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Cioana M, Patodia Y, Tong L, Chiu HH, Tam ES, Somani S. Anterior chamber cytokine production and postoperative macular edema in patients with diabetes undergoing FLACS. J Cataract Refract Surg 2024; 50:160-166. [PMID: 37847109 DOI: 10.1097/j.jcrs.0000000000001335] [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: 08/01/2023] [Accepted: 10/04/2023] [Indexed: 10/18/2023]
Abstract
PURPOSE To evaluate the effect of femtosecond laser-assisted cataract surgery (FLACS) and manual cataract surgery (MCS) on proinflammatory cytokine expression in patients with diabetes vs nondiabetic patients. SETTING Outpatient surgical center in Vaughan, Ontario, Canada. DESIGN Prospective cohort study. METHODS Patients with diabetes and nondiabetic patients undergoing noncomplicated MCS or FLACS were assigned into 4 cohorts: MCS nondiabetic (n = 30), FLACS nondiabetic (n = 42), MCS diabetic (n = 40), and FLACS diabetic (n = 40). Aqueous humor inflammatory mediator concentrations were evaluated at MCS onset and after femtosecond laser treatment. The presence of cystoid macular edema, anterior chamber (AC) inflammation, central retinal thickness, macular volume, and retinal microvascular changes (through optical coherence tomography angiography) were evaluated preoperatively and on postoperative day 1, week 1, month 1 (POM1), and month 3 (POM3). RESULTS Patients with diabetes receiving FLACS had a higher concentration of interleukin (IL)-7, IL-13, and interferon-induced protein-10 than MCS diabetic patients; they also demonstrated higher levels of vascular endothelial growth factor and lower levels of interferon (IFN)-γ, granulocyte colony-stimulating factor, and IFN-α2 compared with MCS nondiabetic patients. Macular volume appeared to be significantly higher in MCS diabetic vs MCS non-diabetic patients at POM1 and between FLACS diabetic vs FLACS nondiabetic patients at POM3. There were no other significant differences between the cohorts for any parameter. CONCLUSIONS FLACS use in patients with diabetes demonstrated some differences in AC cytokine expression compared with non-diabetic FLACS or diabetic patients undergoing MCS; however, there was no increase in clinical inflammatory biomarkers. FLACS seems to be a safe technique to use in patients with diabetes.
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Affiliation(s)
- Milena Cioana
- From the Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada (Cioana); Uptown Eye Specialists, Vaughan, Ontario, Canada (Cioana, Tong, Chiu, Tam, Somani); Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada (Patodia, Tong, Chiu, Tam, Somani); William Osler Health System, Brampton, Ontario, Canada (Tong, Chiu, Tam, Somani); Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada (Chiu)
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Hatamnejad A, Higham A, Somani S, Tam ES, Lim E, Khavandi S, de Pennington N, Chiu HH. Feasibility of an artificial intelligence phone call for postoperative care following cataract surgery in a diverse population: two phase prospective study protocol. BMJ Open Ophthalmol 2024; 9:e001475. [PMID: 38199790 PMCID: PMC10806655 DOI: 10.1136/bmjophth-2023-001475] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Accepted: 12/05/2023] [Indexed: 01/12/2024] Open
Abstract
INTRODUCTION Artificial intelligence (AI) development has led to improvements in many areas of medicine. Canada has workforce pressures in delivering cataract care. A potential solution is using AI technology that can automate care delivery, increase effectiveness and decrease burdens placed on patients and the healthcare system. This study assesses the use of 'Dora', an example of an AI assistant that is able to deliver a regulated autonomous, voice-based, natural-language consultation with patients over the telephone. Dora is used in routine practice in the UK, but this study seeks to assess the safety, usability, acceptability and cost-effectiveness of using the technology in Canada. METHODS AND ANALYSIS This is a two-phase prospective single-centred trial. An expected 250 patients will be recruited for each phase of the study. For Phase I of the study, Dora will phone patients at postoperative week 1 and for Phase II of the study, Dora will phone patients within 24hours of their cataract surgery and again at postoperative week 1. We will evaluate the agreement between Dora and a supervising clinician regarding the need for further review based on the patients' symptoms. A random sample of patients will undergo the System Usability Scale followed by an extended semi-structured interview. The primary outcome of agreement between Dora and the supervisor will be assessed using the kappa statistic. Qualitative data from the interviews will further gauge patient opinions about Dora's usability, appropriateness and level of satisfaction. ETHICS AND DISSEMINATION Research Ethics Board William Osler Health System (ID: 22-0044) has approved this study and will be conducted by guidelines of Declaration of Helsinki. Master-linking sheet will contain the patient chart identification (ID), full name, date of birth and study ID. Results will be shared through peer-reviewed journals and presentations at conferences.
