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Shetty NS, Giammatteo V, Gaonkar M, Li P, Akeju O, Arora G, Berra L, Arora P. Differences in the Response to High-Dose Inhaled Nitric Oxide in Self-identified Black and White Individuals: A Post Hoc Analysis of the NOSARSCOVID Randomized Clinical Trial. Am J Respir Crit Care Med 2024; 209:887-890. [PMID: 38190705 PMCID: PMC10995561 DOI: 10.1164/rccm.202310-1852le] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 01/03/2024] [Indexed: 01/10/2024] Open
Affiliation(s)
| | - Valentina Giammatteo
- Department of Anesthesia, Critical Care and Pain Medicine
- Harvard Medical School, Boston, Massachusetts
| | | | - Peng Li
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama
| | - Oluwaseun Akeju
- Department of Anesthesia, Critical Care and Pain Medicine
- Harvard Medical School, Boston, Massachusetts
| | | | - Lorenzo Berra
- Department of Anesthesia, Critical Care and Pain Medicine
- Anesthesia Critical Care Center for Research, and
- Respiratory Care Services, Massachusetts General Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Pankaj Arora
- Division of Cardiovascular Disease, and
- Section of Cardiology, Birmingham Veterans Affairs Medical Center, Birmingham, Alabama
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Shetty NS, Giammatteo V, Gaonkar M, Li P, Akeju O, Arora G, Berra L, Arora P. Reply to D'Couto and Celi: Racial Physiology: A Dangerous Precedent. Am J Respir Crit Care Med 2024. [PMID: 38452370 DOI: 10.1164/rccm.202402-0333le] [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: 02/12/2024] [Accepted: 03/06/2024] [Indexed: 03/09/2024] Open
Affiliation(s)
- Naman S Shetty
- The University of Alabama at Birmingham Heersink School of Medicine, 9967, Birmingham, Alabama, United States
| | | | - Mokshad Gaonkar
- The University of Alabama at Birmingham Heersink School of Medicine, 9967, Birmingham, Alabama, United States
| | - Peng Li
- University of Alabama at Birmingham, Biostatistics, Birmingham, Alabama, United States
| | - Oluwaseun Akeju
- Massachusetts General Hospital, Department of Anesthesia,Critical Care and Pain Medicine, Boston, Massachusetts, United States
| | - Garima Arora
- University of Alabama at Birmingham, 9968, Division of Cardiology, Birmingham, Alabama, United States
| | - Lorenzo Berra
- Massachusetts General Hospital, 2348, Boston, Massachusetts, United States
- Harvard Medical School, 1811, Boston, Massachusetts, United States
| | - Pankaj Arora
- University of Alabama at Birmingham, 9968, Div of Cardiology, Birmingham, Alabama, United States;
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Shetty NS, Gaonkar M, Patel N, Arora G, Arora P. Reply: Precise Exclusion Criteria Are Necessary to Define Normative Values of NT-proBNP. JACC Heart Fail 2024; 12:603. [PMID: 38448157 DOI: 10.1016/j.jchf.2023.12.015] [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] [Received: 12/22/2023] [Accepted: 12/22/2023] [Indexed: 03/08/2024]
Affiliation(s)
- Naman S Shetty
- University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Mokshad Gaonkar
- University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Nirav Patel
- University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Garima Arora
- University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Pankaj Arora
- University of Alabama at Birmingham, Birmingham, Alabama, USA; Birmingham Veterans Affairs Medical Center, Birmingham, Alabama, USA.
