorrhage blocking defects and retinal ischemic changes in both eyes. Anterior chamber tap fluid polymerase chain reaction for varicella zoster virus, herpes simplex virus I/II, cytomegalovirus, and Epstein-Barr virus was unremarkable. Rheumatology was consulted and systemic vasculitis was ruled out. Her vision improved to 20/50 and 20/20 after pulse methylprednisolone therapy, oral methotrexate, and prednisolone treatment. CONCLUSION Acute multifocal hemorrhagic retinal vasculitis can occur in an immunocompetent patient. Multimodal Imaging is useful in the diagnosis and follow-up. Patients could benefit from early and aggressive immunosuppressive therapy.
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Affiliation(s)
- Ping-Ping Meng
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Chun-Ju Lin
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung, Taiwan
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
- Department of Optometry, Asia University, Taichung, Taiwan; and
| | - Ning-Yi Hsia
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Chun-Ting Lai
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Henry Bair
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung, Taiwan
- Stanford University School of Medicine, Stanford, California
| | - Jane-Ming Lin
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Yi-Yu Tsai
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung, Taiwan
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
- Department of Optometry, Asia University, Taichung, Taiwan; and
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Meng PP, Lin CJ, Hsia NY, Lai CT, Bair H, Lin JM, Chen WL, Tsai YY. Use of Ultra-Widefield Fluorescein Angiography to Guide the Treatment to Idiopathic Retinal Vasculitis, Aneurysms, and Neuroretinitis-Case Report and Literature Review. Medicina (B Aires) 2022; 58:medicina58101467. [PMID: 36295627 PMCID: PMC9611749 DOI: 10.3390/medicina58101467] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 10/03/2022] [Accepted: 10/14/2022] [Indexed: 11/16/2022] Open
Abstract
PURPOSE To review the clinical features, diagnosis, and treatment of idiopathic retinal vasculitis, aneurysms, and neuroretinitis (IRVAN) and to report a case with the use of ultra-widefield fluorescein angiography (UWFA) for confirming the precise staging of IRVAN and aid in early treatment. The patient improved after being treated with intravitreal aflibercept injection. RESULTS A 26-year-old female complained of progressive blurred vision OD for one week. Her BCVA was 0.6 OD and 1.0 OS. Fundus examination showed vitritis, retinal hemorrhage, and vasculitis over bilateral eyes. Fluorescein angiography (FA) with a 55 degree of view revealed aneurysmal dilations of the peripapillary arteriole, peripapillary focal leakage, venous leakage, and capillary nonperfusion area. Stage 2 IRVAN was impressed OU. Oral prednisolone was administered. After four months, she experienced decreased visual acuity OS. Optical coherence tomography (OCT) revealed subretinal and intraretinal fluid with hyperreflective material. One posterior subtenon triamcinolone and one intravitreal aflibercept injection were performed OS, and macular edema subsided. A 105-degree ultra-widefield fluorescein angiography (UWFA) showed multiple peripheral background hypofluorescence areas corresponding to capillary nonperfusion. Retinal neovascularization (NV) was found OS, which had not been revealed by the previous 55-degree FA. Stage 3 IRVAN was made OS and panretinal laser photocoagulation (PRP) was performed. Oral prednisone and cyclosporine were prescribed. Her vision improved to 1.0 OU. CONCLUSION UWFA provides visualization of peripheral retinal pathology and for precise staging. It also had direct implications in the follow-up and treatment strategy.
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Affiliation(s)
- Ping-Ping Meng
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung City 404, Taiwan
| | - Chun-Ju Lin
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung City 404, Taiwan
- School of Medicine, College of Medicine, China Medical University, Taichung City 404, Taiwan
- Department of Optometry, Asia University, Taichung City 404, Taiwan
| | - Ning-Yi Hsia
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung City 404, Taiwan
| | - Chun-Ting Lai
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung City 404, Taiwan
| | - Henry Bair
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung City 404, Taiwan
- Byers Eye Institute, Stanford University School of Medicine, Stanford, CA 94303, USA
| | - Jane-Ming Lin
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung City 404, Taiwan
| | - Wen-Lu Chen
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung City 404, Taiwan
| | - Yi-Yu Tsai
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung City 404, Taiwan
- School of Medicine, College of Medicine, China Medical University, Taichung City 404, Taiwan
- Department of Optometry, Asia University, Taichung City 404, Taiwan
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Lin CJ, Tien PT, Lai CT, Hsia NY, Chang CH, Bair H, Chen HS, Yang YC, Lin JM, Chen WL, Tsai YY. Chronic Kidney Disease as A Potential Risk Factor for Uveitis: A 13-Year Nationwide Population-Based Cohort Study in Taiwan. Ocul Immunol Inflamm 2022; 30:1919-1925. [PMID: 34648389 DOI: 10.1080/09273948.2021.1976213] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE To investigate whether patients with chronic kidney disease (CKD) are at increased risk of uveitis. METHODS Data was collected from the Taiwan National Health Insurance system and included patients newly diagnosed with CKD between 2000 and 2012. The endpoint of interest was a diagnosis of uveitis. RESULTS 30,256 CKD patients and 121,024 matched comparisons were analyzed. CKD patients were found to have a significantly higher cumulative uveitis incidence. Through multivariate Cox regression analysis, the CKD group was found to have higher risk of developing uveitis (adjusted hazard ratio 1.51). After stratified by gender, age, and comorbidities (hypertension, diabetes, and hyperlipidemia), the increased risk of uveitis in CKD patients remained significant. CONCLUSIONS Patients with CKD were found to have higher risk of developing uveitis. For patients over 18 years old and with hypertension, diabetes, or hyperlipidemia, the presence of CKD was demonstrated as an additional crucial factor for uveitis development.
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Affiliation(s)
- Chun-Ju Lin
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung, Taiwan.,School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan.,Department of Optometry, Asia University, Taichung, Taiwan
| | - Peng-Tai Tien
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung, Taiwan.,College of Medicine, Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan
| | - Chun-Ting Lai
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Ning-Yi Hsia
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Cheng-Hsien Chang
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung, Taiwan.,Department of Ophthalmology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Henry Bair
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung, Taiwan.,Stanford University School of Medicine, Stanford, California, USA
| | - Huan-Sheng Chen
- An-Shin Dialysis Center, NephroCare Ltd., Fresenius Medical Care, Taichung, Taiwan
| | - Yu-Cih Yang
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan.,College of Medicine, China Medical University, Taichung, Taiwan
| | - Jan-Ming Lin
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Wen-Lu Chen
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Yi-Yu Tsai
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung, Taiwan.,School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan.,Department of Optometry, Asia University, Taichung, Taiwan
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Lin CY, Wang I, Lin CJ, Lai CT, Bair H, Chen WL, Lin JM, Tien PT, Hsia NY, Tsai YY. Short-term anatomic response of the choroid to tropicamide in myopic patients. Medicine (Baltimore) 2022; 101:e30481. [PMID: 36123905 PMCID: PMC9478313 DOI: 10.1097/md.0000000000030481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
We aimed to investigate how tropicamide alters subfoveal choroidal thickness (SFChT) and choriocapillaris flow density (CD) and determine the predictive factors of choroid thickness and vascular density in myopic eyes. This retrospective study was conducted from September 2018 to March 2019. SFChT was measured with enhanced depth spectrum-domain optical coherence tomography. The choriocapillaris was imaged using optical coherence tomography angiograms. Ocular parameters were measured thirty minutes before and after 1% tropicamide instillation. Twenty-five eyes of 15 patients (mean age 38.12 ± 6.35 years old and refractive error-8.57 ± 3.37 D) met the study criteria. The baseline linear regression model showed an association of thinner choroid with older age (P = .027) and high myopic patients (P = .001). Tropicamide substantially increased SFChT (P = .001), but had no significant influence on CD (P = .526). Moreover, SFChT variation after tropicamide instillation positively correlated with diopter changes in spherical equivalent (P = .005) and percentage changes in CD (P = .046). In myopic eyes, choroidal layer thickened substantially in response to tropicamide. The increase of SFChT only correlates with variations in spherical equivalent and CD. Short-term tropicamide installation altered both choroid thickness and choroid microvasculature, which implies an interplay among choroidal volume, perfusion, and ciliary muscle tone.
