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Vu DM, Elze T, Miller JW, Lorch AC, VanderVeen DK, Oke I. Risk Factors for Glaucoma Diagnosis and Surgical Intervention following Pediatric Cataract Surgery in the IRIS® Registry. Ophthalmol Glaucoma 2024; 7:131-138. [PMID: 37683729 PMCID: PMC10915110 DOI: 10.1016/j.ogla.2023.08.009] [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] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 08/30/2023] [Accepted: 08/31/2023] [Indexed: 09/10/2023]
Abstract
PURPOSE To compare demographic and clinical factors associated with glaucoma following cataract surgery (GFCS) and glaucoma surgery rates between infants, toddlers, and older children using a large, ophthalmic registry. DESIGN Retrospective cohort study. PARTICIPANTS Patients in the IRIS® Registry (Intelligent Research in Sight) who underwent cataract surgery at ≤ 17 years old and between January 1, 2013 and December 31, 2020. METHODS Glaucoma diagnosis and procedural codes were extracted from the electronic health records of practices participating in the IRIS Registry. Children with glaucoma diagnosis or surgery before cataract removal were excluded. The Kaplan-Meier estimator was used to determine the cumulative probability of GFCS diagnosis and glaucoma surgery after cataract surgery. Multivariable Cox regression was used to identify factors associated with GFCS and glaucoma surgery. MAIN OUTCOME MEASURES Cumulative probability of glaucoma diagnosis and surgical intervention within 5 years after cataract surgery. RESULTS The study included 6658 children (median age, 10.0 years; 46.2% female). The 5-year cumulative probability of GFCS was 7.1% (95% confidence interval [CI], 6.1%-8.1%) and glaucoma surgery was 2.6% (95% CI, 1.9%-3.2%). The 5-year cumulative probability of GFCS for children aged < 1 year was 22.3% (95% CI, 15.7%-28.4%). Risk factors for GFCS included aphakia (hazard ratio [HR], 2.63; 95% CI, 1.96-3.57), unilateral cataract (HR, 1.48; 95% CI, 1.12-1.96), and Black race (HR, 1.61; 95% CI, 1.12-2.32). The most common surgery was glaucoma drainage device insertion (32.6%), followed by angle surgery (23.3%), cyclophotocoagulation (15.1%), and trabeculectomy (5.8%). CONCLUSIONS Glaucoma following cataract surgery diagnosis in children in the IRIS Registry was associated with young age, aphakia, unilateral cataract, and Black race. Glaucoma drainage device surgery was the preferred surgical treatment, consistent with the World Glaucoma Association 2013 consensus recommendations for GFCS management. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- Daniel M Vu
- Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts; Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts.
| | - Tobias Elze
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts
| | - Joan W Miller
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts
| | - Alice C Lorch
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts
| | - Deborah K VanderVeen
- Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Isdin Oke
- Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts; Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts
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Seresirikachorn K, Thiamthat W, Annopawong K, Wanichwecharungruang B, Friedman DS, Vu DM. Treatment Outcomes for Juvenile Open Angle Glaucoma in Thailand. J Glaucoma 2023; 32:976-982. [PMID: 37725790 DOI: 10.1097/ijg.0000000000002309] [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] [Received: 02/24/2023] [Accepted: 09/04/2023] [Indexed: 09/21/2023]
Abstract
PRCIS Juvenile open angle glaucoma (JOAG) patients with thick central corneas and negative family history were more likely to undergo surgery, mainly trabeculectomy with half requiring additional surgery within 10 years. PURPOSE To assess the characteristics and treatment outcomes of patients with JOAG in Thailand. PATIENTS AND METHODS This retrospective, multicenter study included all patients diagnosed with JOAG over 12 years from 2 tertiary hospitals in Bangkok, Thailand. RESULTS A total of 200 eyes from 104 patients were included in this study. The mean age of onset was 24.0±10.1 years (range: 5-40 y), with male predominance (60.5%). Over 90% of patients had bilateral JOAG and 25% had a positive family history. Negative family history (adjusted odds ratio=4.59, P =0.02) and thick central corneal thickness were surgical predictors (every 10 µm adjusted odds ratio=1.29, P =0.01). Over 70% of cases needed glaucoma surgery. Trabeculectomy with Mitomycin-C was performed on 131 eyes (65.5%) with a cumulative probability of complete success of 71.0%, 57.8%, 39.2%, and 26.9% and qualified success of 86.3%, 73.6%, 64.8%, and 45.7% at 1, 3, 5, and 10 years, respectively. The mean follow-up after surgery was 94.9 ± 69.8 months (range: 13-153 mo). There were no serious postoperative complications. Myopia and the number of baseline glaucoma medications were significantly associated with surgical failure. CONCLUSIONS Trabeculectomy with mitomycin C was the most common primary surgery performed in Thai patients with JOAG, and successfully reduced intraocular pressure without significant complications. Patients with thicker corneas were more likely to undergo surgery. By 10 years, half of the patients required additional surgery and risk factors for failure included myopia and the number of medications.
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Affiliation(s)
- Kasem Seresirikachorn
- Department of Ophthalmology, College of Medicine, Rangsit University, Rajavithi Hospital
- Department of Ophthalmology, Queen Sirikit National Institute of Child Health, Bangkok, Thailand
| | - Warakorn Thiamthat
- Department of Ophthalmology, College of Medicine, Rangsit University, Rajavithi Hospital
- Department of Ophthalmology, Queen Sirikit National Institute of Child Health, Bangkok, Thailand
| | - Kornkamol Annopawong
- Department of Ophthalmology, College of Medicine, Rangsit University, Rajavithi Hospital
| | | | - David S Friedman
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School
| | - Daniel M Vu
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School
- Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, Boston, MA
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Choudhury A, Stuart E, Stoler J, Vu DM, Chang TC. Regional Disparities in Pediatric Uveitis Care Availability in the United States. Ophthalmology 2023; 130:1099-1101. [PMID: 37236403 PMCID: PMC10524771 DOI: 10.1016/j.ophtha.2023.05.025] [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] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 05/18/2023] [Accepted: 05/18/2023] [Indexed: 05/28/2023] Open
Abstract
A service coverage analysis of pediatric uveitis care in the United States was implemented to determine geographic disparities between subspecialists and the pediatric population. There were substantial potential service deserts, including several small metropolitan areas.