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Shetty NS, Gaonkar M, Giammatteo V, Arora P, Berra L. Reply to Eleuteri et al.: High-Dose Inhaled Nitric Oxide in Acute Hypoxemic Respiratory Failure: Need for Patient Phenotyping? Am J Respir Crit Care Med 2024; 209:460-462. [PMID: 38128097 PMCID: PMC10878377 DOI: 10.1164/rccm.202311-2112le] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 12/20/2023] [Indexed: 12/23/2023] Open
Affiliation(s)
- Naman S. Shetty
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, Alabama
| | - Mokshad Gaonkar
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, Alabama
| | - Valentina Giammatteo
- Department of Anesthesia, Critical Care and Pain Medicine
- Harvard Medical School, Boston, Massachusetts; and
| | - Pankaj Arora
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, Alabama
- Section of Cardiology, Birmingham Veterans Affairs Medical Center, Birmingham, Alabama
| | - Lorenzo Berra
- Department of Anesthesia, Critical Care and Pain Medicine
- Anesthesia Critical Care Center for Research, and
- Respiratory Care Services, Massachusetts General Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts; and
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Shetty NS, Gaonkar M, Patel N, Knowles JW, Natarajan P, Arora G, Arora P. Trends of Lipid Concentrations, Awareness, Evaluation, and Treatment in Severe Dyslipidemia in US Adults. Mayo Clin Proc 2024; 99:271-282. [PMID: 38189687 PMCID: PMC10873035 DOI: 10.1016/j.mayocp.2023.09.016] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 09/22/2023] [Indexed: 01/09/2024]
Abstract
OBJECTIVE To evaluate the contemporary trends of lipid concentrations, cholesterol evaluation, hypercholesterolemia awareness, and statin use among individuals with severe dyslipidemia (low-density lipoprotein cholesterol [LDL-C] level ≥190 mg/dL) between 2011 and 2020. PATIENTS AND METHODS This serial cross-sectional analysis included nonpregnant adults ≥20 years of age from the National Health and Nutrition Examination Survey between 2011 and 2020. Age-adjusted weighted trends of LDL-C, triglycerides, cholesterol evaluation in the past 5 years, hypercholesterolemia awareness, and documented statin use among individuals with severe dyslipidemia were estimated. RESULTS Among 24,722 participants included, the prevalence of severe dyslipidemia was 5.4% (SE: 0.2%) which was stable across the study period (Ptrend=.78). Among individuals with severe dyslipidemia (mean age: 55.3 [SE: 0.7] years; 52.2% females; 68.8% non-Hispanic White), LDL-C (224.3 [SE: 4.2] mg/dL in 2011-2012 to 224.2 [SE: 4.6] mg/dL in 2017-2020; Ptrend =.83), and triglyceride (123.3 [SE: 1.1] mg/dL in 2011-2012 to 101.8 [SE: 1.1] mg/dL in 2017-2020; Ptrend=.13), levels remained stable from 2011 to 2020. The rates of cholesterol evaluation in the past 5 years (72.0% [SE: 5.7%] in 2011-2012 to 78.0% [SE: 4.8%] in 2017-2020; Ptrend=.91), hypercholesterolemia awareness (48.1% [SE: 5.5%] in 2011-2012 to 51.9% [SE: 5.8%] in 2017- 2020; Ptrend=.77), and documented statin use (34.7% [SE: 4.5%] in 2011-2012 to 33.4% [SE: 4.0%] in 2017-2020; Ptrend=.28) remained stagnant in individuals with severe dyslipidemia between 2011 and 2020. CONCLUSION Among individuals with severe dyslipidemia, cholesterol evaluation and hypercholesterolemia awareness rates were stable at ∼75% and ∼50% in the past decade. Only ∼34% of individuals with severe dyslipidemia took statins between 2011 and 2020, which likely contributed to the stable LDL-C levels noted across the study period. Further investigations into the determinants of statin use and adherence to statins are needed.
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Affiliation(s)
- Naman S Shetty
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Mokshad Gaonkar
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, AL, USA; Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Nirav Patel
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Joshua W Knowles
- Department of Medicine, Division of Cardiovascular Medicine, School of Medicine, Stanford University, Stanford, CA, USA; Department of Medicine, Diabetes Research Center, Cardiovascular Institute and Prevention Research Center, Stanford, CA, USA
| | - Pradeep Natarajan
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA; Cardiovascular Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Program in Medical and Population Genetics, Broad Institute of Harvard and MIT, Cambridge, MA, USA
| | - Garima Arora
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Pankaj Arora
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, AL, USA; Section of Cardiology, Birmingham Veterans Affairs Medical Center, Birmingham, AL, USA.
