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Bizrah M, Shunmugam M, Ching G, Patel RP, Din N, Lin DTC, Holland SP. Transepithelial phototherapeutic keratectomy for treatment-resistant recurrent corneal erosion syndrome. Graefes Arch Clin Exp Ophthalmol 2024:10.1007/s00417-024-06482-1. [PMID: 38619603 DOI: 10.1007/s00417-024-06482-1] [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: 10/04/2023] [Revised: 02/09/2024] [Accepted: 04/02/2024] [Indexed: 04/16/2024] Open
Abstract
BACKGROUND To evaluate the efficacy and safety of trans-epithelial phototherapeutic keratectomy (TE-PTK) as a treatment for recurrent corneal erosion syndrome (RCES) in patients with symptoms refractory to conventional treatments. METHODS All patients who received TE-PTK treatment for RCES had failed 3 or more conventional treatments and were reviewed, and if met criteria, approved by healthcare workers of the British Columbia public health authority (Medical Services Plan (MSP). A retrospective chart review and telephone survey were conducted at the Pacific Laser Eye Centre (PLEC). Exclusion criteria were ocular co-morbidities potentially affecting treatment efficacy. RESULTS This study included 593 eyes of 555 patients (46.2% male; 50.9 ± 14.2 years old) who underwent TE-PTK. The leading identified causes of RCES were trauma (45.7%) and anterior basement membrane dystrophy (44.2%). The most common pre-PTK interventions were ocular lubricants (90.9%), hypertonic solutions (77.9%), and bandage contact lenses (50.9%). Thirty-six eyes had undergone surgical interventions such as stromal puncture, epithelial debridement, or diamond burr polishing. Post-PTK, 78% of patients did not require any subsequent therapies and 20% required ongoing drops. Six patients (1.1%) reported no symptom improvement and required repeat TE-PTK for ongoing RCES symptoms after initial TE-PTK. All 6 eyes were successfully retreated with TE-PTK (average time to retreatment was 11.3 ± 14.9 months). There was no significant difference in best corrected visual acuity pre- vs. post-operatively. The mean post-operative follow-up was 60.5 months (range: 5-127 months). CONCLUSION TE-PTK has a good efficacy and safety profile for treatment-resistant RCES. The third-party public health-reviewed nature of this study, the low recurrence rate of RCES, and the low PTK retreatment rate suggest that TE-PTK might be considered for wider use in the management of RCES.
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Affiliation(s)
- Mukhtar Bizrah
- Imperial College Healthcare NHS Trust, Western Eye Hospital, 153-173 Marylebone Road, London, NW1 5QH, UK.
- The Department of Ophthalmology and Visual Sciences, University of British Columbia, Vancouver, Canada.
| | - Maheshver Shunmugam
- The Department of Ophthalmology and Visual Sciences, University of British Columbia, Vancouver, Canada
| | - Geoffrey Ching
- The Department of Ophthalmology and Visual Sciences, University of British Columbia, Vancouver, Canada
| | - Radhika P Patel
- Imperial College Healthcare NHS Trust, Western Eye Hospital, 153-173 Marylebone Road, London, NW1 5QH, UK.
- Imperial College London, London, UK.
| | - Nizar Din
- Imperial College Healthcare NHS Trust, Western Eye Hospital, 153-173 Marylebone Road, London, NW1 5QH, UK
| | | | - Simon P Holland
- The Department of Ophthalmology and Visual Sciences, University of British Columbia, Vancouver, Canada
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Aiello F, Rampat R, Gallo Afflitto G, Din N, Mandal N, Maurino V. Zonular dialysis and cataract surgery: results from a UK tertiary eye care referral centre. Can J Ophthalmol 2024; 59:67-72. [PMID: 36627103 DOI: 10.1016/j.jcjo.2022.12.001] [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] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Revised: 11/27/2022] [Accepted: 12/08/2022] [Indexed: 01/08/2023]
Abstract
OBJECTIVE Zonular dialysis (ZD), referred to as the presence of a deficient zonular support for the lenticular capsule, might be the result of several causes and be detected only at the time of cataract surgery. The aim of this study was to evaluate pre-, intra-, and postoperative features of eyes with ZD regardless of the etiology detected during cataract surgery. METHODS A single-centre retrospective observational cohort study was performed at Moorfields Eye Hospital (NHS Foundation Trust, London, U.K.) to identify patients who underwent cataract surgery whose procedure was intraoperatively described as being complicated by ZD between January 1, 2014, and August 22, 2019. Patient characteristics, intraoperative clinical findings, visual and refractive outcomes, and postoperative complications were recorded. RESULTS ZD was identified intraoperatively in 447 eyes. In most cases (213 of 223; 96.8%), patients underwent a phacoemulsification procedure, not requiring any conversion to intracapsular or extracapsular extraction technique. Intraoperative complications increased to 46.2% (103 of 223), with no significant correlation with ZD width. Capsular tension rings (CTRs) were implanted in 43.4% of patients (97 of 223). The use of CTRs correlated with better postoperative visual and refractive outcomes. CONCLUSIONS ZD is a serious complication of cataract surgery requiring prompt intraoperative diagnosis and proper management. While it tends to worsen cataract surgery outcomes, the implantation of CTRs during the surgical procedure seems to be associated with better postoperative visual and refractive results.