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Affiliation(s)
- Amin Hatamnejad
- McMaster University Michael G DeGroote School of Medicine, Hamilton, Ontario, Canada
| | - Aisling Higham
- Ufonia Limited, Oxford, UK
- Royal Berkshire Hospital NHS Foundation Trust, Reading, UK
| | - Sohel Somani
- Department of Opthalmology and Vision Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- William Osler Health System, Brampton, Ontario, Canada
| | - Eric S Tam
- Department of Opthalmology and Vision Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- William Osler Health System, Brampton, Ontario, Canada
| | - Ernest Lim
- Ufonia Limited, Oxford, UK
- Department of Computer Science, University of York, York, UK
| | | | | | - Hannah H Chiu
- McMaster University Michael G DeGroote School of Medicine, Hamilton, Ontario, Canada
- Department of Opthalmology and Vision Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- William Osler Health System, Brampton, Ontario, Canada
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Murtaza F, Toameh D, Chiu HH, Tam ES, Somani S. Autologous Platelet‐Rich Plasma Drops for Evaporative Dry Eye Disease from Meibomian Gland Dysfunction: A Pilot Study. Clin Ophthalmol 2022; 16:2199-2208. [PMID: 35821787 PMCID: PMC9271282 DOI: 10.2147/opth.s367807] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 06/22/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose To evaluate the effects of autologous platelet‐rich plasma (PRP) drops for evaporative dry eye (EDE) disease from meibomian gland dysfunction (MGD). Methods This is a retrospective, consecutive case series of 20 eyes of 10 patients with EDE from MGD treated with PRP drops from November 2020 to November 2021 at a single outpatient clinic in Ontario, Canada. PRP drops were prepared from whole blood using a two-step centrifugation method. Patients were instructed to instill these drops six times daily for 4 weeks. The Canadian Dry Eye Assessment (CDEA) questionnaire score, patient subjective assessment (PSA) score, first and average non-invasive break-up times (f/a NIBUT), tear meniscus height (TMH), bulbar redness (BR), and meibograph grade (MG) were measured before and after the treatment course. Results Significant improvements in dry eye symptoms and tear film parameters were observed. Dry eye symptoms significantly improved as per the CDEA (mean difference (MD) = −5.45, 95% confidence interval (CI) = [−7.9, −3.1], p<0.001) and PSA (MD = −2.6, 95% CI = [−3.9, −1.2], p<0.001). There were significant improvements in tear film parameters including fNIBUT (MD = 3.85s, 95% CI = [1.2, 6.8], p=0.006), aNIBUT (MD = −6.81s, 95% CI = [5.7, 11.1], p<0.001) and TMH (MD = 0.08, 95% CI = [0.003, 0.2], p=0.045). There was an improvement in conjunctival injection as measured by BR (MD = −0.36, 95% CI = [−0.4, −0.15], p=0.373). Five eyes experienced a one-grade improvement in MG (p=0.453), and none experienced worsening in MG with treatment. No temporary or permanent adverse effects were noted. Conclusion Four weeks of PRP therapy resulted in significant functional improvements in dry eye symptoms and tear film quality and quantity. Improvements in conjunctival injection and microstructural improvements in meibomian glands were also observed in some eyes. Overall, PRP is a promising treatment option for patients with EDE from MGD refractory to conventional treatments.