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Affiliation(s)
- Chih-Ying Lin
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
- Department of Ophthalmology, Eye Center, China Medical University Hospital, Taichung, Taiwan
| | - I. Wang
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
- Department of Ophthalmology, Eye Center, China Medical University Hospital, Taichung, Taiwan
| | - Chun-Ju Lin
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
- Department of Ophthalmology, Eye Center, China Medical University Hospital, Taichung, Taiwan
- Department of Optometry, Asia University, Taichung, Taiwan
| | - Chun-Ting Lai
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
- Department of Ophthalmology, Eye Center, China Medical University Hospital, Taichung, Taiwan
- * Correspondence: Chun-Ting Lai, Department of Ophthalmology, China Medical University Hospital, No. 2 Yu-Der Road, Taichung 404, Taiwan (e-mail: )
| | - Henry Bair
- School of Medicine, Stanford University, United States of America
| | - Wen-Lu Chen
- Department of Ophthalmology, Eye Center, China Medical University Hospital, Taichung, Taiwan
| | - Jane-Ming Lin
- Department of Ophthalmology, Eye Center, China Medical University Hospital, Taichung, Taiwan
| | - Peng-Tai Tien
- Department of Ophthalmology, Eye Center, China Medical University Hospital, Taichung, Taiwan
- Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan
| | - Ning-Yi Hsia
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
- Department of Ophthalmology, Eye Center, China Medical University Hospital, Taichung, Taiwan
| | - Yi-Yu Tsai
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
- Department of Ophthalmology, Eye Center, China Medical University Hospital, Taichung, Taiwan
- Department of Optometry, Asia University, Taichung, Taiwan
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Gao MZ, Chou YH, Chang YZ, Pai JY, Bair H, Pai S, Yu NC. Designing Mobile Epidemic Prevention Medical Stations for the COVID-19 Pandemic and International Medical Aid. Int J Environ Res Public Health 2022; 19:ijerph19169959. [PMID: 36011595 PMCID: PMC9407823 DOI: 10.3390/ijerph19169959] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 08/08/2022] [Accepted: 08/09/2022] [Indexed: 06/01/2023]
Abstract
The demand for mobile epidemic prevention medical stations originated from the rapid spread of the COVID-19 pandemic. In order to reduce the infection risk of medical practitioners and provide flexible medical facilities in response to the variable needs of the pandemic, this research aimed to design mobile medical stations for COVID-19 epidemic prevention, the emergence of which began in February 2020. The mobile medical stations include a negative pressure isolation ward, a positive pressure swabbing station, a fever clinic and a laboratory. In Taiwan, many medical institutions used the mobile swabbing station design of this study to practice COVID-19 screening pre-tests. Internationally, this study assisted Palau in setting up medical stations to provide anti-epidemic goods and materials. The design of this study not only provides a highly flexible and safe medical environment but the benefits of screening can also be used as resources for medical research, forming an economic circulation for operation sustainability. In addition, the design of this study can also be used during the non-epidemic period as a healthcare station for rural areas or as a long-term community medical station.
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Affiliation(s)
- Mi-Zuo Gao
- Institute of Medicine, Chung Shan Medical University, No. 110, Sec. 1, Jianguo N. Rd., South Dist., Taichung City 40201, Taiwan
| | - Ying-Hsiang Chou
- Radiotherapy, Department of Medical Imaging and Radiological Sciences, Chung Shan Medical University Hospital, Chung Shan Medical University, No. 110, Sec. 1, Jianguo N. Rd., South Dist., Taichung City 40201, Taiwan
| | - Yan-Zin Chang
- Institute of Medicine, Chung Shan Medical University, No. 110, Sec. 1, Jianguo N. Rd., South Dist., Taichung City 40201, Taiwan
| | - Jar-Yuan Pai
- Department of Health Policy and Management, Chung Shan Medical University Hospital, Chung Shan Medical University, No. 110, Sec. 1, Jianguo N. Rd., South Dist., Taichung City 40202, Taiwan
| | - Henry Bair
- Byers Eye Institute, Department of Ophthalmology, Stanford University School of Medicine, 450 Jane Stanford Way, Stanford, CA 94305, USA
| | - Sharon Pai
- Department of Health Science, University of Washington, 4218 Roosevelt Way, Seattle, WA 98105, USA
| | - Nai-Chi Yu
- Department of Health Policy and Management, Chung Shan Medical University Hospital, Chung Shan Medical University, No. 110, Sec. 1, Jianguo N. Rd., South Dist., Taichung City 40202, Taiwan
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13
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Huang YT, Chang YC, Meng PP, Lin CJ, Lai CT, Hsia NY, Chen HS, Tien PT, Bair H, Lin JM, Chen WL, Tsai YY. Optical Coherence Tomography Biomarkers in Predicting Treatment Outcomes of Diabetic Macular Edema After Dexamethasone Implants. Front Med (Lausanne) 2022; 9:852022. [PMID: 35755055 PMCID: PMC9218219 DOI: 10.3389/fmed.2022.852022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 05/23/2022] [Indexed: 01/09/2023] Open
Abstract
Purpose To identify optical coherence tomography (OCT) biomarkers that may predict functional and anatomical outcomes in diabetic macular edema (DME) patients treated with intravitreal dexamethasone (DEX) implant. Materials and Methods Sixty-four eyes from 50 patients with DME were enrolled. Best-corrected visual acuity (BCVA) and OCT biomarkers including central retinal thickness (CRT), subretinal fluid (SRF), intraretinal cysts (IRC), ellipsoid zone disruption (EZD), disorganization of retinal inner layers (DRIL), hard exudate (HE), hyperreflective foci (HRF), epiretinal membrane (ERM), and vitreomacular interface (VMI) changes were evaluated at baseline and at 3, 6, and 12 months after treatment. Multiple logistic analysis was performed to evaluate each OCT biomarker as a predictive factor for functional and anatomical improvement at the end of treatment. Results The presence of SRF at baseline was associated with a favorable outcome, with CRT improving by more than 100 μm after treatment from multivariate logistic regression analysis [odds ratio 6.16 (1.75-21.6)]. In addition, baseline SRF predicted a greater CRT improvement from multiple regression analysis (model R-square 0.11, p = 0.006). The reduction of DRIL, SRF, LONLC, IRC, and EZD were correlated with better CRT improvement (more than 100 μm) (P < 0.05). SRF and EZD recovery can also predict better visual prognosis (P < 0.05). Conclusion OCT biomarkers can be used to predict who may benefit the most after DEX treatment. We suggest that the DEX implant should be considered as a first line treatment in DME patients with SRF.
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Affiliation(s)
- Yu-Te Huang
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Yen-Chieh Chang
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Ping-Ping Meng
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Chun-Ju Lin
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung, Taiwan.,School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan.,Department of Optometry, Asia University, Taichung, Taiwan
| | - Chun-Ting Lai
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Ning-Yi Hsia
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Huan-Sheng Chen
- An-Shin Dialysis Center, NephroCare Ltd., Fresenius Medical Care, Taichung, Taiwan
| | - Peng-Tai Tien
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung, Taiwan.,Graduate Institute of Clinical Medical Science, College of Medicine, China Medical University, Taichung, Taiwan
| | - Henry Bair
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung, Taiwan.,Byers Eye Institute, Stanford University School of Medicine, Stanford, CA, United States
| | - Jane-Ming Lin
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung, Taiwan.,Department of Optometry, Asia University, Taichung, Taiwan
| | - Wen-Lu Chen
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung, Taiwan.,Department of Optometry, Asia University, Taichung, Taiwan
| | - Yi-Yu Tsai
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung, Taiwan.,School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan.,Department of Optometry, Asia University, Taichung, Taiwan
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Abstract
The swift global spread of COVID-19 prompted public health authorities to explore digital technologies to aid in contact tracing for infection control. Exposure notification, a mobile device-based technology that notifies individuals of potential exposure to COVID-19 without requiring personally identifiable information, has been broadly favored because of its relative ease of use, scalability, and protection of personal privacy. Although several exposure notification protocols were developed, a partnership between Google and Apple led to the development of the most widely implemented exposure notification protocol in the world, including in the United States. In this article, we first describe the development of the Google Apple Exposure Notification (GAEN) protocol, noting the value of the discourse among software developers and public health authorities concerning the protocol's design and features. We track states' deployment of GAEN mobile applications (apps) and population-level adoption rates, finding the nationwide rollout of GAEN apps to be more fragmented than anticipated. We then discuss how the limited data collected from these apps make assessments of their effectiveness challenging. Finally, we consider the importance of the federal government playing a greater role in GAEN's early development, emphasize the power of public-private partnerships, and highlight the overriding importance of public messaging over technological details.