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Shetty NS, Gaonkar M, Patel N, Yerabolu K, Patel KV, Arora G, Arora P. Change in Troponin I Levels With Intensive Blood Pressure Control: A Post-Hoc Analysis of SPRINT. JACC Adv 2024; 3:100775. [PMID: 38698882 PMCID: PMC11064929 DOI: 10.1016/j.jacadv.2023.100775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/05/2024]
Affiliation(s)
- Naman S. Shetty
- University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Mokshad Gaonkar
- University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Nirav Patel
- University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Krishin Yerabolu
- University of Alabama at Birmingham, Birmingham, Alabama, USA
- Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
| | - Kershaw V. Patel
- Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
| | - Garima Arora
- University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Pankaj Arora
- University of Alabama at Birmingham, Birmingham, Alabama, USA
- Birmingham Veterans Affairs Medical Center, Birmingham, Alabama, USA
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Shetty NS, Patel N, Gaonkar M, Li P, Arora G, Arora P. Natriuretic Peptide Normative Levels and Deficiency: The National Health and Nutrition Examination Survey. JACC Heart Fail 2024; 12:50-63. [PMID: 37768244 PMCID: PMC10924765 DOI: 10.1016/j.jchf.2023.07.018] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 07/10/2023] [Accepted: 07/19/2023] [Indexed: 09/29/2023]
Abstract
BACKGROUND Natriuretic peptides (NPs) are hormones with a range of key functions vital for cardiometabolic health. However, the reference ranges of NPs and the prevalence of NP deficiency in the healthy United States population remains poorly defined. OBJECTIVES This study aims to establish the reference range for N-terminal pro-B-type natriuretic peptide (NT-proBNP) values and to assess the prevalence of NP deficiency in a nationally representative healthy United States population. METHODS Healthy participants with NT-proBNP measurements from the 1999-2004 National Health and Nutrition Examination Survey were included. Weighted multivariable-adjusted linear regression models were used to assess the adjusted percentage difference of NT-proBNP concentrations by sex and race and ethnicity. NP deficiency was defined as concentrations <2.5th percentile in the study cohort. RESULTS Among 18,145 individuals (median age: 33.9 years [IQR: 17.1-49.0 years], 49.8% males, and 68.5% non-Hispanic White individuals), females had similar NT-proBNP concentrations in the 1-10 years group (4.2% [95% CI: -3.3% to 12.2%]), and highest differences in the 20-30 years group (150.5% [95% CI: 123.5%-180.8%]) compared with males in their respective age groups. Compared with non-Hispanic White individuals, non-Hispanic Black individuals had lower NT-proBNP concentrations in the 1- to 10-years group (19.6% [95% CI: 10.7%-27.6%]), and these differences were most pronounced in the 30-40 years group (40.2% [95% CI: 33.7%-46.0%]). An estimated 9.1 million United States individuals had NP deficiency. NP deficiency was associated with a higher risk of cardiometabolic diseases such as hypertension, dyslipidemia, obesity, and insulin resistance. CONCLUSIONS This study establishes the normative NP concentrations across the lifespan of a healthy United States population.
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Affiliation(s)
- Naman S Shetty
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Nirav Patel
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Mokshad Gaonkar
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Peng Li
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Garima Arora
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Pankaj Arora
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, Alabama, USA; Section of Cardiology, Birmingham Veterans Affairs Medical Center, Birmingham, Alabama, USA.