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Affiliation(s)
- Fahmeeda Murtaza
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Dana Toameh
- Uptown Eye Specialists, Vaughan, Ontario, Canada
| | - Hannah H Chiu
- Uptown Eye Specialists, Vaughan, Ontario, Canada
- Division of Ophthalmology, William Osler Health System, Brampton, Ontario, Canada
- Department of Ophthalmology & Vision Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Eric S Tam
- Uptown Eye Specialists, Vaughan, Ontario, Canada
- Division of Ophthalmology, William Osler Health System, Brampton, Ontario, Canada
- Department of Ophthalmology & Vision Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Sohel Somani
- Uptown Eye Specialists, Vaughan, Ontario, Canada
- Division of Ophthalmology, William Osler Health System, Brampton, Ontario, Canada
- Department of Ophthalmology & Vision Sciences, University of Toronto, Toronto, Ontario, Canada
- Correspondence: Sohel Somani, 401-7900 Hurontario Street, Brampton, Ontario, L6Y 0P6, Canada, Tel +416 292-0330, Fax +416 292-0331, Email
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Lukewich MK, Murtaza F, Somani S, Tam ES, Chiu HH. Comparison of Barrett Toric Calculations Using Measured and Predicted Posterior Corneal Astigmatism in Cataract Surgery Patients. Clin Ophthalmol 2022; 16:1739-1751. [PMID: 35673350 PMCID: PMC9167600 DOI: 10.2147/opth.s351011] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 05/16/2022] [Indexed: 11/23/2022] Open
Affiliation(s)
- Mark K Lukewich
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Fahmeeda Murtaza
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Sohel Somani
- William Osler Health System, Brampton, Ontario, Canada
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
- Uptown Eye Specialists, Vaughan, Ontario, Canada
| | - Eric S Tam
- William Osler Health System, Brampton, Ontario, Canada
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
- Uptown Eye Specialists, Vaughan, Ontario, Canada
| | - Hannah H Chiu
- William Osler Health System, Brampton, Ontario, Canada
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
- Uptown Eye Specialists, Vaughan, Ontario, Canada
- Correspondence: Hannah H Chiu, Uptown Eye Specialists, 401-7900 Hurontario Street, Brampton, Ontario, L6Y 0P6, Canada, Tel +1 416 292-0330, Fax +1 416 292-0331, Email
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Murtaza F, Toameh D, Al-Habib S, Maini R, Chiu HH, Tam ES, Somani S. Safety and Efficacy of BroadBand Intense Pulsed Light Therapy for Dry Eye Disease with Meibomian Gland Dysfunction. Clin Ophthalmol 2021; 15:3983-3991. [PMID: 34629862 PMCID: PMC8495232 DOI: 10.2147/opth.s331289] [Citation(s) in RCA: 3] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 08/31/2021] [Indexed: 01/05/2023] Open
Abstract
Background BroadBand light intense pulsed light (BBL-IPL) therapy has shown to reduce hordeolum and blepharitis frequency. This study aims to evaluate the efficacy and safety of BBL-IPL therapy in patients with dry eye disease (DED) from meibomian gland dysfunction (MGD). Methods This is a retrospective, consecutive case series of 48 patients with DED from MGD who underwent BBL-IPL therapy from October 2016 to January 2019 at a single, outpatient clinic in Ontario, Canada. Clinical outcomes included first and average non-invasive keratograph tear break-up times (NIKBUT), bulbar redness (BR) scores, tear meniscus heights (TMH), visual acuity (VA) and meibograph grades. Patient-reported outcomes included the Canadian dry eye assessment (CDEA) questionnaire and patient subjective assessment (PSA) scores. Outcomes were measured at baseline and after completion of 4 monthly BBL-IPL sessions. Results The mean severity of dry eye symptoms as measured by the CDEA and PSA decreased significantly from 19.78 ± 9.62 to 12.08 ± 7.40 (p<0.001) and from 7.65 ± 1.74 to 4.77 ± 2.03 (p<0.001), respectively. Twenty-five percent of patients reported no dry eye symptoms after treatment. The meibograph grade improved significantly in both eyes (p<0.001). Approximately 71.0% and 80.1% of patients had an improved meibograph grade in the right and left eye, respectively. Near-significant improvements were observed for BR scores and VA. There was also a trend towards improved first/average NIKBUT and TMH scores. No adverse events were noted. Conclusion BBL-IPL appears to be an effective and safe treatment modality in improving dry eye symptoms and meibomian gland function in patients with DED from MGD.