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Affiliation(s)
- Henry Bair
- Stanford University School of Medicine, Stanford, CA, USA
| | | | - Nirav R. Shah
- Clinical Excellence Research Center, Stanford University, Stanford, CA, USA
- Sharecare, Inc., Atlanta, GA, USA
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15
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Bair H, Lin CJ, Li YL, Hsia NY, Lai CT, Lin JM, Chen WL, Chiang CC, Tsai YY. MultiColor imaging in urticarial vasculitis with recurrent branch retinal artery occlusion in a case with positive toxoplasma IgG and interferon-gamma release assay - Case report. Am J Ophthalmol Case Rep 2022; 26:101437. [PMID: 35243172 PMCID: PMC8881411 DOI: 10.1016/j.ajoc.2022.101437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Revised: 02/09/2022] [Accepted: 02/15/2022] [Indexed: 11/11/2022] Open
Abstract
Introduction We report a male who presented with acute visual defect and was diagnosed with urticarial vasculitis with recurrent branch retinal artery occlusion (BRAO) after systemic disease survey, fluorescein angiography (FA), and MultiColor imaging (MCI). Case report A 47-year-old male with a history of urticarial vasculitis presented with visual defect OD. Fundus examination showed two foci of ischemic retinal whitening beneath the inferior arcade and above the superior arcade. MCI demonstrated a greenish tinge in the corresponding area. FA revealed segmental arteriolar staining and arterial occlusive changes. BRAO with retinal arteritis was diagnosed. Toxoplasma IgG was positive. Sulfamethoxazole 400mg plus trimethoprim 80mg was given. His vision worsened after 1-week of treatment. The established lesions improved, but new lesions occurred. Interferon-gamma release assay was positive but tuberculosis DNA qualitative amplification test of sputum was negative. Sputum acid-fast stain was positive and culture revealed nontuberculous mycobacteria. Left facial itching and reactive lymphadenopathy developed. Prednisolone and cyclophosphamide were started. The initial retinal artery lesions regained perfusion. Conclusions Urticarial vasculitis with recurrent BRAO is an immune complex-mediated disease. Greenish-tinged occlusive lesions were noted from MCI with high resolution and contrast. MCI could be a valuable method for retinal vessel occlusive disease detection before FA and follow up.
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16
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Horak PW, Bair H, Pompei P, Gisondi MA. Lessons from designing a medical school course on mortality. Med Educ 2022; 56:566. [PMID: 35230720 DOI: 10.1111/medu.14767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
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17
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Huang YT, Wang I, Lin CJ, Lai CT, Hsia NY, Chen HS, Tien PT, Bair H, Lin JM, Chen WL, Chen CH, Wu WC, Tsai YY. Comparison of Choroidal Thickness, Foveal Avascular Zone, and Macular Capillary Density in Macular Edema Secondary to Branch Retinal Vein Occlusion Treated with Ranibizumab or Aflibercept-A Prospective Study. Medicina (Kaunas) 2022; 58:medicina58040540. [PMID: 35454378 PMCID: PMC9031043 DOI: 10.3390/medicina58040540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 04/10/2022] [Accepted: 04/11/2022] [Indexed: 11/16/2022]
Abstract
This prospective comparative case series aims to compare best-corrected visual acuity (BCVA), retinal microvasculature, and retinal structural changes in patients treated with either ranibizumab or aflibercept for macular edema (ME) secondary to treatment-naïve branch retinal vein occlusion (BRVO) by optical coherence tomography angiography (OCTA). Ten patients were enrolled with macular capillary density of the superficial capillary plexus (SCP) and deep capillary plexus (DCP) and foveal avascular zone (FAZ) measured in both eyes before and after treatment. Final central retinal thickness and BCVA improved significantly (p < 0.05), and densities of SCP and DCP of BRVO sectors were significantly lower at baseline than fellow eye counterparts and remained persistently lower during treatment, particularly in the aflibercept group (p < 0.05). SCP density, DCP density of both BRVO sectors (p = 0.0001, p < 0.0001), and non-BRVO sectors (p < 0.0001, p < 0.0001) were significantly correlated with final BCVA for diseased eyes. Using multivariate general linear model analysis, and including OCTA parameters only, but not all of the available clinical data, DCP density of BRVO sectors in both eyes was the most predictive factor for final visual outcome (probability p < 0.0001). OCTA offered further qualitative and quantitative evaluation of treatment-naïve BRVO. Judging by OCTA parameters, not only in the diseased eye but also in the fellow eye, DCP density of BRVO sectors was the most predictive factor of final visual outcome.
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Affiliation(s)
- Yu-Te Huang
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung 404, Taiwan; (Y.-T.H.); (I.W.); (N.-Y.H.); (P.-T.T.); (J.-M.L.); (W.-L.C.); (C.-H.C.); (W.-C.W.); (Y.-Y.T.)
| | - I Wang
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung 404, Taiwan; (Y.-T.H.); (I.W.); (N.-Y.H.); (P.-T.T.); (J.-M.L.); (W.-L.C.); (C.-H.C.); (W.-C.W.); (Y.-Y.T.)
| | - Chun-Ju Lin
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung 404, Taiwan; (Y.-T.H.); (I.W.); (N.-Y.H.); (P.-T.T.); (J.-M.L.); (W.-L.C.); (C.-H.C.); (W.-C.W.); (Y.-Y.T.)
- School of Medicine, College of Medicine, China Medical University, Taichung 404, Taiwan
- Department of Optometry, Asia University, Taichung 413, Taiwan
- Correspondence: (C.-J.L.); (C.-T.L.); Tel.: +886-4-22052121 (ext. 1141) (C.-J.L.); Fax: 886-4-22059265 (C.-J.L.)
| | - Chun-Ting Lai
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung 404, Taiwan; (Y.-T.H.); (I.W.); (N.-Y.H.); (P.-T.T.); (J.-M.L.); (W.-L.C.); (C.-H.C.); (W.-C.W.); (Y.-Y.T.)
- Correspondence: (C.-J.L.); (C.-T.L.); Tel.: +886-4-22052121 (ext. 1141) (C.-J.L.); Fax: 886-4-22059265 (C.-J.L.)
| | - Ning-Yi Hsia
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung 404, Taiwan; (Y.-T.H.); (I.W.); (N.-Y.H.); (P.-T.T.); (J.-M.L.); (W.-L.C.); (C.-H.C.); (W.-C.W.); (Y.-Y.T.)
| | - Huan-Sheng Chen
- An-Shin Dialysis Center, NephroCare Ltd., Fresenius Medical Care, Taichung 401, Taiwan;
| | - Peng-Tai Tien
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung 404, Taiwan; (Y.-T.H.); (I.W.); (N.-Y.H.); (P.-T.T.); (J.-M.L.); (W.-L.C.); (C.-H.C.); (W.-C.W.); (Y.-Y.T.)
- Graduate Institute of Clinical Medical Science, College of Medicine, China Medical University, Taichung 404, Taiwan
| | - Henry Bair
- Byers Eye Institute, Stanford University School of Medicine, Stanford, CA 94303, USA;
| | - Jane-Ming Lin
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung 404, Taiwan; (Y.-T.H.); (I.W.); (N.-Y.H.); (P.-T.T.); (J.-M.L.); (W.-L.C.); (C.-H.C.); (W.-C.W.); (Y.-Y.T.)
| | - Wen-Lu Chen
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung 404, Taiwan; (Y.-T.H.); (I.W.); (N.-Y.H.); (P.-T.T.); (J.-M.L.); (W.-L.C.); (C.-H.C.); (W.-C.W.); (Y.-Y.T.)
| | - Chang-He Chen
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung 404, Taiwan; (Y.-T.H.); (I.W.); (N.-Y.H.); (P.-T.T.); (J.-M.L.); (W.-L.C.); (C.-H.C.); (W.-C.W.); (Y.-Y.T.)
| | - Wen-Chuan Wu
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung 404, Taiwan; (Y.-T.H.); (I.W.); (N.-Y.H.); (P.-T.T.); (J.-M.L.); (W.-L.C.); (C.-H.C.); (W.-C.W.); (Y.-Y.T.)
| | - Yi-Yu Tsai
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung 404, Taiwan; (Y.-T.H.); (I.W.); (N.-Y.H.); (P.-T.T.); (J.-M.L.); (W.-L.C.); (C.-H.C.); (W.-C.W.); (Y.-Y.T.)
- School of Medicine, College of Medicine, China Medical University, Taichung 404, Taiwan
- Department of Optometry, Asia University, Taichung 413, Taiwan
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18
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Bair H. With an end in sight. J Pain Symptom Manage 2022; 63:e445-e446. [PMID: 34339810 DOI: 10.1016/j.jpainsymman.2021.07.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 06/26/2021] [Accepted: 07/21/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Henry Bair
- School of Medicine, Stanford University, Stanford, CA, USA.