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Affiliation(s)
- Francesco Aiello
- Ophthalmology Unit, Department of Experimental Medicine, University of Rome "Tor Vergata," Rome, Italy.
| | - Radhika Rampat
- Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
| | - Gabriele Gallo Afflitto
- Ophthalmology Unit, Department of Experimental Medicine, University of Rome "Tor Vergata," Rome, Italy; Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL
| | - Nizar Din
- Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
| | - Niraj Mandal
- Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
| | - Vincenzo Maurino
- Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
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Darian-Smith E, Gouvea L, Gendler S, Alshaker S, Din N, Weill Y, Skouras N, Rabinovitch T, Singal N, Chan CC, Rootman DS. KAMRA presbyopic inlay refractive outcomes: a Canadian perspective. Can J Ophthalmol 2024; 59:7-11. [PMID: 36463966 DOI: 10.1016/j.jcjo.2022.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Revised: 10/24/2022] [Accepted: 11/07/2022] [Indexed: 12/03/2022]
Abstract
OBJECTIVE To retrospectively analyze the visual outcomes of KAMRA (AcuFocus Inc, Irvine, Calif.) inlay insertion in a cohort of patients reporting success of procedure, complications, patient satisfaction, and refractive outcomes. DESIGN Retrospective trial at the TLC Laser Centre, Toronto. METHODS A total of 5 surgeons at the practice inserted 35 KAMRA inlays in 35 patients between October 2012 and June 2014. Some patients had a sole KAMRA inlay insertion, whereas others had combined laser vision correction (LVC) and KAMRA inlay on either the same day or sequentially. There was a small cohort of patients who had previous unrelated LVC. Mean time of follow-up was 299 days. RESULTS After KAMRA inlay insertion there was a significant improvement in uncorrected near visual acuity (p = 0.00009), uncorrected intermediate visual acuity (p = 0.00006), and uncorrected distance visual acuity (p = 0.02), but levels of patient dissatisfaction were 43%. The most common cause for dissatisfaction was requirements for readers (23%), followed by dysphotopsias (11%). The explantation rate was 11.42%, and 28.5% of patients required enhancements after inlay insertion. CONCLUSIONS The KAMRA corneal inlay has significant improvements in uncorrected near visual acuity, uncorrected intermediate visual acuity, and uncorrected distance visual acuity when used in isolation or combined with LVC. Appropriate patient selection is crucial. This procedure should not be used as first-line presbyopia management because of low levels of patient satisfaction, biocompatibility concerns, and explantation rates.
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Affiliation(s)
- Erica Darian-Smith
- Department of Ophthalmology and Visual Sciences, University of Toronto, Toronto, ON; Department of Ophthalmology, University of New South Wales at Prince of Wales Hospital, Sydney, Australia; Department of Ophthalmology, Sydney University Medical School, Sydney, Australia.