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Shetty NS, Pampana A, Patel N, Li P, Yerabolu K, Gaonkar M, Arora G, Arora P. Sex Differences in the Association of Genome-Wide Systolic Blood Pressure Polygenic Risk Score With Hypertension. Circ Genom Precis Med 2023; 16:e004259. [PMID: 37807951 PMCID: PMC10841815 DOI: 10.1161/circgen.123.004259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
Affiliation(s)
- Naman S. Shetty
- Division of Cardiovascular Disease, University of Alabama at Birmingham
| | - Akhil Pampana
- Division of Cardiovascular Disease, University of Alabama at Birmingham
| | - Nirav Patel
- Division of Cardiovascular Disease, University of Alabama at Birmingham
| | - Peng Li
- School of Nursing, University of Alabama at Birmingham
| | - Krishin Yerabolu
- Division of Cardiovascular Disease, University of Alabama at Birmingham
| | - Mokshad Gaonkar
- Department of Biostatistics, University of Alabama at Birmingham
| | - Garima Arora
- Division of Cardiovascular Disease, University of Alabama at Birmingham
| | - Pankaj Arora
- Division of Cardiovascular Disease, University of Alabama at Birmingham
- Section of Cardiology, Birmingham Veterans Affairs Medical Center, Birmingham, AL
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Shetty NS, Patel N, Gaonkar M, Kalra R, Li P, Pavela G, Arora G, Arora P. Trends of cardiovascular health in Asian American individuals: A national health and nutrition examination survey study. Am J Prev Cardiol 2023; 14:100509. [PMID: 37334161 PMCID: PMC10273280 DOI: 10.1016/j.ajpc.2023.100509] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 05/18/2023] [Accepted: 05/21/2023] [Indexed: 06/20/2023] Open
Abstract
Objective Oversampling of Asian American individuals in the National Health and Nutrition Examination Survey (NHANES) provides a unique opportunity to assess the population-level cardiovascular health (CVH) in the fastest-growing racial group in the US. Methods The Life's Essential 8 (LE8) score and its components were calculated in self-reported Asian American individuals ≥20 years of age and free of cardiovascular disease in the NHANES cycles from 2011-March 2020. Multivariable adjusted linear and logistic regression models were used for analysis. Results Among 2,059 Asian American individuals, the weighted mean LE8 score was 69.1 (0.4) with US-born [69.0 (0.8)] and foreign-born individuals [69.1 (0.4)] having similar CVH. From 2011 to March 2020, CVH in the overall population [69.7 (0.8) to 68.1 (0.8); Ptrend: 0.009] and foreign-born individuals [69.7 (0.8) to 67.7 (0.8); Ptrend: 0.005] declined. Decreasing trends were noted in the body mass index score irrespective of stratification and in the blood pressure scores in the overall population and foreign-born Asian American individuals. Compared with US-born individuals, the odds of ideal levels of smoking [ORadj:<5 years: 2.23 (95%CI: 1.45-3.44); 5-15 years: 1.97 (95%CI: 1.27-3.05); 15-30 years: 1.61 (95%CI: 1.11-2.34); ≥30 years: 1.69(95%CI:1.20-2.36)] and diet [ORadj: <5 years: 1.87 (95%CI: 1.26-2.79); 5-15 years: 2.00 (95%CI: 1.38-2.89); 15-30 years: 1.74 (95%CI: 1.14-2.68)] were higher in foreign-born individuals. Foreign-born individuals had lower odds of ideal physical activity levels [ORadj: 5-15 years: 0.55 (95%CI: 0.39-0.79); 15-30 years: 0.68 (95%CI: 0.49-0.95)] and ideal cholesterol levels [ORadj: 5-15 years: 0.59 (95%CI: 0.42-0.82); 15-30 years: 0.54 (95%CI :0.38-0.76); ≥30 years: 0.52 (95%CI: 0.38-0.76)]. Conclusion The CVH in Asian American individuals declined from 2011 to March 2020. The odds of ideal CVH decreased with increasing duration of stay in the US, with foreign-born individuals residing in the US for ≥30 years having ∼28% lower odds of ideal CVH compared with US-born individuals.