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19
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Huang YT, Lin CJ, Liao PL, Hsu MY, Chang CH, Tien PT, Lai CT, Hsia NY, Bair H, Chen HS, Chiang CC, Tsai YY. The incidence of uveitis after systemic lymphoma in Taiwan: An 18-year nationwide population-based cohort study. Medicine (Baltimore) 2022; 101:e28881. [PMID: 35212287 PMCID: PMC8878792 DOI: 10.1097/md.0000000000028881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Accepted: 02/03/2022] [Indexed: 01/04/2023] Open
Abstract
Although uveitis can be an intraocular presentation of systemic lymphoma, it may be associated with direct lymphomatous infiltration and immune-mediated alterations. There have been no published studies describing the incidence of uveitis after systemic lymphoma. We conducted a nationwide cohort study to investigate the incidence of uveitis after systemic lymphoma diagnosis in Taiwan. Data were collected from the Taiwan National Health Insurance system and included patients newly diagnosed with systemic lymphoma between 2000 and 2017. We observed the risk of uveitis among study population since the index date until December 2017. The 1:8 of systemic lymphoma patient and paired comparison was identified by time distribution matching and individual paired with sex and age. Subsequent propensity score matching (PSM) was used to select the 1:1 of systemic lymphoma patient and paired comparison by greedy algorism with caliper of 0.05. The multiple Cox proportional hazard regression model was used to compare the developmental risk of uveitis (time-to-uveitis) between the systemic lymphoma and non-systemic lymphoma, while controlling for selected covariates. After time distribution matching, we selected 6846 patients with systemic lymphoma, and 54,768 comparisons. Among patients with systemic lymphoma groups, there were more men than women (52.94% vs 47.06%) and the mean age was 53.32 ± 21.22 years old. Systemic lymphoma incidence rates (per 10,000 person-months) of uveitis were 1.94 (95% confidence interval [CI], 1.60-2.35) in the systemic lymphoma cohort and 1.52 (95% CI, 1.42-1.63) in the non-systemic lymphoma cohort. Compared with the non-systemic lymphoma cohort, adjusted hazard ratio (aHR) of developing uveitis were 1.24 (95% CI, 1.00-1.52) in people with systemic lymphoma. But not significant in after PSM, aHR of developing uveitis were 1.17 (95% CI, 0.90-1.53). This 18-year nationwide population-based cohort study in Taiwan, showed that the risk of uveitis in patients' systemic lymphoma was not significantly higher than non-systemic lymphoma after PSM. In elderly and rheumatic patients with intraocular inflammation, it is important to first exclude uveitis masquerade syndrome, which could be a harbinger of intraocular involvement from systemic lymphoma. Further large-scale prospective clinical studies to investigate whether systemic lymphoma influences the incidence of uveitis are warranted.
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Affiliation(s)
- Yu-Te Huang
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Chun-Ju Lin
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung, Taiwan
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
- Department of Optometry, Asia University, Taichung, Taiwan
| | - Pei-Lun Liao
- Department of Medical Research, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Min-Yen Hsu
- Department of Ophthalmology, Chung Shan Medical University Hospital, Taichung, Taiwan
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Cheng-Hsien Chang
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung, Taiwan
- Department of Ophthalmology, Changhua Hospital, Changhua, Taiwan
| | - Peng-Tai Tien
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung, Taiwan
- Graduate Institute of Clinical Medical Science, College of Medicine, China Medical University, Taichung, Taiwan
| | - Chun-Ting Lai
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Ning-Yi Hsia
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Henry Bair
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung, Taiwan
- Byers Eye Institute, Stanford University School of Medicine, Stanford, CA
| | - Huan-Sheng Chen
- An-Shin Dialysis Center, NephroCare Ltd., Fresenius Medical Care, Taichung, Taiwan
| | - Chun-Chi Chiang
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung, Taiwan
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
- Department of Optometry, Asia University, Taichung, Taiwan
| | - Yi-Yu Tsai
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung, Taiwan
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
- Department of Optometry, Asia University, Taichung, Taiwan
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20
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Huang YT, Lin CJ, Hsia NY, Lai CT, Bair H, Tsai YY. Intravitreal aflibercept combined with transpupillary thermotherapy in the treatment of refractory macular edema due to primary uveal melanoma. Taiwan J Ophthalmol 2022; 12:482-486. [PMID: 36660121 PMCID: PMC9843562 DOI: 10.4103/tjo.tjo_44_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Accepted: 10/07/2021] [Indexed: 01/22/2023] Open
Abstract
We reported a 74 year old Asian female with a uveal tumor with subretinal fluid (SRF) and cystoid macula edema. Since she declined biopsy, multimodal imaging study was performed, including fundus photography, ultrasonography, optical coherence tomography, fluorescein angiography, and magnetic resonance imaging. Uveal melanoma was diagnosed. However, despite aggressive treatment with TTT and three adjuvant intravitreal bevacizumab doses, SRF, and cystoid macula edema were persistent. Therefore, aflibercept was administered, resulting in anatomical and functional improvement within 1 month, which lasted for 12 months. Aflibercept offered great efficacy in improving refractory macular edema in this case of primary uveal melanoma. Multimodal imaging can provide us with more diagnostic clues in differentiating the nature of intraocular tumors.
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Affiliation(s)
- Yu-Te Huang
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Chun-Ju Lin
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung, Taiwan,School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan,Department of Optometry, Asia University, Taichung, Taiwan,Address for correspondence: Dr. Chun-Ju Lin, Department of Ophthalmology, 2 Yuh-Der Road, Taichung 40447, Taiwan. E-mail:
| | - Ning-Yi Hsia
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Chun-Ting Lai
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Henry Bair
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung, Taiwan,Stanford University School of Medicine, Stanford, California, USA
| | - Yi-Yu Tsai
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung, Taiwan,School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan,Department of Optometry, Asia University, Taichung, Taiwan
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21
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Lin CJ, Huang LY, Lai CT, Hsia NY, Bair H, Tien PT, Chen WL, Lin JM, Chiang CC, Tsai YY. Temporal and double inverted internal limiting membrane flap for bilateral choroidal ruptures complicated by bilateral macular holes. Taiwan J Ophthalmol 2022. [PMID: 37484614 PMCID: PMC10361440 DOI: 10.4103/tjo.tjo_20_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Choroidal ruptures occur in 5% to 10% closed-globe injuries with wide variation in visual prognosis, which depending on the visual acuity at presentation, the location of the rupture, and other associated ocular injuries. We reported a case of bilateral traumatic choroidal rupture with a large macular hole. We performed surgery in the right eye of microincisional vitrectomy, temporally inverted internal limiting membrane (ILM) flap, and C3F8 tamponade; then microincisional vitrectomy, fibrotic scar removal, double inverted ILM flap, and C3F8 tamponade in the left eye. After surgery, she achieved both good anatomical and visual acuity improvement in the right eye, but limited visual acuity improvement in the left eye due to subfoveal choroidal scar formation.
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22
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Affiliation(s)
- Henry Bair
- Stanford University School of Medicine, Stanford, California, USA
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23
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Bair H. Found in translation. Patient Educ Couns 2021; 104:2437-2438. [PMID: 33583650 DOI: 10.1016/j.pec.2021.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 11/01/2020] [Accepted: 02/03/2021] [Indexed: 06/12/2023]
Abstract
In this essay, the author, a medical student, details his experience interpreting for a physician and his Chinese-speaking depression-afflicted patient. The author describes and reflects on the difficulties presented in cross-cultural interactions, especially when it involves culturally sensitive medical issues, and through this case ultimately examines lessons on how healthcare providers can more compassionately approach all patients.
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Affiliation(s)
- Henry Bair
- Stanford University School of Medicine, 291 Campus Drive, Stanford, CA, 94305, USA.
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24
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Bair H. A witness for the unconsoled. J Am Geriatr Soc 2021; 69:3677-3678. [PMID: 34478573 DOI: 10.1111/jgs.17431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 08/08/2021] [Indexed: 11/25/2022]
Affiliation(s)
- Henry Bair
- Stanford University School of Medicine, Stanford, California, USA
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25
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Garcia GA, Bair H, Kossler AL. Perioperative Management of Antithrombotic Medications: An Investigation into Current U. S. Ophthalmologic Recommendations. J Curr Ophthalmol 2021; 33:182-188. [PMID: 34409230 PMCID: PMC8365588 DOI: 10.4103/2452-2325.303201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 02/16/2021] [Accepted: 03/03/2021] [Indexed: 12/01/2022] Open
Abstract
Purpose: To investigate the availability and content of educational statements or recommendations disseminated by U. S. ophthalmologic organizations regarding perioperative management of antithrombotic agents for ophthalmic and orbital surgery, given the highly variable management of these agents by U. S. ophthalmologists and limited consensus recommendations in the literature. Methods: National U. S. ophthalmic surgical organization websites were systematically examined for educational statements, which were reviewed for discussion of perioperative management of antithrombotic agents including antiplatelet and anticoagulant medications. A “statement” was defined as either: (a) a guideline directed toward ophthalmologists or (b) a surgical/clinical educational posting directed toward ophthalmologists or patients. Results: Fourteen surgical organizations were identified, with eight of these publishing clinical/surgical educational statements. A total of 3408 organizational statements were identified, with 252 (7.4%) and 3156 (92.6%) statements directed toward physicians and patients, respectively. In total, 0.3% (9/3408) of statements discussed perioperative management of antithrombotics. These accounted for 0.8% (2/252) of ophthalmologist-directed statements and 0.2% (7/3156) of patient-directed statements. The majority of patient-directed statements (57.1%, 4/7) recommended that patients discuss antithrombotic cessation with their ophthalmologists, though ophthalmologist-directed information regarding these medications was scant or absent. Conclusions: Educational material from U. S. ophthalmologic organizations regarding perioperative management of antithrombotics is notably lacking despite the fact that ophthalmic and orbital surgeries carry unique vision-threatening hemorrhagic risks. Given these risks, as well as the medicolegal consequences of hemorrhagic complications in ophthalmic surgery, increased dissemination of educational material, and consensus statements by ophthalmic surgical organizations on the perioperative management of antithrombotics may be justified.