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Affiliation(s)
| | - Eliza Stuart
- Department of Geography and Sustainable Development, University of Miami, Coral Gables, Florida
| | - Justin Stoler
- Department of Geography and Sustainable Development, University of Miami, Coral Gables, Florida
| | - Daniel M Vu
- Bascom Palmer Eye Institute, University of Miami, Miami, Florida; Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts
| | - Ta Chen Chang
- Bascom Palmer Eye Institute, University of Miami, Miami, Florida.
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Vazquez LE, Llaneras CN, Vu DM. Complications of Glaucoma Surgery. Int Ophthalmol Clin 2023; 63:103-124. [PMID: 37755446 DOI: 10.1097/iio.0000000000000498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/28/2023]
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Birnbaum F, Wakil S, Vu DM, McBurney-Lin S, ElMallah M, Tseng H. Postoperative Management of Kahook Dual Blade Goniotomy with Phacoemulsification Cataract Extraction. J Curr Glaucoma Pract 2023; 17:169-174. [PMID: 38269267 PMCID: PMC10803275 DOI: 10.5005/jp-journals-10078-1419] [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: 04/20/2020] [Accepted: 09/19/2023] [Indexed: 01/26/2024] Open
Abstract
Aim To review the efficacy and safety of two common postoperative regimens following Kahook Dual Blade goniotomy with phacoemulsification cataract extraction (KDB-CE). Materials and methods This is a retrospective review of eyes undergoing KDB-CE from May 2016 to 2018 by a single surgeon. Almost 12-month follow-up data were assessed for two common postop regimens-treatment with (1) topical prednisolone acetate 1% with pilocarpine 1% (pred-pilo) or (2) difluprednate 0.05% postoperatively. Postoperative results were compared to each respective baseline intraocular pressure (IOP) levels. Results There were 53 eyes in the difluprednate group and 25 eyes in the pred-pilo group. In the difluprednate group, the IOP decreased at postoperative day 1 (POD1) [16 ± 5 baseline vs 15 ± 5 POD1, mean ± standard deviation (SD) in mm Hg, and p = 0.321], but increased at postoperative week 1 (POW1) due to a 15% rate of IOP-spikes (19 ± 9, p = 0.099). The number of IOP-lowering drops decreased from baseline (2 ± 1 drops) to 1 ± 1 drops at POD1 (p < 0.0001), and remained at 1 ± 1 drops through postoperative month 12 (POM12) (p < 0.0001). In the pred-pilo group, there was a statistically significant decrease in mean IOP at POW1 (16 ± 4 POW1 vs 18 ± 6 baseline, p = 0.044), which persisted through POM6. The number of IOP-lowering drops was not statistically significantly lower from baseline at POM3 (2 ± 1 at POM3, p = 0.188). Spikes in IOP, corneal edema, and hyphema were the most common complications. Conclusion Both postoperative regimens were effective following KDB-CE at reducing IOP at 12 months. The difluprednate group was likely to experience an IOP-spike at POW1 but used fewer IOP-lowering drops 12 months after KDB goniotomy. In the pred-pilo group, the number of IOP-lowering drops was equivalent to baseline levels at POM3. Aside from IOP spikes, there were similar complication rates observed between the two postoperative regimens. Due to demographic differences, it was not possible to compare relative IOP-lowering efficacy between the two postoperative regimens. Clinical significance It is efficacious and safe to use either postoperative regimen following KBD-CE. Postoperative trajectories may differ with respect to the postoperative regimen, but further randomized controlled trials are needed to compare various topical steroid medications for postoperative regimens following KDB-CE. How to cite this article Birnbaum F, Wakil S, Vu DM, et al. Postoperative Management of Kahook Dual Blade Goniotomy with Phacoemulsification Cataract Extraction. J Curr Glaucoma Pract 2023;17(4):169-174.
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Affiliation(s)
- Faith Birnbaum
- Department of Ophthalmology, Duke Eye Center, Durham, North Carolina, United States
| | - Susan Wakil
- Department of Ophthalmology, Duke Eye Center, Durham, North Carolina, United States
| | - Daniel M Vu
- Department of Ophthalmology, Duke Eye Center, Durham, North Carolina, United States
| | - Shan McBurney-Lin
- Department of Ophthalmology, Duke Eye Center, Durham, North Carolina, United States
| | | | - Henry Tseng
- Department of Ophthalmology, Duke Eye Center, Durham, North Carolina, United States
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Seresirikachorn K, Thiamthat W, Aramtiantamrong N, Traichaiyaporn S, Wanichwecharungruang B, Patel NA, Vu DM. Two types of childhood glaucoma secondary to familial exudative vitreoretinopathy. J AAPOS 2023; 27:192.e1-192.e8. [PMID: 37453666 DOI: 10.1016/j.jaapos.2023.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 04/21/2023] [Accepted: 05/02/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND Glaucoma secondary to familial exudative vitreoretinopathy presents as angle closure by either neovascular or non-neovascular mechanisms. We analyze the presentation and outcomes of two types of childhood glaucoma secondary to familial exudative vitreoretinopathy (FEVR). METHODS This retrospective cross-sectional study included all patients <18 years of age diagnosed with glaucoma after or concurrently with a diagnosis of FEVR between 2010 and 2020 from Queen Sirikit National Institute of Child Health in Bangkok, Thailand. Two groups were analyzed: neovascular or non-neovascular angle-closure status. Primary outcome measures were final visual acuity and intraocular pressure (IOP) in both groups. RESULTS Of 144 FEVR patients, 8 children (5.5%; 11 eyes, 3 bilateral cases) developed childhood glaucoma. Mean time between FEVR presentation and glaucoma was 42.2 ± 40.0 months. In the neovascular group, 3 of 9 eyes presented with glaucoma at FEVR diagnosis; 3 of 9 eyes (33%) required glaucoma surgery. In the non-neovascular group, 2 eyes presented with acute angle closure secondary to a phacomorphic lens. Both were treated with trabeculectomy, with resolution of pupillary block. All eyes had stage 4B FEVR or greater. Six of 8 eyes had stable or better visual acuity, and 10 eyes (91%) had IOP <21 mm Hg at final follow-up. CONCLUSIONS Childhood glaucoma secondary to FEVR is a rare complication caused by later stages of the disease. It may present as neovascular or non-neovascular angle closure, often requiring complex care. Therefore, awareness and adequate management of FEVR can help prevent additional morbidity from childhood glaucoma.