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Affiliation(s)
- Naman S. Shetty
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Nirav Patel
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Mokshad Gaonkar
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Rajat Kalra
- Cardiovascular Division, University of Minnesota, Minneapolis, MN, United States of America
| | - Peng Li
- School of Nursing, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Gregory Pavela
- Department of Health Behavior, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Garima Arora
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Pankaj Arora
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, AL, USA
- Section of Cardiology, Birmingham Veterans Affairs Medical Center, Birmingham, AL, USA
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Seasely AR, Gaonkar M, Battarbee AN, Casey BM, Sinkey RG, Dionne-Odom J, Szychowski JM, Tita AT, Subramaniam A. Are abnormal coagulation studies upon hospital admission in gravidas with COVID-19 associated with adverse outcomes? Am J Obstet Gynecol 2022. [PMCID: PMC8696657 DOI: 10.1016/j.ajog.2021.11.1176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
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El Hamdaoui M, Levy AM, Gaonkar M, Gawne TJ, Girkin CA, Samuels BC, Grytz R. Effect of Scleral Crosslinking Using Multiple Doses of Genipin on Experimental Progressive Myopia in Tree Shrews. Transl Vis Sci Technol 2021; 10:1. [PMID: 34003978 PMCID: PMC8088221 DOI: 10.1167/tvst.10.5.1] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 02/07/2021] [Indexed: 02/06/2023] Open
Abstract
Purpose To evaluate the effect of scleral crosslinking (SXL) on slowing experimental progressive myopia in tree shrew eyes using sub-Tenon's injections of genipin (GEN) at different concentrations and number of injections. Methods Three or five sub-Tenon's injections of GEN at 0 mM (sham), 10 mM, or 20 mM were performed in one eye every other day starting at 18 days of visual experience. Form deprivation (FD) myopia was induced in the injected eye between 24 and 35 days of visual experience; the fellow eye served as control. Tree shrews were randomly assigned to five experimental groups: FD (n = 8); FD + 5 × sham injections (n = 6); FD + 3 × GEN injections at 10 mM (n = 6) and 20 mM (n = 6); and FD + 5 × GEN injections at 20 mM (n = 6). Refractive state and ocular dimensions were measured daily. Results Compared with the FD group, the sham-injected group showed a transient effect on slowing vitreous chamber elongation. With increasing GEN dose, SXL had an increasing treatment effect on slowing vitreous chamber elongation and myopia progression. In addition, SXL led to a dose-dependent shortening of the aqueous chamber depth and corneal thickening. Lens thickening was observed in the group with the highest concentration. Conclusions We have shown that SXL using GEN can slow axial elongation and myopia progression in tree shrews. The extent of this treatment effect was dose dependent. Several unexpected effects were observed (corneal thickening, decrease of the anterior chamber depth, and lens thickening), which require further optimization of the GEN delivery approach before clinical consideration. Translational Relevance The results of this preclinical study suggest that scleral crosslinking using genipin can slow myopia progression.
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Affiliation(s)
- Mustapha El Hamdaoui
- Department of Ophthalmology and Visual Sciences, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Alexander M. Levy
- Department of Biomedical Engineering, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Mokshad Gaonkar
- Department of Biostatistics, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Timothy J. Gawne
- Department of Optometry and Vision Science, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Christopher A. Girkin
- Department of Ophthalmology and Visual Sciences, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Brian C. Samuels
- Department of Ophthalmology and Visual Sciences, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Rafael Grytz
- Department of Ophthalmology and Visual Sciences, The University of Alabama at Birmingham, Birmingham, Alabama, USA
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Abstract
PURPOSE To evaluate the anesthetic effect of single-point low-volume peribulbar anesthesia supplemented by topical anesthesia. SETTING Private ambulatory ophthalmic practice. METHODS Five hundred consecutive patients received 4 cc of lidocaine 2% with 200 units hyaluronidase as 1-point peribulbar anesthesia. This was supplemented by lidocaine 4%, 1 drop every 3 to 5 minutes for 3 instillations. Phacoemulsification and intraocular lens implantation were performed through a scleral tunnel or clear corneal approach. All patients were evaluated for intraoperative akinesia, lid closure, and anesthesia. One hour after surgery, the eye patch was removed and patients were evaluated for pain, discomfort, foreign-body sensation, diplopia, and lid closure. RESULTS All patients had no pain to mild discomfort during surgery; 34% had total and 58% partial akinesia; 78% had poor orbicularis action (lid closure); 12% had subconjunctival hemorrhage. Postoperatively, 42% of patients had foreign-body sensation caused by conjunctival coaptation by diathermy or corneal edema. Diplopia occurred in 32% of patients but resolved within 1 hour after eye-patch removal, and partial ptosis occurred in 58%, resolving within 2 hours of patch removal. All patients had normal lid closure when the eye patch was removed. CONCLUSIONS Low-volume 1-point peribulbar anesthesia supplemented by topical anesthesia was safe and effective and provided early visual recovery. Topical therapy can be started 1 hour postoperatively.
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Affiliation(s)
- K Kothari
- Bombay City Eye Institute, Maharashtra, India
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