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Affiliation(s)
- Giancarlo A Garcia
- Department of Ophthalmology, Byers Eye Institute, Stanford University, Palo Alto, CA, USA
| | - Henry Bair
- Stanford University School of Medicine, Stanford, CA, USA
| | - Andrea L Kossler
- Department of Ophthalmology, Byers Eye Institute, Stanford University, Palo Alto, CA, USA
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26
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Huang YT, Lin CJ, Lai CT, Hsia NY, Tien PT, Bair H, Chen HS, Chiang CC, Lin JM, Chen WL, Wu WC, Tsai YY. Astigmatism Management with Astigmatism-Correcting Intraocular Lens Using Two Toric Calculators - A Comparative Case Series. Clin Ophthalmol 2021; 15:3259-3266. [PMID: 34385813 PMCID: PMC8352642 DOI: 10.2147/opth.s325234] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 07/26/2021] [Indexed: 11/23/2022] Open
Abstract
Background To compare refractive outcomes after phacoemulsification and toric IOL implantation using two different toric calculators for initial astigmatism assessment in a real-world setting. Methods This was a retrospective, comparative, interventional case series. Patients over 30-year-old who underwent phacoemulsification and toric IOL implantation (AcrySof® Toric IOL) by the same surgeon between 2017 and 2018 were included. Eyes with irregular astigmatism, previous corneal refractive surgery, intraocular surgery, corneal pathology, macular pathology and pupil abnormalities were excluded. IOL toricity was determined by using a calculator provided by the AcrySof Toric calculator before 2018 and Barrett Toric Calculator after 2018. Patient demographics, corneal topography, vector and preoperative and postoperative refraction were collected and analyzed at three months postoperative. Results Thirty-two eyes of 32 patients were included in the final analysis. 0.1D for surgically induced astigmatism was used. Group 1 included 14 eyes assessed with the original (AcrySof) toric IOL calculator, and group 2 included 18 eyes assessed with the Barrett toric IOL calculator. In group 1, postoperative astigmatism less than −1.00D, −0.75 D, and −0.5D was achieved in 88.2%, 76.1% and 53.7% of eyes, respectively, while, in group 2, 89% eyes achieved postoperative residual astigmatism less than 0.5D and all eyes achieved postoperative residual astigmatism less than 0.75D. The proportion of patients with lower postoperative astigmatism was significantly higher in Group 2 (p< 0.05 by chi-square test), a pattern that still held when we divided patients into multiple groups. Vector analysis with the Alpins methods also supported better outcomes in the Barrett group (0.71 D vs 0.35 D). Conclusion The Barrett Toric calculator resulted in better results in the prediction of residual astigmatism than original (AcrySof) toric calculators.
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Affiliation(s)
- Yu-Te Huang
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Chun-Ju Lin
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung, Taiwan.,School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan.,Department of Optometry, Asia University, Taichung, Taiwan
| | - Chun-Ting Lai
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Ning-Yi Hsia
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Peng-Tai Tien
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung, Taiwan.,Graduate Institute of Clinical Medical Science, College of Medicine, China Medical University, Taichung, Taiwan
| | - Henry Bair
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung, Taiwan.,Stanford University School of Medicine, Stanford, CA, USA
| | - Huan-Sheng Chen
- An-Shin Dialysis Center, NephroCare Ltd., Fresenius Medical Care, Taichung, Taiwan
| | - Chun-Chi Chiang
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung, Taiwan.,School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
| | - Jane-Ming Lin
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung, Taiwan.,Department of Optometry, Asia University, Taichung, Taiwan
| | - Wen-Lu Chen
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung, Taiwan.,Department of Optometry, Asia University, Taichung, Taiwan
| | - Wen-Chuan Wu
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Yi-Yu Tsai
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung, Taiwan.,School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan.,Department of Optometry, Asia University, Taichung, Taiwan
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27
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Bair H. Still I Croon. Palliat Med Rep 2021; 2:199-200. [PMID: 34223521 PMCID: PMC8244509 DOI: 10.1089/pmr.2020.0076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/27/2020] [Indexed: 11/25/2022] Open
Abstract
The is a poem inspired by my conversations with several patients burdened with chronic pain and who found themselves dependent on opioids for relief. For these patients, pain is an omnipresent and debilitating force permeating their existence, curbed only by the use of opioids; I was struck by the vivid language these patients would use when describing their relationship with pain and with these medications—some of which are directly used in this poem. They would simultaneously express a torn affection for the opioids, while recognizing the danger of continuing to use them. The poem is structured as an imaginary conversation between the patient/narrator and a personification of the medication/addiction. With this poem, I hope to share with readers a sense of the nuanced struggle and affliction I witnessed.
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Affiliation(s)
- Henry Bair
- Stanford University School of Medicine, Stanford, California, USA
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28
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Lai CT, Hsieh YT, Lin CJ, Wang JK, Lin CY, Hsia NY, Bair H, Chen HS, Chiu CY, Weng SW. Age, Initial Central Retinal Thickness, and OCT Biomarkers Have an Influence on the Outcome of Diabetic Macular Edema Treated With Ranibizumab- Tri-center 12-Month Treat-and-Extend Study. Front Med (Lausanne) 2021; 8:668107. [PMID: 34012972 PMCID: PMC8126636 DOI: 10.3389/fmed.2021.668107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 04/06/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: We report the tri-center 1-year outcomes of a treat-and-extend (T&E) regimen in four-week intervals with ranibizumab for diabetic macular edema (DME). Methods: In this retrospective study, all eyes received 3 monthly loading injections of 0.5 mg ranibizumab, followed by a T&E regimen for DME. Regression models were used to evaluate the associating factors for visual and anatomical outcomes. Results: Ninety one eyes from 64 patients were enrolled. Mean LogMAR best-corrected visual acuity (BCVA) improved from 0.58 at baseline to 0.36 at month 12 and mean central retinal thickness (CRT) decreased from 411 μm at baseline to 290 μm at month 12. Younger age and eyes having thinner baseline CRT, with ellipsoid zone disruption (EZD), and without epiretinal membrane (ERM) were associated with better final CRT. Moreover, eyes with thicker baseline CRT tend to receive more injections. Among the parameters, only having ERM or EZD was associated with significant BCVA recovery. Conclusions: A T&E regimen with ranibizumab by 4-week intervals is effective in improving BCVA and reducing CRT with efficacy notable starting from the third month. Clinical parameters including age, initial CRT, and presence of ERM or EZD significantly influenced therapeutic outcomes. Moreover, the presence of ERM should not preclude DME patients from receiving anti-VEGF therapy. Future studies with larger cohorts are warranted.
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Affiliation(s)
- Chun-Ting Lai
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Yi-Ting Hsieh
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan
| | - Chun-Ju Lin
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung, Taiwan.,School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan.,Department of Optometry, Asia University, Taichung, Taiwan
| | - Jia-Kang Wang
- Department of Ophthalmology, Far Eastern Memorial Hospital, Taipei, Taiwan.,Department of Electrical Engineering, Yuan Ze University, Taoyuan City, Taiwan
| | - Chih-Ying Lin
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung, Taiwan.,School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
| | - Ning-Yi Hsia
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung, Taiwan.,School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
| | - Henry Bair
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Huan-Sheng Chen
- An-Shin Dialysis Center, NephroCare Ltd., Fresenius Medical Care, Taichung, Taiwan
| | - Chiung-Yi Chiu
- Department of Ophthalmology, Far Eastern Memorial Hospital, Taipei, Taiwan
| | - Shao-Wei Weng
- Department of Ophthalmology, Far Eastern Memorial Hospital, Taipei, Taiwan
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29
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Hsia NY, Lin CJ, Chen HS, Chang CH, Bair H, Lai CT, Lin JM, Chen WL, Tien PT, Wu WC, Tsai YY. Short-Term Outcomes of Refractory Diabetic Macular Edema Switch From Ranibizumab to Dexamethasone Implant and the Influential Factors: A Retrospective Real World Experience. Front Med (Lausanne) 2021; 8:649979. [PMID: 33996856 PMCID: PMC8121145 DOI: 10.3389/fmed.2021.649979] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 03/24/2021] [Indexed: 12/16/2022] Open
Abstract
Introduction: To evaluate the effectiveness and safety of intravitreal dexamethasone (DEX) implants in refractory diabetic macular edema (DME) treated by intravitreal ranibizumab. Materials and Methods: We retrospectively analyzed DME patients who received DEX implant treatment after being refractory to at least 3 monthly intravitreal ranibizumab injections. The main outcomes were best-corrected visual acuity (BCVA), central retinal thickness (CRT), and intraocular pressure (IOP). Results: Twenty-nine eyes of 26 patients who had previously received an average of 8.1 ± 4.4 ranibizumab injections were included. Patients received between one and three DEX implants during 12.4 ± 7.4 months of follow-up. The mean final CRT significantly decreased from 384.4 ± 114.4 μm at baseline to 323.9 ± 77.7 μm (p = 0.0249). The mean final BCVA was 51.4 ± 21.3 letters, which was not significant compared to baseline (44.9 ± 30.2 letters, p = 0.1149). Mean IOP did not increase significantly. All patients tolerated the treatment well without serious adverse events. Higher baseline CRT and worse BCVA correlated with better therapeutic responses. Conclusion: Switching to DEX implant is feasible and safe for treating patients of DME refractory to intravitreal ranibizumab in real world. Further larger-scale or multicenter studies would be conducted to explore different DEX treatment strategies for DME, such as first-line or early switch therapy, for better BCVA improvement.