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Affiliation(s)
- Kasem Seresirikachorn
- Department of Ophthalmology, College of Medicine, Rangsit University, Rajavithi Hospital, Bangkok, Thailand; Department of Ophthalmology, Queen Sirikit National Institute of Child Health, Bangkok, Thailand.
| | - Warakorn Thiamthat
- Department of Ophthalmology, College of Medicine, Rangsit University, Rajavithi Hospital, Bangkok, Thailand; Department of Ophthalmology, Queen Sirikit National Institute of Child Health, Bangkok, Thailand
| | - Nattawadee Aramtiantamrong
- Department of Ophthalmology, College of Medicine, Rangsit University, Rajavithi Hospital, Bangkok, Thailand
| | - Sumalin Traichaiyaporn
- Department of Ophthalmology, Queen Sirikit National Institute of Child Health, Bangkok, Thailand
| | | | - Nimesh A Patel
- Department of Ophthalmology, Boston Children's Hospital, Boston, Massachusetts; Department of Ophthalmology, Massachusetts Eye and Ear, Boston, Massachusetts
| | - Daniel M Vu
- Department of Ophthalmology, Boston Children's Hospital, Boston, Massachusetts; Department of Ophthalmology, Massachusetts Eye and Ear, Boston, Massachusetts
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Vu DM, Stoler J, Rothman AL, Chang TC. A Service Coverage Analysis of Primary Congenital Glaucoma Care Across the United States. Am J Ophthalmol 2021; 224:112-119. [PMID: 33340505 PMCID: PMC10619983 DOI: 10.1016/j.ajo.2020.12.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 12/03/2020] [Accepted: 12/07/2020] [Indexed: 01/19/2023]
Abstract
PURPOSE To assess the number of infants at risk of delayed primary congenital glaucoma (PCG) evaluation due to long travel times to specialists. DESIGN Cross-sectional geospatial service coverage analysis. METHODS All American Glaucoma Society (AGS) and American Association for Pediatric Ophthalmology and Strabismus (AAPOS) provider locations were geocoded using each organization's member directory. Sixty-minute drive time regions to providers were generated using ArcGIS Pro (Esri). The geographic intersection of AGS and AAPOS service areas was computed because patients typically require visits to both types of specialists. American Community Survey data were then overlaid to estimate the number of infants within and beyond the AGS/AAPOS service areas. RESULTS One thousand twenty-nine AGS and 1,040 AAPOS provider locations were geocoded. The analysis yielded 944,047 infants age 0-1 year (23.6%) who live beyond the AGS/AAPOS service areas. Therefore, approximately 14-94 new PCG cases/year may be at risk of delayed diagnosis as a result of living in a potential service desert. Compared with children living within the AGS/AAPOS service areas, children aged <6 years in these potential service deserts were more likely to live in households earning below the US federal poverty level, lack health insurance, and live in a single-parent home. These communities are disproportionately likely to experience other rural health disparities and are more prevalent across the Great Plains. CONCLUSION Service coverage analysis is a useful tool for identifying underserved regions for PCG referrals and evaluation. These data may assist in targeting screening programs in low access areas for pediatric glaucoma care.
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Affiliation(s)
- Daniel M Vu
- Bascom Palmer Eye Institute, University of Miami Health System, Miami, Florida, USA.
| | - Justin Stoler
- Department of Geography and Regional Studies, University of Miami, Coral Gables, Florida, USA; Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Adam L Rothman
- Bascom Palmer Eye Institute, University of Miami Health System, Miami, Florida, USA
| | - Ta Chen Chang
- Bascom Palmer Eye Institute, University of Miami Health System, Miami, Florida, USA
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Abstract
PRECIS Approximately 1 in 9 Florida residents over the age of 65 years (438,642 people) live more than an hour away from a glaucoma specialist, which represents a significant barrier to care. PURPOSE To describe access to glaucoma care for Florida's elderly population using travel time to American Glaucoma Society (AGS) member offices. METHODS For this cross-sectional service coverage analysis, a list of AGS member locations was extracted from the AGS website, and addresses were geocoded using ArcGIS Online. Driving time regions were created using the service area tool in ArcGIS Pro 2.4 and overlaid with 2010 United States Census and 2016 American Community Survey data for all Florida residents age 65 or older. RESULTS Fifty-eight AGS member providers with 65 locations were identified and geocoded. There were 3,797,625 individuals aged over 65 years in Florida, of which 1,153,320 (30.4%) lived within 15 minutes of driving time from an AGS provider's office, 2,586,825 (68.1%) within 30 minutes, 3,358,983 (88.4%) within 60 minutes, and 3,491,815 (91.9%) within 120 minutes. The areas with the lowest access include rural areas near Lake Okeechobee and the Florida Panhandle. The population living beyond a 60-minute drive was more likely to be White, non-Hispanic and older, but less likely to be living below the federal poverty level or receiving public assistance than the population living within a 60-minute drive. CONCLUSIONS There is a significant travel burden for the elderly community of Florida to reach AGS providers. Additional studies could help identify other social barriers to accessing glaucoma providers in Florida and beyond in an effort to improve patient compliance and, ultimately, vision outcomes.
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Affiliation(s)
- Adam L Rothman
- Bascom Palmer Eye Institute, University of Miami Health System
| | - Justin B Stoler
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami
- Department of Geography and Regional Studies, University of Miami, Coral Gables, FL
| | - Daniel M Vu
- Bascom Palmer Eye Institute, University of Miami Health System
| | - Ta C Chang
- Bascom Palmer Eye Institute, University of Miami Health System
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Abstract
A 69-year-old man with myelofibrosis presented with a two-day history of left periorbital swelling, blurred vision, and non-radiating dull orbital pain. On examination, there was restricted left-sided extraocular motility with conjunctival injection, chemosis, and periorbital edema. Magnetic resonance imaging demonstrated left-sided pre- and post-septal fat stranding concerning for orbital cellulitis. Two weeks before symptom onset, the patient began fedratinib therapy for myelofibrosis but discontinued this medication upon hospital admission. After restarting fedratinib, he presented with similar right-sided ophthalmic signs. A review of his medication history revealed a temporal relationship between symptom onset and fedratinib use. After medication discontinuation, his symptoms improved rapidly.