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Affiliation(s)
- Fahmeeda Murtaza
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Dana Toameh
- Uptown Eye Specialists, Brampton, Ontario, Canada
| | | | - Raj Maini
- Uptown Eye Specialists, Brampton, Ontario, Canada
| | - Hannah H Chiu
- Uptown Eye Specialists, Brampton, Ontario, Canada.,Department of Ophthalmology & Vision Sciences, University of Toronto, Toronto, Ontario, Canada.,William Osler Health System, Brampton, Ontario, Canada
| | - Eric S Tam
- Uptown Eye Specialists, Brampton, Ontario, Canada.,Department of Ophthalmology & Vision Sciences, University of Toronto, Toronto, Ontario, Canada.,William Osler Health System, Brampton, Ontario, Canada
| | - Sohel Somani
- Uptown Eye Specialists, Brampton, Ontario, Canada.,Department of Ophthalmology & Vision Sciences, University of Toronto, Toronto, Ontario, Canada.,William Osler Health System, Brampton, Ontario, Canada
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Nithianandan H, Sharma S, Tam ES, Chiu H, Maini R, Somani S. Evaluating newer generation intraocular lens calculation formulas in manual versus femtosecond laser-assisted cataract surgery. Int J Ophthalmol 2021; 14:1174-1178. [PMID: 34414080 DOI: 10.18240/ijo.2021.08.06] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 04/07/2021] [Indexed: 11/23/2022] Open
Abstract
AIM To determine the refractive accuracy of the Haigis, Barrett Universal II (Barrett), and Hill-radial basis function 2.0 (Hill-RBF) intraocular lens (IOL) power calculations formulas in eyes undergoing manual cataract surgery (MCS) and refractive femtosecond laser-assisted cataract surgery (ReLACS). METHODS This was a REB-approved, retrospective interventional comparative case series of 158 eyes of 158 patients who had preoperative biometry completed using the IOL Master 700 and underwent implantation of a Tecnis IOL following uncomplicated cataract surgery using either MCS or ReLACS. Target spherical equivalence (SE) was predicted using the Haigis, Barrett, and Hill-RBF formulas. An older generation formula (Hoffer Q) was included in the analysis. Mean refractive error (ME) was calculated one month postoperatively. The lens factors of all formulas were retrospectively optimized to set the ME to 0 for each formula across all eyes. The median absolute errors (MedAE) and the proportion of eyes achieving an absolute error (AE) within 0.5 diopters (D) were compared between the two formulas among MCS and ReLACS eyes, respectively. RESULTS Of the 158 eyes studied, 64 eyes underwent MCS and 94 eyes underwent ReLACS. Among MCS eyes, the MedAE did not differ between the formulas (P=0.59), however among ReLACS eyes, Barrett and Hill-RBF were more accurate (P=0.001). Barrett and Hill-RBF were both more likely to yield AE<0.5 D among both groups (P<0.001). CONCLUSION The Barrett and Hill-RBF formula lead to greater refractive accuracy and likelihood of refractive success when compare to Haigis in eyes undergoing ReLACS.