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Affiliation(s)
- Ning-Yi Hsia
- Department of Ophthalmology, Eye Center, China Medical University Hospital, Taichung, Taiwan
| | - Chun-Ju Lin
- Department of Ophthalmology, Eye Center, China Medical University Hospital, Taichung, Taiwan.,School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan.,Department of Optometry, Asia University, Taichung, Taiwan
| | - Huan-Sheng Chen
- An-Shin Dialysis Center, NephroCare Ltd., Fresenius Medical Care, Taichung, Taiwan
| | - Cheng-Hsien Chang
- Department of Ophthalmology, Eye Center, China Medical University Hospital, Taichung, Taiwan.,School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan.,Department of Optometry, Asia University, Taichung, Taiwan
| | - Henry Bair
- Department of Ophthalmology, Eye Center, China Medical University Hospital, Taichung, Taiwan.,School of Medicine, Stanford University, Stanford, CA, United States
| | - Chun-Ting Lai
- Department of Ophthalmology, Eye Center, China Medical University Hospital, Taichung, Taiwan
| | - Jane-Ming Lin
- Department of Ophthalmology, Eye Center, China Medical University Hospital, Taichung, Taiwan.,Department of Optometry, Asia University, Taichung, Taiwan
| | - Wen-Lu Chen
- Department of Ophthalmology, Eye Center, China Medical University Hospital, Taichung, Taiwan.,Department of Optometry, Asia University, Taichung, Taiwan
| | - Peng-Tai Tien
- Department of Ophthalmology, Eye Center, China Medical University Hospital, Taichung, Taiwan.,Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan
| | - Wen-Chuan Wu
- Department of Ophthalmology, Eye Center, China Medical University Hospital, Taichung, Taiwan
| | - Yi-Yu Tsai
- Department of Ophthalmology, Eye Center, China Medical University Hospital, Taichung, Taiwan.,School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan.,Department of Optometry, Asia University, Taichung, Taiwan
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30
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Lin CJ, Tien PT, Lai CT, Hsia NY, Chang CH, Yang YC, Bair H, Chen HS, Wu WC, Tsai YY. Chronic kidney disease as a potential risk factor for retinal vascular disease: A 13-year nationwide population-based cohort study in Taiwan. Medicine (Baltimore) 2021; 100:e25224. [PMID: 33847619 PMCID: PMC8052046 DOI: 10.1097/md.0000000000025224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 02/20/2021] [Indexed: 01/04/2023] Open
Abstract
We investigate whether patients with chronic kidney disease (CKD) are at increased risk of retinal vascular disease (RVD). Data was collected from the Taiwan National Health Insurance system and included patients newly diagnosed with CKD between 2000 and 2012. The endpoint of interest was a diagnosis of RVD. Follow-up data of 85,596 patients with CKD and 85,596 matched comparisons (non-CKD) from 2000 to 2012 were analyzed. Patients with CKD were found to have a significantly higher cumulative incidence of RVD (Kaplan-Meier analysis, log-rank test P < .0001). Through multivariate Cox regression analysis, the CKD group was found to have higher risk of developing RVD (adjusted hazard ratio (HR) [95% confidence interval (CI)]: 2.30 [2.16-2.44]) when compared to the control cohort. When comparison of CKD group and non-CKD group was stratified by gender, age and comorbidities (hypertension, diabetes, and hyperlipidemia), the higher risk of RVD in patients with CKD remained significant in all subgroups. Patients with CKD were found to have higher risk of developing RVD in this cohort study. In addition, CKD imposed the same risk for RVD development in all age groups and in patients with or without hypertension or diabetes. Thus, patients with CKD should be vigilant for symptoms of RVD. Understanding the link between CKD and RVD could lead to the development of new treatment and screening strategies for both diseases.
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Affiliation(s)
- Chun-Ju Lin
- Department of Ophthalmology, Eye Center, China Medical University Hospital
- School of Medicine, College of Medicine, China Medical University
- Department of Optometry, Asia University
| | - Peng-Tai Tien
- Department of Ophthalmology, Eye Center, China Medical University Hospital
- Graduate Institute of Clinical Medical Science, College of Medicine, China Medical University, Taichung
| | - Chun-Ting Lai
- Department of Ophthalmology, Eye Center, China Medical University Hospital
| | - Ning-Yi Hsia
- Department of Ophthalmology, Eye Center, China Medical University Hospital
| | - Cheng-Hsien Chang
- Department of Ophthalmology, Eye Center, China Medical University Hospital
- Department of Ophthalmology, Kaohsiung Medical University Hospital, Kaohsiung
| | - Yu-Cih Yang
- Management Office for Health Data, China Medical University Hospital
- College of Medicine, China Medical University, Taichung, Taiwan
| | - Henry Bair
- Department of Ophthalmology, Eye Center, China Medical University Hospital
- Stanford University School of Medicine, Stanford, California, United States
| | - Huan-Sheng Chen
- An-Shin Dialysis Center, NephroCare Ltd., Fresenius Medical Care, Taichung, Taiwan
| | - Wen-Chuan Wu
- Department of Ophthalmology, Eye Center, China Medical University Hospital
| | - Yi-Yu Tsai
- Department of Ophthalmology, Eye Center, China Medical University Hospital
- School of Medicine, College of Medicine, China Medical University
- Department of Optometry, Asia University
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31
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Bair H. They Do Not See Humans. Acad Psychiatry 2021; 45:235. [PMID: 33029701 DOI: 10.1007/s40596-020-01322-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 09/08/2020] [Accepted: 09/21/2020] [Indexed: 06/11/2023]
Affiliation(s)
- Henry Bair
- Stanford University School of Medicine, Stanford, CA, USA.
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32
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Bair H, Kung WH, Lai CT, Lin CJ, Chen HS, Chang CH, Lin JM, Hsia NY, Chen WL, Tien PT, Wu WC, Tsai YY. Preoperative Vision, Gender, and Operation Time Predict Visual Improvement After Epiretinal Membrane Vitrectomy: A Retrospective Study. Clin Ophthalmol 2021; 15:807-814. [PMID: 33658756 PMCID: PMC7917339 DOI: 10.2147/opth.s294690] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Accepted: 01/21/2021] [Indexed: 11/23/2022] Open
Abstract
Background To evaluate the efficacy of micro-incision vitrectomy surgery using a non-contact wide-angle viewing system for fovea-attached type epiretinal membrane, and to report the factors influencing the outcome. Methods A retrospective, comparative case series that included 50 patients with fovea-attached type epiretinal membrane who received micro-incision vitrectomy surgery using a non-contact wide-angle viewing system. Results All patients were followed-up for a minimum of 12 months. Seven cases were classified as group 1A (mainly outer retinal thickening), 17 were group 1B (more tenting of outer retina and distorted inner retina), and 26 were group 1C (prominent inner retina thickening and inward tenting of outer retina). Outcome measures included operation time, recurrent rate, postoperative BCVA, and CRT. The mean operative time was 26.2 minutes. The mean change of BCVA (LogMAR) was −0.43 (p< 0.001). The mean change of CRT was 135.3 μm (p< 0.001). The mean change of CRT was significantly higher in group 1C. Worse preoperative BCVA, male gender, and longer operative time can predict better postoperative BCVA found by multivariate logistic regression and multiple regression models. Conclusion Significant improvement in BCVA and CRT is noted after micro-incision vitrectomy surgery to operate fovea-attached type epiretinal membranes. Worse preoperative BCVA, male, and longer operation time could predict better improvement. These findings may assist surgeons in better evaluating the potential of this method to help their patients with epiretinal membranes.