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Affiliation(s)
| | | | - Daniel M Vu
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Apostolos G Anagnostopoulos
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Andrew J Rong
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
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Vu DM, Swaminathan SS. Progressive Vision Loss in a 62-Year-Old Woman. JAMA Ophthalmol 2020; 138:1207-1208. [PMID: 32910149 DOI: 10.1001/jamaophthalmol.2020.1746] [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: 11/14/2022]
Affiliation(s)
- Daniel M Vu
- University of Miami Miller School of Medicine, Bascom Palmer Eye Institute, Department of Ophthalmology, Miami, Florida
| | - Swarup S Swaminathan
- University of Miami Miller School of Medicine, Bascom Palmer Eye Institute, Department of Ophthalmology, Miami, Florida
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Vu DM, Junk AK. XEN Gel Stent Implantation Following Encircling Scleral Buckle Surgery. Ophthalmic Surg Lasers Imaging Retina 2020; 51:289-292. [PMID: 32511733 DOI: 10.3928/23258160-20200501-07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 03/30/2020] [Indexed: 11/20/2022]
Abstract
Scleral buckling procedures create a challenge for intraocular pressure (IOP) control in the glaucoma patient. The encircling band is believed to compress vortex veins, causing increased episcleral venous pressure, a proposed mechanism for secondary glaucoma. Glaucoma drainage device implantation is preferred over trabeculectomy when medical management fails, but often involves modification of the glaucoma implant and manipulation of the fibrotic capsule surrounding the scleral buckle. This case demonstrates that ab externo XEN gel stent implantation may successfully reduce IOP without interfering with the previous scleral buckle, a major limitation of previous glaucoma filtering surgeries. [Ophthalmic Surg Lasers Imaging Retina. 2020;51:289-292.].
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Thompson AC, Vu DM, Postel EA, Challa P. Factors Impacting Outcomes and the Time to Recovery From Malignant Glaucoma. Am J Ophthalmol 2020; 209:141-150. [PMID: 31377283 DOI: 10.1016/j.ajo.2019.07.023] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 07/28/2019] [Accepted: 07/29/2019] [Indexed: 11/18/2022]
Abstract
PURPOSE To identify factors associated with the successful treatment of malignant glaucoma (MG). DESIGN Retrospective case series. METHODS Setting: single institution; study population: 64 eyes (55 subjects) with MG; observation procedure(s): chart review; main outcome measures: anatomy, intraocular pressure (IOP), best visual acuity (BVA). RESULTS 87.5% (n=56/64) of eyes with MG required surgical intervention. Vitrectomy was more likely to be successful in eyes with a history of <3 incisional surgeries, <3 glaucoma drops, or IOP ≤30 mm Hg (P < .05). If vitrectomy was performed within 30 days, recovery of anatomy, BVA, and IOP occurred sooner (P < .05). IOP reduction was greater in subjects treated with oral carbonic anhydrase inhibitors (P = .016) or Nd:YAG laser hyaloidotomy (P = .007), and without a history of MG (P = .007). Time to maximal improvement was significantly longer for IOP and BVA than anatomy (P < .001). Treatment of MG with an oral carbonic anhydrase inhibitor hastened anatomic recovery (P = .01). Time to improvement in BVA was significantly faster in men and African Americans (P < .05). Time to maximal reduction in IOP occurred sooner in eyes that underwent anterior chamber reformation in clinic (P < .002). Trabeculectomy surgery prior to MG was associated with prolonged recovery of anatomy, BVA, and IOP (P < .05). CONCLUSIONS Earlier vitrectomy may shorten recovery times for MG. Nd:YAG laser hyaloidotomy and oral carbonic anhydrase inhibitors may lead to greater IOP reduction. The time to maximal improvement in IOP and BVA may be longer than the time to anatomic resolution. Although trabeculectomy may impede time to recovery from MG, oral carbonic anhydrase inhibitors may shorten the time to anatomic recovery and anterior chamber reformation may hasten IOP recovery.
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Affiliation(s)
- Atalie C Thompson
- Department of Ophthalmology, Duke University, Durham, North Carolina, USA
| | - Daniel M Vu
- Department of Ophthalmology, Duke University, Durham, North Carolina, USA
| | - Eric A Postel
- Department of Ophthalmology, Duke University, Durham, North Carolina, USA
| | - Pratap Challa
- Department of Ophthalmology, Duke University, Durham, North Carolina, USA.
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Thompson AC, Vu DM, Cowan LA, Asrani S. Factors Associated with Interventions after Laser Peripheral Iridotomy for Primary Angle-Closure Spectrum Diagnoses. Ophthalmol Glaucoma 2019; 2:192-200. [PMID: 32672592 DOI: 10.1016/j.ogla.2019.03.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 03/09/2019] [Accepted: 03/11/2019] [Indexed: 11/30/2022]
Abstract
PURPOSE To assess factors associated with receipt of subsequent medical, laser, or surgical interventions after laser peripheral iridotomy (LPI). DESIGN Retrospective review. PARTICIPANTS A total of 1271 eyes in 692 subjects with narrow angles (NAs) that were treated with LPI. METHODS Demographic and clinical factors associated with primary angle-closure (PAC) or PAC glaucoma (PACG) versus PAC suspect (PACS) diagnosis and use of glaucoma medications at the time of LPI, as well as factors predictive of subsequent addition of glaucoma medications, and receipt of selective laser trabeculoplasty (SLT), cataract surgery, and glaucoma surgery were assessed using logistic regression with generalized estimating equations. Kaplan-Meier curves and Cox proportional-hazards regression analysis were used to assess baseline factors affecting the time to SLT, cataract surgery, or glaucoma surgery. MAIN OUTCOME MEASURES Diagnosis of PAC/PACG and medical, laser, or surgical interventions after LPI. RESULTS African Americans (odds ratio [OR], 2.12; P < 0.001) were significantly more likely than whites to have PAC/PACG than PACS and to already be taking glaucoma medications (OR, 2.25, P < 0.001) at the time of LPI. In multivariable logistic regression analysis, African Americans were significantly more likely to be prescribed additional glaucoma medications after LPI (OR, 1.73; P = 0.025) and receive glaucoma surgery (OR, 2.7; P = 0.007), but were less likely to receive SLT (OR, 0.37; P = 0.009). In multivariate Cox proportional-hazards regression analysis, African Americans had longer time to SLT than whites (hazard ratio [HR], 0.41; P = 0.022), but a shorter time to glaucoma surgery (HR, 2.57; P = 0.004). There was no significant association between race and the likelihood of cataract surgery or time to cataract surgery (P > 0.10). CONCLUSIONS African Americans were more likely than whites to carry a diagnosis of PAC or PACG at the time of LPI and were significantly more likely to be prescribed additional glaucoma medications and require glaucoma surgery after LPI. Improved screening methods that target African Americans with NAs are needed so that preventive interventions such as LPI can be performed earlier to decrease the risk of progression.