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Affiliation(s)
- Harrish Nithianandan
- Department of Ophthalmology & Visual Sciences, McGill University, Montreal H4A 3S5, Canada
| | - Soumya Sharma
- Ryerson University, Toronto, Ontario M5B 2K3, Canada
| | - Eric S Tam
- Department of Ophthalmology, University of Toronto, Toronto M5T 3A9, Canada.,Uptown Eye Specialists, Vaughan, Ontario L4K 2Z5, Canada.,William Osler Health System, Brampton, Ontario L6R 3J7, Canada
| | - Hannah Chiu
- Department of Ophthalmology, University of Toronto, Toronto M5T 3A9, Canada.,Uptown Eye Specialists, Vaughan, Ontario L4K 2Z5, Canada.,William Osler Health System, Brampton, Ontario L6R 3J7, Canada
| | - Rajiv Maini
- Uptown Eye Specialists, Vaughan, Ontario L4K 2Z5, Canada
| | - Sohel Somani
- Department of Ophthalmology, University of Toronto, Toronto M5T 3A9, Canada.,Uptown Eye Specialists, Vaughan, Ontario L4K 2Z5, Canada.,William Osler Health System, Brampton, Ontario L6R 3J7, Canada
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Lim CW, Somani S, Chiu HH, Maini R, Tam ES. Astigmatic Outcomes of Single, Non-Paired Intrastromal Limbal Relaxing Incisions During Femtosecond Laser-Assisted Cataract Surgery Based on a Custom Nomogram. Clin Ophthalmol 2020; 14:1059-1070. [PMID: 32368004 PMCID: PMC7183774 DOI: 10.2147/opth.s238016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 11/10/2019] [Accepted: 03/25/2020] [Indexed: 12/02/2022] Open
Abstract
Purpose To determine astigmatic changes of intrastromal limbal-relaxing incisions (LRIs) performed during femtosecond laser-assisted cataract surgery (FLACS). Design Retrospective case series. Patients and Methods Patients undergoing FLACS with adjunctive astigmatism management with intrastromal LRIs were included. All eyes had preoperative corneal cylinder (Kcyl) ≥0.20 D on ocular biometry. An intrastromal LRI nomogram of single, non-paired LRIs placed at the 9 mm optical zone was used. Keratometry was measured preoperatively, and postoperatively at 1 week, 1 month, and 3 months (POM3). Alpins astigmatism analysis was used to calculate target-induced astigmatism (TIA, equivalent to preoperative Kcyl), surgically induced astigmatism (SIA), difference vectors (DV), and correction indices (CI). Secondary analysis included multivariable binary logistic regression to determine clinical factors associated with corrections >125% (CI > 1.25). Results A total of 154 eyes (125 patients) were studied. Mean preoperative Kcyl was 0.87±0.42 D (SD), which did not significantly differ from POM3 Kcyl (0.87±0.51 D, p=0.470). Only the against-the-rule (ATR) subgroup demonstrated a small but significant reduction in Kcyl from preoperative (0.96±0.51D) to POM3 (0.89±0.55D, p=0.032). Sixteen eyes (10.4%) had Kcyl ≤0.5 D preoperatively, compared to 46 eyes (29.9%) at POM3 (p<0.0001). Mean SIA was 0.80±0.52 D. Mean DV was 0.85±0.47. Mean CI was 0.79. Fifty-one eyes (33%) had astigmatism correction >125%. On multivariable regression analysis, ATR astigmatism class (p=0.026) and lower arc lengths (30º) (p=0.005) were associated with correction >125%. Lower preoperative corneal astigmatism was inversely correlated with CI (p<0.001). Conclusion Although intrastromal LRIs can be conveniently performed during FLACS and appear safe, only patients with ATR astigmatism demonstrated a significant reduction in corneal astigmatism 3-months postoperatively under the current nomogram. Areas for future refinements to the nomogram were identified.