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Affiliation(s)
- Henry Bair
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung, Taiwan.,Stanford University School of Medicine, Stanford, CA, USA
| | - Wei-Hsun Kung
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Chun-Ting Lai
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Chun-Ju Lin
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung, Taiwan.,School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan.,Department of Optometry, Asia University, Taichung, Taiwan
| | - Huan-Sheng Chen
- An-Shin Dialysis Center, NephroCare Ltd., Fresenius Medical Care, Taichung, Taiwan
| | - Cheng-Hsien Chang
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Jane-Ming Lin
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Ning-Yi Hsia
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Wen-Lu Chen
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Peng-Tai Tien
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung, Taiwan.,Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan
| | - Wen-Chuan Wu
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Yi-Yu Tsai
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung, Taiwan.,School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan.,Department of Optometry, Asia University, Taichung, Taiwan
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33
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Affiliation(s)
- C Jason Wang
- Center for Policy, Outcomes and Prevention, Division of General Pediatrics, Department of Pediatrics, Stanford University School of Medicine, Stanford, California.,Center for Health Policy, Freeman Spogli Institute for International Studies, Stanford, California
| | - Henry Bair
- Stanford University School of Medicine, Stanford, California
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34
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Affiliation(s)
- Henry Bair
- Stanford University School of Medicine, Stanford, California, USA
| | - Paul W Horak
- Stanford University School of Medicine, Stanford, California, USA
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35
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Affiliation(s)
- Henry Bair
- Stanford University School of Medicine, Stanford, California
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36
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Bair H. To a Friend in the Small Hours. J Clin Oncol 2020. [DOI: 10.1200/jco.20.00887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Henry Bair
- Stanford University School of Medicine, Stanford, CA
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Garcia GA, Veerappan Pasricha M, Bair H, Charlson ES, Wu AY. "Percussive" orbital trauma from wooden drumstick. Can J Ophthalmol 2020; 56:e24-e26. [PMID: 32818428 DOI: 10.1016/j.jcjo.2020.07.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 06/26/2020] [Accepted: 07/21/2020] [Indexed: 10/23/2022]
Affiliation(s)
| | | | - Henry Bair
- Stanford University School of Medicine, Stanford, CA
| | | | - Albert Y Wu
- Stanford University School of Medicine, Stanford, CA.
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Zhaorigetu S, Bair H, Jin D, Gupta VS, Pandit LM, Bryan RM, Lally KP, Olson SD, Cox CS, Harting MT. Extracellular Vesicles Attenuate Nitrofen-Mediated Human Pulmonary Artery Endothelial Dysfunction: Implications for Congenital Diaphragmatic Hernia. Stem Cells Dev 2020; 29:967-980. [PMID: 32475301 DOI: 10.1089/scd.2020.0063] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Congenital diaphragmatic hernia (CDH) leads to pathophysiologic pulmonary vasoreactivity. Previous studies show that mesenchymal stromal cell-derived extracellular vesicles (MSCEv) inhibit lung inflammation and vascular remodeling. We characterize MSCEv and human pulmonary artery endothelial cell (HPAEC) interaction, as well as the pulmonary artery (PA) response to MSCEv treatment. HPAECs were cultured with and without exposure to nitrofen (2,4-dichloro-phenyl-p-nitrophenylether) and treated with MSCEv. HPAEC viability, architecture, production of reactive oxygen species (ROS), endothelial dysfunction-associated protein levels (PPARγ, LOX-1, LOX-2, nuclear factor-κB [NF-κB], endothelial NO synthase [eNOS], ET-1 [endothelin 1]), and the nature of MSCEv-cellular interaction were assessed. Newborn rodents with and without CDH (nitrofen model and Sprague-Dawley) were treated with intravascular MSCEv or vehicle control, and their PAs were isolated. Contractility was assessed by wire myography. The contractile (KCL and ET-1) and relaxation (fasudil) responses were evaluated. HPAEC viability correlated inversely with nitrofen dose, while architectural compromise was directly proportional. There was a 2.1 × increase in ROS levels in nitrofen HPAECs (P < 0.001), and MSCEv treatment attenuated ROS levels by 1.5 × versus nitrofen HPAECs (P < 0.01). Nitrofen-induced alterations in endothelial dysfunction-associated proteins are shown, and exposure to MSCEv restored more physiologic expression. Nitrofen HPAEC displayed greater MSCEv uptake (80% increase, P < 0.05). Adenosine, a clathrin-mediated endocytosis inhibitor, decreased uptake by 46% (P < 0.05). CDH PA contraction was impaired with KCL (108.6% ± 1.4% vs. 112.0% ± 1.4%, P = 0.092) and ET-1 (121.7% ± 3.0% vs. 131.2% ± 1.8%, P < 0.01). CDH PA relaxation was impaired with fasudil (32.2% ± 1.9% vs. 42.1% ± 2.2%, P < 0.001). After MSCEv treatment, CDH PA contraction improved (125.9% ± 3.4% vs. 116.4 ± 3.5, P = 0.06), and relaxation was unchanged (32.5% ± 3.2% vs. 29.4% ± 3.1%, P = 0.496). HPAEC exposure to nitrofen led to changes consistent with vasculopathy in CDH, and MSCEv treatment led to a more physiologic cellular response. MSCEv were preferentially taken up by nitrofen-treated cells by clathrin-dependent endocytosis. In vivo, MSCEv exposure improved PA contractile response. These data reveal mechanisms of cellular and signaling alterations that characterize MSCEv-mediated attenuation of pulmonary vascular dysfunction in CDH-associated pulmonary hypertension.
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Affiliation(s)
- Siqin Zhaorigetu
- Department of Pediatric Surgery, McGovern Medical School at the University of Texas Health Science Center (UTHealth) and Children's Memorial Hermann Hospital, Houston, Texas, USA
| | - Henry Bair
- Department of Pediatric Surgery, McGovern Medical School at the University of Texas Health Science Center (UTHealth) and Children's Memorial Hermann Hospital, Houston, Texas, USA.,Stanford University School of Medicine, Stanford, California, USA
| | - Di Jin
- Department of Pediatric Surgery, McGovern Medical School at the University of Texas Health Science Center (UTHealth) and Children's Memorial Hermann Hospital, Houston, Texas, USA
| | - Vikas S Gupta
- Department of Pediatric Surgery, McGovern Medical School at the University of Texas Health Science Center (UTHealth) and Children's Memorial Hermann Hospital, Houston, Texas, USA
| | - Lavannya M Pandit
- Baylor College of Medicine and Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA
| | - Robert M Bryan
- Baylor College of Medicine and Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA
| | - Kevin P Lally
- Department of Pediatric Surgery, McGovern Medical School at the University of Texas Health Science Center (UTHealth) and Children's Memorial Hermann Hospital, Houston, Texas, USA
| | - Scott D Olson
- Department of Pediatric Surgery, McGovern Medical School at the University of Texas Health Science Center (UTHealth) and Children's Memorial Hermann Hospital, Houston, Texas, USA
| | - Charles S Cox
- Department of Pediatric Surgery, McGovern Medical School at the University of Texas Health Science Center (UTHealth) and Children's Memorial Hermann Hospital, Houston, Texas, USA
| | - Matthew T Harting
- Department of Pediatric Surgery, McGovern Medical School at the University of Texas Health Science Center (UTHealth) and Children's Memorial Hermann Hospital, Houston, Texas, USA
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39
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Bair H. A Confession for the End. J Am Geriatr Soc 2020; 69:264. [PMID: 32710636 DOI: 10.1111/jgs.16708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 06/22/2020] [Accepted: 06/23/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Henry Bair
- School of Medicine, Stanford University, Stanford, California, USA
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Lin CJ, Tien PT, Chang CH, Hsia NY, Yang YC, Lai CT, Bair H, Chen HS, Tsai YY. Relationship between Uveitis and Thyroid Disease: A 13-Year Nationwide Population-based Cohort Study in Taiwan. Ocul Immunol Inflamm 2020; 29:1292-1298. [PMID: 32643974 DOI: 10.1080/09273948.2020.1762899] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
PURPOSE To investigate whether patients with thyroid disease are at increased risk of uveitis. METHODS Data was collected from the Taiwan National Health Insurance system and included patients newly diagnosed with thyroid disease from 2000 to 2012. The endpoint of interest was a diagnosis of uveitis. RESULTS In analyzing 21,396 patients with thyroid disease, yielding 85,584 matched comparisons, patients with thyroid disease to have a significantly higher cumulative incidence of uveitis when compared to the control cohort with the Kaplan-Meier analysis. This result was further confirmed by Cox regression analysis. The increased risk was persistent in both genders. The association between thyroid disease and uveitis was stronger in patients without diabetes or hypertension. CONCLUSION Patients with thyroid disease were found to have a higher risk for uveitis. For certain age groups or patients without diabetes or hypertension, the role of thyroid disease might be more crucial for uveitis development.