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Affiliation(s)
- Atalie C Thompson
- Duke University Medical Center, Department of Ophthalmology, Durham, North Carolina
| | - Daniel M Vu
- Duke University Medical Center, Department of Ophthalmology, Durham, North Carolina
| | - Lisa A Cowan
- Duke University Medical Center, Department of Ophthalmology, Durham, North Carolina; Southern California Permanente Medical Group, Bakersfield, California
| | - Sanjay Asrani
- Duke University Medical Center, Department of Ophthalmology, Durham, North Carolina.
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Pham CN, Radcliffe NM, Vu DM. Surgical outcomes associated with a sutureless drainage valve implantation procedure in patients with refractory glaucoma. Clin Ophthalmol 2018; 12:2607-2615. [PMID: 30587907 PMCID: PMC6296183 DOI: 10.2147/opth.s186369] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [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] [Indexed: 12/01/2022] Open
Abstract
Purpose To evaluate the safety and efficacy profile of a sutureless procedure for drainage valve implantation with combined cataract removal and/or endoscopic cyclophotocoagulation (ECP). Materials and methods A retrospective case series study of consecutive surgeries for Ahmed glaucoma valve (AGV; New World Medical) implantation in a 1-year period was analyzed. The surgery was performed using a Tisseel fibrin sealant (Baxter Healthcare Corporation) in place of sutures. Some subsets within the case series also included a cataract extraction with intraocular lens (CEIOL) insertion and/or ECP (Endo Optiks) within the same procedure. Primary outcomes for this study including efficacy (IOP change, reduction in medications) and safety (complications and reoperations) were measured out to 3 years. Comparisons between subsets were made using ANOVA with post hoc Tukey’s pairwise tests. Results One hundred twenty-two eyes of 99 patients underwent sutureless AGV implantation surgery. Of the 122, 18 had an AGV implantation only, 46 had an AGV + CEIOL, 35 had an AGV + ECP, and 23 had an AGV + CEIOL + ECP. In total, there was a significant decrease in IOP (P<0.0001) and number of glaucoma medications (P≤0.0054) at each postoperative visit. In a one-way ANOVA, there were no significant differences in mean IOP between the different subsets of surgeries (P>0.05); 10.7% and 14.8% of eyes required a reoperation either for a complication or for uncontrolled glaucoma, respectively. Conclusion Sutureless valve implantation is associated with a significant reduction in IOP percentage and medication use after the procedure with a safety profile comparable with other glaucoma surgeries.
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Affiliation(s)
| | - Nathan M Radcliffe
- New York University, New York, NY, USA, .,Weill Cornell Medical College, New York, NY, USA, .,New York Eye Surgery Center, New York, NY, USA,
| | - Daniel M Vu
- Weill Cornell Medical College, New York, NY, USA,
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15
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Gudo ES, Ali S, António VS, Chelene IR, Chongo I, Demanou M, Falk K, Guiliche OC, Heinrich N, Monteiro V, Muianga AF, Oludele J, Mula F, Mutuku F, Amade N, Alho P, Betsem E, Chimbuinhe Z, Cristovam AJ, Galano G, Gessain A, Harris E, Heise M, Inalda F, Jala I, Jaszi E, King C, Kitron U, Kümmerer BM, LaBeaud AD, Lagerqvist N, Malai G, Mazelier M, Mendes S, Mukoko D, Ndenga B, Njouom R, Pinto G, Tivane A, Vu DM, Vulule J. Seroepidemiological Studies of Arboviruses in Africa. Adv Exp Med Biol 2018; 1062:361-371. [PMID: 29845545 DOI: 10.1007/978-981-10-8727-1_25] [Citation(s) in RCA: 3] [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] [Indexed: 04/17/2023]
Abstract
The literature on sero-epidemiological studies of flaviviral infections in the African continent is quite scarce. Much of the viral epidemiology studies have been focussing on diseases such as HIV/AIDS because of their sheer magnitude and impact on the lives of people in the various affected countries. Increasingly disease outbreaks caused by arboviruses such as the recent cases of chikungunya virus, dengue virus and yellow fever virus have prompted renewed interest in studying these viruses. International agencies from the US, several EU nations and China are starting to build collaborations to build capacity in many African countries together with established institutions to conduct these studies. The Tofo Advanced Study Week (TASW) was established to bring the best scientists from the world to the tiny seaside town of Praia do Tofo to rub shoulders with African virologists and discuss cutting-edge science and listen to the work of researchers in the field. In 2015 the 1st TASW focussed on Ebola virus. The collections of abstracts from participants at the 2nd TASW which focused on Dengue and Zika virus as well as presentations on other arboviruses are collated in this chapter.