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Affiliation(s)
- Carter W Lim
- Faculty of Medicine, University of Ottawa, Ottawa K1H 8M5, Canada.,Eye Foundation of Canada, Toronto M3N 2V6, Canada.,William Osler Health System, Brampton L6R 3J7, Canada
| | - Sohel Somani
- William Osler Health System, Brampton L6R 3J7, Canada.,Uptown Eye Specialists, Brampton L6Y 0P6, Canada.,Faculty of Medicine, University of Toronto, Toronto M5S 1A8, Canada
| | - Hannah H Chiu
- William Osler Health System, Brampton L6R 3J7, Canada.,Uptown Eye Specialists, Brampton L6Y 0P6, Canada.,Faculty of Medicine, University of Toronto, Toronto M5S 1A8, Canada
| | - Raj Maini
- William Osler Health System, Brampton L6R 3J7, Canada.,Uptown Eye Specialists, Brampton L6Y 0P6, Canada.,Faculty of Medicine, University of Toronto, Toronto M5S 1A8, Canada
| | - Eric S Tam
- William Osler Health System, Brampton L6R 3J7, Canada.,Uptown Eye Specialists, Brampton L6Y 0P6, Canada.,Faculty of Medicine, University of Toronto, Toronto M5S 1A8, Canada
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Nithianandan H, Tam ES, Somani S. Refractive Laser-Assisted Cataract Surgery versus Conventional Manual Surgery: Comparing Efficacy and Safety in 3144 Eyes: Reply to Correspondence. Am J Ophthalmol 2019; 208:442. [PMID: 31376911 DOI: 10.1016/j.ajo.2019.06.022] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Accepted: 06/23/2019] [Indexed: 11/17/2022]
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Pereira A, Somani S, Tam ES, Chiu H, Maini R. Comparison of Surgically Induced Astigmatism and Corneal Morphological Features Between Femtosecond Laser and Manual Clear Corneal Incisions. J Refract Surg 2019; 35:796-802. [PMID: 31830296 DOI: 10.3928/1081597x-20191024-02] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Accepted: 10/23/2019] [Indexed: 11/20/2022]
Abstract
PURPOSE To assess corneal morphologic changes and surgically induced astigmatism (SIA) following clear corneal incisions (CCIs) created manually or with the Catalys femtosecond laser (Johnson & Johnson Vision, Santa Ana, CA). METHODS In this retrospective cohort analysis, patients undergoing femtosecond laser-assisted cataract surgery (FLACS) or manual cataract surgery between June and September 2018 from a single surgical center in Toronto, Canada, were considered for inclusion. Postoperative corneal astigmatism values were compared to preoperative astigmatism indices to determine the SIA at the postoperative 3-month (POM3) mark using the Alpins vector method. Secondary outcomes included postoperative corrected distance visual acuity (CDVA), central corneal thickness (CCT), and CCI morphology parameters. RESULTS Refractive outcomes from 104 eyes of 61 patients (54 eyes in the manual group and 50 eyes in the FLACS group) were included. There was no significant difference in POM3 SIA (manual: 0.45 ± 0.28 diopters [D], FLACS: 0.57 ± 0.46 D, P = .11); however, a significantly larger SIA was noted in the FLACS cohort at postoperative 1 week (P = .02) and 1 month (P = .04). FLACS led to a significantly smaller POM3 CCI thickness (P = .006), and CCI position was comparable between the two techniques (P = .44). There were no significant differences between groups in CDVA (P = .19), CCT thickness (P = .20), or phacoemulsification time (P = .59). CONCLUSIONS There was no significant difference in SIA between FLACS and manual cataract surgery at POM3. With a significantly smaller CCI thickness seen in FLACS cases, and a comparable CCI position, the reason for the increased SIA following laser CCIs in the early postoperative period was unclear. [J Refract Surg. 2019;35(12):796-802.].