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Affiliation(s)
- Chun-Ju Lin
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung, Taiwan.,School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan.,Department of Optometry, Asia University, Taichung, Taiwan
| | - Peng-Tai Tien
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung, Taiwan.,Graduate Institute of Clinical Medical Science, College of Medicine, China Medical University, Taichung, Taiwan
| | - Cheng-Hsien Chang
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung, Taiwan.,School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan.,Department of Optometry, Asia University, Taichung, Taiwan
| | - Ning-Yi Hsia
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Yu-Cih Yang
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan.,College of Medicine, China Medical University, Taichung, Taiwan
| | - Chun-Ting Lai
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Henry Bair
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung, Taiwan.,Stanford University School of Medicine, Stanford, CA, USA
| | - Huan-Sheng Chen
- An-Shin Dialysis Center, NephroCare Ltd., Fresenius Medical Care, Taichung, Taiwan
| | - Yi-Yu Tsai
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung, Taiwan.,School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan.,Department of Optometry, Asia University, Taichung, Taiwan
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Bair H. “Not Until I See My Other Doctor”. Perm J 2020; 24:19.033. [DOI: 10.7812/tpp/19.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Henry Bair
- Stanford University School of Medicine, CA
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Wang CJ, Bair H, Yeh CC. How to Prevent and Manage Hospital-Based Infections During Coronavirus Outbreaks: Five Lessons from Taiwan. J Hosp Med 2020; 15:370-371. [PMID: 32490801 DOI: 10.12788/jhm.3452] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Accepted: 04/22/2020] [Indexed: 11/20/2022]
Affiliation(s)
- C Jason Wang
- Department of Pediatrics, Department of Medicine, and Department of Health Research and Policy, Stanford University School of Medicine, Stan-ford, California
- The New School for Leadership in Health Care, Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan
| | - Henry Bair
- Stanford University School of Medicine, Stanford, California
| | - Ching-Chuan Yeh
- Department of Public Health, Tzu-Chi University, Hualien, Taiwan
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Affiliation(s)
- Giancarlo A Garcia
- Department of Ophthalmology, Byers Eye Institute at Stanford University, Palo Alto, California, USA.,Department of Ophthalmology, Santa Clara Valley Medical Center, San Jose, California, USA
| | - Henry Bair
- Stanford University School of Medicine, Stanford, California, USA
| | - Emily S Charlson
- Department of Ophthalmology, Byers Eye Institute at Stanford University, Palo Alto, California, USA
| | - James E Egbert
- Department of Ophthalmology, Byers Eye Institute at Stanford University, Palo Alto, California, USA.,Department of Ophthalmology, Santa Clara Valley Medical Center, San Jose, California, USA
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Bair H. The wedding proposal. Patient Educ Couns 2020; 103:1055-1056. [PMID: 31744703 DOI: 10.1016/j.pec.2019.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 11/03/2019] [Accepted: 11/07/2019] [Indexed: 06/10/2023]
Abstract
In this narrative essay, the author, a medical student, describes a patient who was nearing the end of her life and who feared passing away before she could witness her daughter's wedding. This story describes the lengths to which the medical team went to in order to address this concern, illustrating a particularly humanistic instance of what end-of-life care can mean.
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Affiliation(s)
- Henry Bair
- Stanford University School of Medicine, Stanford, CA, USA.
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Kung WH, Lai CT, Lin CJ, Bair H, Chen HS, Lin JM, Chen WL. Positive culture results and longer duration between onset and microincision vitrectomy have adverse effects on post-cataract surgery endophthalmitis outcome. J Formos Med Assoc 2020; 119:385-391. [DOI: 10.1016/j.jfma.2019.06.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Revised: 06/16/2019] [Accepted: 06/18/2019] [Indexed: 11/17/2022] Open
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Bair H. Deliverance, Their Way. J Palliat Med 2019; 22:1614-1615. [PMID: 31794376 DOI: 10.1089/jpm.2019.0230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Henry Bair
- School of Medicine, Stanford University, Stanford, California
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Affiliation(s)
- Henry Bair
- School of Medicine, Stanford University, CA
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Lai CT, Kung WH, Lin CJ, Chen HS, Bair H, Lin JM, Chen WL, Tien PT, Tsai YY. Outcome of primary rhegmatogenous retinal detachment using microincision vitrectomy and sutureless wide-angle viewing systems. BMC Ophthalmol 2019; 19:230. [PMID: 31744475 PMCID: PMC6862752 DOI: 10.1186/s12886-019-1238-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Accepted: 11/05/2019] [Indexed: 11/26/2022] Open
Abstract
Background To evaluate the efficacy of micro-incision vitrectomy surgery (MIVS) using Lumera and Resight non-contact sutureless wide-angle viewing systems (WAVS) for primary rhegmatogenous retinal detachment (RRD), and to analyze the anatomical and visual outcomes. Methods The retrospective, non-comparative, interventional case series reported here was conducted from June 2014 through November 2016. Enrolled patients presented with primary RRD and received MIVS with/without cryopexy by one surgeon using the Lumera and Resight non-contact sutureless WAVS. All patients were followed-up for a minimum of 12 months. Variables collected included patient demographics, best-corrected visual acuity, and macular status. The number and position of retinal break(s), and the use of cryopexy, were also recorded. Outcome measures included operative time, single-operation anatomical success rate, final anatomical success rate, recurrent rate, postoperative best-corrected visual acuity, and surgical complications. The end points were operative time, anatomical outcome, and functional outcome. Results In total, 110 eyes from 110 patients (68 men and 42 women) were treated. Of these, 103 (93%) eyes were reattached after primary vitrectomy. One hundred ten eyes (100%) reached final anatomical success. The mean operative time was 50.55 min. Multivariate analyses were performed with best model selection principle based on general linear model by Akaike Information Criteria for detecting possible factors related to operation time, and with multivariate logistic regression analysis for revealing probable clinical parameters which might influence the anatomical outcome after first operation and final visual outcome. Intraoperative cryopexy and multiple breaks increased operative time significantly. More favorable BCVA was significantly correlated with shorter operation time and the preoperative macula-on status. Multivariate logistic regression on the group of patients who have received the cataract surgery revealed that the pre-operative BCVA is a significant factor which can predict the visual outcome after MIVS. Conclusions The outcome of primary RRD repaired by MIVS using the Lumera and Resight sutureless WAVS was not inferior to any other published method. This instrument combination resulted in a relatively rapid and comfortable procedure without serious postoperative complications. Cryopexy and multiple breaks affected operative time significantly. Shorter operative times and preoperative macula-on status are associated with better final visual outcomes.
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Affiliation(s)
- Chun-Ting Lai
- Department of Ophthalmology, China Medical University Hospital, China Medical University, 2 Yuh-Der Road, Taichung City, Taiwan, 40447
| | - Wei-Hsun Kung
- Department of Ophthalmology, China Medical University Hospital, China Medical University, 2 Yuh-Der Road, Taichung City, Taiwan, 40447
| | - Chun-Ju Lin
- Department of Ophthalmology, China Medical University Hospital, China Medical University, 2 Yuh-Der Road, Taichung City, Taiwan, 40447. .,School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan. .,Department of Optometry, Asia University, Taichung, Taiwan.
| | - Huan-Sheng Chen
- An-Shin Dialysis Center, NephroCare Ltd., Fresenius Medical Care, Taichung, Taiwan
| | - Henry Bair
- Department of Ophthalmology, China Medical University Hospital, China Medical University, 2 Yuh-Der Road, Taichung City, Taiwan, 40447.,Stanford University School of Medicine, Stanford, USA
| | - Jane-Ming Lin
- Department of Ophthalmology, China Medical University Hospital, China Medical University, 2 Yuh-Der Road, Taichung City, Taiwan, 40447
| | - Wen-Lu Chen
- Department of Ophthalmology, China Medical University Hospital, China Medical University, 2 Yuh-Der Road, Taichung City, Taiwan, 40447
| | - Peng-Tai Tien
- Department of Ophthalmology, China Medical University Hospital, China Medical University, 2 Yuh-Der Road, Taichung City, Taiwan, 40447.,Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan
| | - Yi-Yu Tsai
- Department of Ophthalmology, China Medical University Hospital, China Medical University, 2 Yuh-Der Road, Taichung City, Taiwan, 40447.,School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan.,Department of Optometry, Asia University, Taichung, Taiwan
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Bair H. 2019 Hope Babette Tang Humanism in Healthcare Essay Contest: Third Place Medical Student Essay: The Hallmark Store. Acad Med 2019; 94:1476-1477. [PMID: 31567216 DOI: 10.1097/acm.0000000000002865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- Henry Bair
- H. Bair is a second-year medical student, Stanford University School of Medicine, Stanford, California;
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Affiliation(s)
- Henry Bair
- Stanford University School of Medicine, Stanford, CA
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