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Affiliation(s)
| | - S Ali
- National Institute of Health, Maputo, Mozambique
| | - V S António
- National Institute of Health, Maputo, Mozambique
| | - I R Chelene
- National Institute of Health, Maputo, Mozambique
| | - I Chongo
- National Institute of Health, Maputo, Mozambique
| | - M Demanou
- Laboratoire des arbovirus et des virus de fièvres hémorragiques, Centre Pasteur du Cameroun (CPC), Yaoundé, Cameroon.
| | - K Falk
- The Public Health Agency of Sweden and Karolinska Institute, Solna, Sweden.
| | - O C Guiliche
- National Institute of Health, Maputo, Mozambique
| | - N Heinrich
- Infectious Diseases & Tropical Medicine, Medical Center of the University of Munich (LMU), Munich, Germany.
| | - V Monteiro
- National Institute of Health, Maputo, Mozambique
| | - A F Muianga
- National Institute of Health, Maputo, Mozambique
| | - J Oludele
- National Institute of Health, Maputo, Mozambique
| | - F Mula
- National Institute of Health, Maputo, Mozambique
| | - F Mutuku
- Technical University of Mombasa, Mombasa, Kenya.
| | - N Amade
- National Institute of Health, Maputo, Mozambique
| | - P Alho
- National Institute of Health, Maputo, Mozambique
| | - E Betsem
- Faculté de médecine et des Sciences Biomédicales, Université de Yaoundé 1, Yaoundé, Cameroon
- Unité d'Epidémiologie et Physiopathologie des Virus Oncogènes, Institut Pasteur, Paris, France
| | | | | | - G Galano
- Pemba Provincial Hospital, Pemba, Mozambique
| | - A Gessain
- Unité d'Epidémiologie et Physiopathologie des Virus Oncogènes, Institut Pasteur, Paris, France
| | - E Harris
- Division of Infectious Diseases and Vaccinology, School of Public Health, University of California, Berkeley, CA, USA
| | - M Heise
- University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - F Inalda
- National Institute of Health, Maputo, Mozambique
| | - I Jala
- Laboratoire des arbovirus et des virus de fièvres hémorragiques, Centre Pasteur du Cameroun (CPC), Yaoundé, Cameroon
- Tropical Disease Research Center (TDRC), Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - E Jaszi
- Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - C King
- Center for Global Health and Diseases, Case Western Reserve University, Cleveland, OH, USA
| | - U Kitron
- Center for Global Health and Diseases, Case Western Reserve University, Cleveland, OH, USA
| | - B M Kümmerer
- Institute of Virology, University of Bonn Medical Centre, Bonn, Germany
| | - A D LaBeaud
- Center for Global Health and Diseases, Case Western Reserve University, Cleveland, OH, USA
- Department of Pediatrics, Division of Infectious Diseases, Stanford University School of Medicine, California, USA
| | - N Lagerqvist
- The Public Health Agency of Sweden and Karolinska Institute, Solna, Sweden
| | - G Malai
- Polana Caniço General Hospital Mozambique, Maputo, Mozambique
| | - M Mazelier
- Laboratoire des arbovirus et des virus de fièvres hémorragiques, Centre Pasteur du Cameroun (CPC), Yaoundé, Cameroon
| | - S Mendes
- Nampula Central Hospital, Nampula, Mozambique
| | - D Mukoko
- Department of Pediatrics, Division of Infectious Diseases, Stanford University School of Medicine, California, USA
| | - B Ndenga
- Centre for Global Health Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - R Njouom
- Laboratoire des arbovirus et des virus de fièvres hémorragiques, Centre Pasteur du Cameroun (CPC), Yaoundé, Cameroon
| | - G Pinto
- National Institute of Health, Maputo, Mozambique
| | - A Tivane
- National Institute of Health, Maputo, Mozambique
| | - D M Vu
- Department of Pediatrics, Division of Infectious Diseases, Stanford University School of Medicine, California, USA
| | - J Vulule
- Centre for Global Health Research, Kenya Medical Research Institute, Nairobi, Kenya
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Thompson AC, Vu DM, Cowan LA, Asrani S. Risk Factors Associated with Missed Diagnoses of Narrow Angles by the Van Herick Technique. Ophthalmol Glaucoma 2018; 1:108-114. [PMID: 32672561 DOI: 10.1016/j.ogla.2018.08.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 07/31/2018] [Accepted: 08/01/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE To identify which factors are associated with a deep-appearing anterior chamber on slit-lamp examination by the Van Herick (VH) technique in eyes with a diagnosis of narrow angle (NA) on gonioscopy. DESIGN Retrospective review. PARTICIPANTS One thousand three hundred fourteen eyes in 696 participants with NA on indirect gonioscopy. METHODS All included eyes were graded as narrow with iridotrabecular contact on indirect gonioscopy in a darkened room by a single trained glaucoma specialist. Before gonioscopy, eyes were graded as narrow or deep by VH slit-lamp examination technique. Demographic and clinical factors predictive of a deep VH grading were assessed using logistic regression with generalized estimating equations. MAIN OUTCOME MEASURES Factors associated with deep versus narrow VH grade. RESULTS Using the VH technique, 13.7% of eyes (n = 180/1314) with NA on gonioscopy were classified as deep. Eyes with primary angle-closure glaucoma (PACG; odds ratio, 2.43; P < 0.001) and primary angle closure (PAC; odds ratio, 1.38; P = 0.006) were significantly more likely to be graded as deep by the VH technique relative to eyes that were primary angle-closure suspects (PACSs). In multivariate analysis, male gender (odds ratio, 2.22; P < 0.001), myopia (odds ratio, 1.4; P = 0.048), and black (odds ratio, 4.11; P < 0.001) and Asian (odds ratio, 2.24; P = 0.044) race were independent risk factors for a deep grading with the VH technique in eyes with NA on gonioscopy. CONCLUSIONS Patients with NAs on gonioscopy who are men, myopic, and of black or Asian race are at increased risk of being misdiagnosed with deep angles if examined with the VH technique alone. Eyes with PACG and PAC may be more likely than those with PACS to be misdiagnosed as deep with the VH technique. It is possible that by being missed by the VH technique, these eyes could have progressed from PACS to PAC and PACG. Patients with these demographic and clinical characteristics in the presence of other risk factors for glaucoma should undergo careful gonioscopy.
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Affiliation(s)
- Atalie C Thompson
- Department of Ophthalmology, Duke University, Durham, North Carolina
| | - Daniel M Vu
- Department of Ophthalmology, Duke University, Durham, North Carolina
| | - Lisa A Cowan
- Department of Ophthalmology, Southern California Permanente Medical Group, Bakersfield, California
| | - Sanjay Asrani
- Department of Ophthalmology, Duke University, Durham, North Carolina.