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Ke Y, Hao R, He Y, Tam ES, Li X. The value of color Doppler imaging and intralesional steroid injection in pediatric orbital capillary hemangioma. J Chin Med Assoc 2014; 77:258-64. [PMID: 24694673 DOI: 10.1016/j.jcma.2014.02.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2013] [Accepted: 10/07/2013] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND To evaluate color Doppler imaging (CDI) as the primary imaging modality in the diagnosis of pediatric orbital capillary hemangioma. METHODS This is a retrospective study of 36 consecutive cases of orbital capillary hemangiomas between January 2006 and July 2011. Data on demographic details, clinical findings, gray-scale ultrasonography, CDI characteristics, treatment, and follow-up period were reviewed. RESULTS The mean age of onset was 7 weeks. Twenty-nine (81%) lesions presented as eyelid masses, whereas seven (19%) presented as exophthalmos. Nineteen (53%) tumors were located on the upper eyelid, seven (19%) on the lower eyelid, six (17%) in the medial canthus, and one on both upper and lower eyelids. Ultrasonography depicted a heterogeneous, well-defined, irregular tumor with a low or moderate echogenicity. All lesions presented with abundant color blood flow on CDI. The intralesional blood flow had a mean peak systolic velocity of 37.5 ± 24.5 cm/second, and a mean resistance index of 0.69 ± 0.16, representing a shift in the pulse Doppler toward high velocity and high resistance. After a single intratumoral injection of betamethasone, 18 cases (50%) resolved. Additionally, 15 (42%) and four (11%) cases resolved after two injections and three injections, respectively. Only three (8%) masses persisted after three injections within the follow-up period. CONCLUSION The blood flow characteristics of CDI play a vital role in the differentiation of orbital capillary hemangiomas from other orbital lesions. The availability and lack of adverse effects of CDI enable its utilization in the early clinical diagnosis of pediatric orbital capillary hemangioma.
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Affiliation(s)
- Yifeng Ke
- Tianjin Medical University Eye Hospital, Tianjin, China.
| | - Rui Hao
- Tianjin Eye Hospital, Tianjin Key Laboratory of Ophthalmology and Visual Science, Tianjin Eye Institute, Clinical College of Ophthalmology Tianjin Medical University, Tianjin, China
| | - Yanjin He
- Tianjin Medical University Eye Hospital, Tianjin, China
| | - Eric S Tam
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Canada
| | - Xiaorong Li
- Tianjin Medical University Eye Hospital, Tianjin, China
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Abstract
PURPOSE Solitary fibrous tumor (SFT) occurs rarely in the orbit. We present four such cases, representing one of the largest case series reported to date of this rare orbital tumor. METHOD The four patients ranged from ages 20 to 50, all of whom presented with lid swelling or bulging in the involved eye. All four patients underwent CT scan to confirm the diagnosis of an orbital mass, which was then excised. RESULTS The tumors of all four specimens contained spindle-shaped cells with bland nuclei and rare mitotic figures. They all stained positively with CD34 and vimentin. Resection margins were positive in two of the four cases. One of these cases demonstrated residual tumor on follow-up CT scan, which remained unchanged at one-year follow-up. No evidence of residual tumor was found in the other three cases, despite one having malignant pathology. CONCLUSION SFT is a rare and generally benign tumor of the orbit. Immunohistochemical testing with CD34 is necessary to confirm the diagnosis. Although en bloc tumor resection is the definitive treatment, residual tumor may remain stable for some time. However, this must be followed closely if complete resection is not carried out.