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17
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Nakatsu MN, Vartanyan L, Vu DM, Ng MY, Li X, Deng SX. Preferential biological processes in the human limbus by differential gene profiling. PLoS One 2013; 8:e61833. [PMID: 23630617 PMCID: PMC3632514 DOI: 10.1371/journal.pone.0061833] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2013] [Accepted: 03/14/2013] [Indexed: 12/14/2022] Open
Abstract
Corneal epithelial stem cells or limbal stem cells (LSCs) are responsible for the maintenance of the corneal epithelium in humans. The exact location of LSCs is still under debate, but the increasing need for identifying the biological processes in the limbus, where LSCs are located, is of great importance in the regulation of LSCs. In our current study we identified 146 preferentially expressed genes in the human limbus in direct comparison to that in the cornea and conjunctiva. The expression of newly identified limbal transcripts endomucin, fibromodulin, paired-like homeodomain 2 (PITX2) and axin-2 were validated using qRT-PCR. Further protein analysis on the newly identified limbal transcripts showed protein localization of PITX2 in the basal and suprabasal layer of the limbal epithelium and very low expression in the cornea and conjunctiva. Two other limbal transcripts, frizzled-7 and tenascin-C, were expressed in the basal epithelial layer of the limbus. Gene ontology and network analysis of the overexpressed limbal genes revealed cell-cell adhesion, Wnt and TGF-β/BMP signaling components among other developmental processes in the limbus. These results could aid in a better understanding of the regulatory elements in the LSC microenvironment.
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Affiliation(s)
- Martin N. Nakatsu
- Cornea Division, Jules Stein Eye Institute, University of California Los Angeles, Los Angeles, California, United States of America
| | - Lily Vartanyan
- Cornea Division, Jules Stein Eye Institute, University of California Los Angeles, Los Angeles, California, United States of America
| | - Daniel M. Vu
- Cornea Division, Jules Stein Eye Institute, University of California Los Angeles, Los Angeles, California, United States of America
| | - Madelena Y. Ng
- Cornea Division, Jules Stein Eye Institute, University of California Los Angeles, Los Angeles, California, United States of America
| | - Xinmin Li
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States of America
| | - Sophie X. Deng
- Cornea Division, Jules Stein Eye Institute, University of California Los Angeles, Los Angeles, California, United States of America
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18
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Vu DM, Silva FQ, Haseltine SJ, Ehrlich JR, Radcliffe NM. Relationship between corneal hysteresis and optic nerve parameters measured with spectral domain optical coherence tomography. Graefes Arch Clin Exp Ophthalmol 2013; 251:1777-83. [PMID: 23519885 DOI: 10.1007/s00417-013-2311-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2012] [Revised: 01/31/2013] [Accepted: 03/04/2013] [Indexed: 10/27/2022] Open
Abstract
BACKGROUND Corneal hysteresis (CH) has been associated with visual field damage in glaucoma and is related to the velocity of perimetric glaucoma progression. We undertook this investigation to determine whether CH is associated with structural markers of glaucoma damage on spectral domain optical coherence tomography (SD-OCT). METHODS In this retrospective study, 131 patients under glaucoma evaluation were evaluated with SD-OCT (Cirrus; Carl Zeiss Meditec, Dublin, CA) and had CH measurements with the ocular response analyzer (Reichert, Inc., Buffalo, NY). Pearson and partial correlation adjusting for age were preformed to examine the association between CH and variables of interest. Generalized estimating equations were used to construct simple and multiple linear models. RESULTS While Pearson correlations were modest overall, CH best correlated with mean deviation (MD; r = 0.19) followed by average retinal nerve fiber layer (RNFL) thickness (r = 0.18) and vertical cup to disc ratio (r = -0.11) in the open angle glaucoma group. In univariable models, CH varied as a function of MD (ß = 0.1, 95 % CI 0.03, 0.1; p < 0.001) and of average RNFL thickness (ß = 0.2, 95 % CI 0.1, 0.4; p = 0.001). In a multivariable analysis including MD, age, average RNFL thickness, and glaucoma status, MD (p = 0.001) and age (p < 0.001) retained significant associations with CH. CONCLUSIONS In patients under evaluation and treatment for glaucoma, CH was more closely related to visual field MD than to structural markers of glaucoma damage as measured by SD-OCT.
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Affiliation(s)
- Daniel M Vu
- Department of Ophthalmology, Weill Cornell Medical College, 1305 York Avenue, 11th Floor, New York, NY 10021, USA
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19
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Sach MB, Sharpe CM, Spilkin AM, Ballantyne AO, Magnuson CN, Chien S, Vu DM, Eakin CM, Trauner DA. Where damage causes deficit - the neural substrates of language in the developing brain. Neuroimage 2009. [DOI: 10.1016/s1053-8119(09)71103-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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20
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Vu DM, Reid KL, Rodriguez HM, Gregoret LM. Examination of the folding of E. coli CspA through tryptophan substitutions. Protein Sci 2001; 10:2028-36. [PMID: 11567094 PMCID: PMC2374221 DOI: 10.1110/ps.16201] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [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: 05/03/2001] [Revised: 07/02/2001] [Accepted: 07/12/2001] [Indexed: 10/16/2022]
Abstract
Escherichia coli cold shock protein, CspA, folds very rapidly (time constant, tau = 4 msec) by an apparent two-state mechanism. However, recent time-resolved infrared (IR) temperature-jump experiments indicate that the folding trajectory of CspA may be more complicated. The sole tryptophan of wild-type CspA (Trp11), which is used to monitor the folding process by fluorescence spectroscopy, is located in an unusual aromatic cluster on the surface of CspA within the nucleic acid binding site. To gain a more global picture of the folding kinetics of CspA and to determine if there are any previously undetected intermediates, we have introduced a second tryptophan at three different surface locations in the protein. The three mutations did not significantly alter the tertiary structure of CspA, although two of the substitutions were found to be slightly stabilizing. Two-state folding, as detected by stopped-flow fluorescence spectroscopy, is preserved in all three mutants. These results indicate that the fast folding of CspA is driven by a concerted mechanism.
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Affiliation(s)
- D M Vu
- Department of Chemistry and Biochemistry, University of California, Santa Cruz, California 95064, USA
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21
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Abstract
Escherichia coli CspA is a member of the cold shock protein family. All cold shock proteins studied to date fold rapidly by an apparent two-state mechanism. CspA contains an unusual cluster of aromatic amino acids on its surface that is necessary for nucleic acid binding and also provides stability to CspA (Hillier et al., 1998). To elucidate the role this aromatic cluster plays in the determining the folding rate and pathway of CspA, we have studied the folding kinetics of mutants containing either leucine or serine substituted for Phe 18, Phe20, and/or Phe31. The leucine substitutions are found to accelerate folding and the serine substitutions to decelerate folding. Because these residues exert effects on the free energy of the folding transition state, they may be necessary for nucleating folding. They are not responsible, however, for the very compact, native-like transition state ensemble seen in the cold shock proteins, as the refolding rates of the mutants all show a similar, weak dependence of unfolding rate on denaturant concentration. Using mutant cycle analysis, we show that there is energetic coupling among the three residues between the unfolded and transition states, suggesting that the cooperative nature of these interactions helps to determine the unfolding rate. Overall, our results suggest that separate evolutionary pressures can act simultaneously on the same group of residues to maintain function, stability, and folding rate.
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Affiliation(s)
- H M Rodriguez
- Department of Chemistry and Biochemistry, University of California, Santa Cruz 95064, USA
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22
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Chen H, Qi S, Xu D, Vu DM, Fitzsimmons WE, Bekersky I, Peets J, Sehgal SN, Daloze P. FK 506 and rapamycin in combination are not antagonistic but produce extended small bowel graft survival in the mouse. Transplant Proc 1998; 30:1039-41. [PMID: 9636419 DOI: 10.1016/s0041-1345(98)00141-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- H Chen
- Laboratory of Experimental Surgery, Research Center, Notre-Dame Hospital, University of Montreal, Quebec, Canada
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23
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Bandini LG, Vu DM, Must A, Dietz WH. Body fatness and bioelectrical impedance in non-obese pre-menarcheal girls: comparison to anthropometry and evaluation of predictive equations. Eur J Clin Nutr 1997; 51:673-7. [PMID: 9347287 DOI: 10.1038/sj.ejcn.1600463] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVES To determine in non-obese pre-menarcheal girls if bioelectrical impedance (BIA) is a better predictor of body fatness than triceps skinfold (TSF) or body mass index (BMI) and to cross-validate published equations for determination of fat-free mass (FFM) from BIA in pre-menarcheal girls. DESIGN Cross-sectional analysis of data from 132 non-obese pre-menarcheal girls. The relationship of percent body fat (%BF), derived from isotopic dilution of H2 18O to TSF, BMI, and %BF by BIA, calculated from measures of height, weight and resistance was examined by correlation analysis. SETTING Massachusetts Institute of Technology (MIT) Clinical Research Center in Cambridge, MA, USA. SUBJECTS Pre-menarcheal girls aged 8-12 y were recruited from local schools, MIT summer day camp and by word of mouth. RESULTS TSF accounted for 68% of the explained variance (R2) in the prediction of %BF measured by H2 18O, compared to 38% for BMI and 70% for BIA. Prediction of FFM by comparison of published equations was evaluated in this population. The predictive ability differed by Tanner stage. Kushner's equation (Kushner et al, 1992), based solely on height2/resistance was the only equation that provided estimates that did not differ significantly from measured values among all Tanner stages. CONCLUSIONS BIA appears to be a valid and reliable measure of FFM but is no better than TSF in predictions of body fat.
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Affiliation(s)
- L G Bandini
- Clinical Research Center, Massachusetts Institute of Technology, Cambridge 02139, USA
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24
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Swenson IE, Nguyen MT, Pham BS, Vu QN, Vu DM. Factors influencing infant mortality in Vietnam. J Biosoc Sci 1993; 25:285-302. [PMID: 8360224] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Selected determinants of overall infant mortality in Vietnam were examined using data from the 1988 Vietnam Demographic and Health Survey, and factors underlying neonatal and post-neonatal mortality were also compared. Effects of community development characteristics, including health care, were studied by logistic regression analysis in a subsample of rural children from the 1990 Vietnam Accessibility of Contraceptives Survey. Infant neonatal and post-neonatal mortality rates showed comparable distributions by birth order, maternal age, pregnancy intervals, mother's education and urban-rural residence. Rates were highest among first order births, births after an interval of less than 12 months, births to illiterate mothers and to those aged under 21 or over 35 years of age. Logistic regression analysis showed that the most significant predictor of infant mortality was residence in a province where overall infant mortality was over 40 per 1000 live births. In the rural subsample, availability of public transport was the most persistent community development predictor of infant mortality. Reasons for the low infant mortality rates in Vietnam compared to countries with similar levels of economic development are discussed.
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Affiliation(s)
- I E Swenson
- Carolina Population Center, University of North Carolina, Chapel Hill
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25
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Abstract
Data from the 1988 Vietnamese Demographic and Health Survey and the 1990 Vietnam Study of Accessibility of Contraceptives were used in this analysis to determine how selective individual and community characteristics influenced the use of modern methods of contraception in Vietnam. Although there were no significant differences in the use of contraceptives between women with a primary education and those with a higher educational attainment, the illiterate women with no formal education were significantly less likely to use modern methods of contraception. Women living in provinces with high infant mortality rates were significantly less likely to use modern methods of contraception than women in low-infant-mortality provinces. Independent of other individual and community characteristics, there were no significant differences in the use of contraception between urban and rural women.
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Affiliation(s)
- M T Nguyen
- National Committee on Population and Family Planning, Hanoi, Vietnam
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26
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Allman J, Vu QN, Nguyen MT, Pham BS, Vu DM. Fertility and family planning in Vietnam. Stud Fam Plann 1991; 22:308-17. [PMID: 1759276] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
This report provides the first reliable statistical data on fertility patterns and the family planning program in the Socialist Republic of Vietnam. Findings are from the 1988 Demographic and Health Survey of Vietnam and the 1989 census survey. The data show that the total fertility rate has declined from over 6 children per woman in the early 1970s to under 4 in the later 1980s. Contraceptive prevalence for modern methods is estimated at 37 percent among married women of reproductive age in 1988. The average duration of breastfeeding is over 14 months; marriage is relatively late. The IUD is the most common contraceptive method and abortion is widespread. The major factors likely to influence fertility and family planning in the future are the government's population policy, improved access to modern methods of contraception, and the institution of new economic policies that are currently under way in Vietnam.
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Affiliation(s)
- J Allman
- National Committee for Population and Family Planning (NCPFP), Hanoi
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27
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Vu DM, Prendergast TJ, Engle P. Tuberculosis in refugees from Southeast Asia. Chest 1982; 82:133-5. [PMID: 7094640 DOI: 10.1378/chest.82.2.133-b] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
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