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Affiliation(s)
- Eric S Tam
- St. Michael's Hospital, Department of Ophthalmology, University of Toronto, Toronto, Canada
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Tam ES, Rootman DS. Comparison of central corneal thickness measurements by specular microscopy, ultrasound pachymetry, and ultrasound biomicroscopy. J Cataract Refract Surg 2003; 29:1179-84. [PMID: 12842687 DOI: 10.1016/s0886-3350(02)01921-1] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE To compare the reproducibility and mean values of central corneal thickness (CCT) obtained by specular microscopy, ultrasound pachymetry, and ultrasound biomicroscopy (UBM). SETTING Department of Ophthalmology, University of Toronto, Toronto, Ontario, Canada. METHODS Thirty-one healthy volunteers were recruited for a sample size of 62 eyes. All subjects had pachymetric measurements by specular microscopy, ultrasound pachymetry, and UBM. Three separate measurements meeting criteria for centrality and perpendicularity were recorded for each eye. RESULTS The mean CCT by specular microscopy was 572 microm (95% confidence interval (CI), 566-578 microm), which was significantly greater than 550 microm (95% CI, 545-556 microm) (P<.001) and 555 microm (95% CI, 550-560 microm) (P<.001) by ultrasound pachymetry and UBM, respectively. The mean standard deviation (SD) of repeated measurements by specular microscopy was 7.82 microm, which was significantly greater than the mean SDs of 4.14 microm (P<.001) and 3.90 microm (P<.001) by ultrasound pachymetry and UBM, respectively. There was no statistically significant difference between the mean SDs by ultrasound pachymetry and UBM (P=.156). CONCLUSIONS Although the CCT measurements by specular microscopy were significantly less reproducible than those by ultrasound pachymetry and UBM, the error levels were clinically acceptable. Both ultrasound pachymetry and UBM produced similar CCT measurements, which were significantly less than those generated by specular microscopy. One should be aware of the advantages and limitations of each machine and of possible differences in the CCT measurements by optical and ultrasound pachymetry.
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Affiliation(s)
- Eric S Tam
- Department of Ophthalmology, Toronto Western Hospital, Toronto, Ontario, Canada
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Tam ES, Ferguson DG, Bielefeld DR, Lorenz JN, Cohen RM, Pun RY. Norepinephrine-mediated calcium signaling is altered in vascular smooth muscle of diabetic rat. Cell Calcium 1997; 21:143-50. [PMID: 9132297 DOI: 10.1016/s0143-4160(97)90038-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [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: 02/04/2023]
Abstract
We studied the influence of diabetes on norepinephrine (NE)-induced changes in intracellular free Ca2+ levels (receptor-mediated Ca2+ signaling) in single tail artery vascular smooth muscle (VSM) cells. VSM cells from 12-16 week streptozotocin-induced diabetic (SID) rats showed an increase in sensitivity to NE when compared to control VSM cells in that the concentration of NE needed to elicit half maximal response of the initial Ca2+ transient was reduced more than 4-fold though the maximal response attained was apparently reduced. In addition, the slope factor (steepness) of the dose-response relation was lowered 4-fold. Moreover, VSM cells of diabetic animals had a higher incidence of NE-induced Ca2+ oscillatory responses. The shift of the dose-response curve to the left, coupled with a higher incidence of oscillations, indicate that the noradrenergic receptor-mediated Ca2+ signaling pathways in tail artery VSM of diabetic rat may be altered.
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MESH Headings
- Animals
- Calcium/metabolism
- Calcium-Binding Proteins
- Cells, Cultured
- Diabetes Mellitus, Experimental/metabolism
- Dose-Response Relationship, Drug
- Female
- Fluorescent Dyes
- Fura-2
- Male
- Muscle, Smooth, Vascular/cytology
- Muscle, Smooth, Vascular/drug effects
- Muscle, Smooth, Vascular/metabolism
- Norepinephrine/pharmacology
- Procaine/pharmacology
- Rats
- Rats, Sprague-Dawley
- Ryanodine/pharmacology
- Signal Transduction/drug effects
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Affiliation(s)
- E S Tam
- Department of Molecular and Cellular Physiology, University of Cincinnati, OH 45267-0576, USA
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