| | - Larissa Gouvea
- Department of Ophthalmology and Visual Sciences, University of Toronto, Toronto, ON
| | - Shai Gendler
- Department of Ophthalmology and Visual Sciences, University of Toronto, Toronto, ON
| | - Sara Alshaker
- Department of Ophthalmology and Visual Sciences, University of Toronto, Toronto, ON
| | - Nizar Din
- Department of Ophthalmology and Visual Sciences, University of Toronto, Toronto, ON
| | - Yishay Weill
- Department of Ophthalmology and Visual Sciences, University of Toronto, Toronto, ON
| | - Nick Skouras
- Department of Ophthalmology and Visual Sciences, University of Toronto, Toronto, ON
| | - Theodore Rabinovitch
- Department of Ophthalmology and Visual Sciences, University of Toronto, Toronto, ON
| | - Neera Singal
- Department of Ophthalmology and Visual Sciences, University of Toronto, Toronto, ON
| | - Clara C Chan
- Department of Ophthalmology and Visual Sciences, University of Toronto, Toronto, ON
| | - David S Rootman
- Department of Ophthalmology and Visual Sciences, University of Toronto, Toronto, ON
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Patel RP, Price L, Bizrah M, Din N. Persistent Localized Descemet Membrane Endothelial Keratoplasty Detachments Secondary to Corneal Ink Stain Marks. Cornea 2024; 43:133-135. [PMID: 37699571 DOI: 10.1097/ico.0000000000003388] [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: 06/13/2023] [Accepted: 08/08/2023] [Indexed: 09/14/2023]
Abstract
PURPOSE The aim of this study was to describe 2 cases of persistent endothelial graft detachments secondary to corneal gentian violet ink stain marks. METHODS This study included a case review of hospital records of 2 eyes with localized Descemet's membrane detachments after Descemet membrane endothelial keratoplasty (DMEK) surgery. RESULTS Two patients underwent consecutive uncomplicated DMEK surgery for Fuchs endothelial dystrophy with identical techniques. The grafts were marked with an ink marker through a stromal window to ensure correct orientation during donor graft preparation. Both patients had localized detachments around the ink mark on day 1, week 1, and up to 1 month at postoperative review. The persistent detachment was believed to be due to the gentian violet marker used which had a higher concentration of isopropyl alcohol solvent than the standard marking pen routinely used. CONCLUSIONS Ink markers with higher concentrations of isopropyl solvent may result in higher DMEK detachment rates and caution is advised when using these markers.
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Affiliation(s)
- Radhika Pooja Patel
- Imperial College Healthcare NHS Trust, Western Eye Hospital, London, United Kingdom
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Gouvea L, Din N, AlShaker S, Gendler S, Weill Y, Chan CC, Rootman DS. Clinical Outcomes of Transscleral-Sutured Intraocular Lens Combined With Descemet Membrane Endothelial Keratoplasty. Cornea 2023; 42:1497-1502. [PMID: 36729033 DOI: 10.1097/ico.0000000000003215] [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: 08/15/2022] [Accepted: 11/05/2022] [Indexed: 02/03/2023]
Abstract
PURPOSE The aim of the study was to report clinical outcomes of Descemet membrane endothelial keratoplasty (DMEK) combined with transscleral-sutured intraocular lens (IOL) compared with DMEK combined with phacoemulsification and posterior chamber IOL (Phaco-DMEK). METHODS A retrospective chart review of all patients who underwent DMEK combined with transscleral-sutured intraocular lens fixation or combined with phacoemulsification for Fuchs endothelial corneal dystrophy from 2016 to 2021 at the Toronto Western Hospital or the Kensington Eye Institute (Toronto, ON, Canada) and had at least 18 months of follow-up was performed. Main outcomes were postoperative distance-corrected visual acuity, rebubbling rate, graft survival rate, and complications. RESULTS Twenty-one cases of DMEK combined with transscleral-sutured IOL (DMEK-TSS-IOL) and 44 cases of Phaco-DMEK were evaluated. Twelve eyes (57.15%) had a foldable acrylic 3-piece IOL (AR40E) and 9 (42.85%) had a single-piece polymethylmethacrylate (PMMA) IOL (CZ70BD). LogMAR distance-corrected visual acuity improved significantly from 1.48 ± 0.62 (SD) to 0.86 ± 0.82 ( P = 0.01) 12 months after DMEK-TSS-IOL and from 0.41 ± 0.29 logMAR to 0.11 ± 0.11 logMAR ( P < 0.0001) after Phaco-DMEK. No statistically significant differences were observed in donor ( P = 0.97) or 1-year postoperative endothelial cell density ( P = 0.11) between the groups. Rebubbling was necessary in 33.33% of eyes in DMEK-TSS-IOL compared with 25% of Phaco-DMEK eyes ( P = 0.55). Graft survival rate was 76.19% in the DMEK-TSS-IOL group compared with 90.90% in the Phaco-DMEK group ( P = 0.13). CONCLUSIONS Transscleral-sutured IOL combined with DMEK is an option for the management of endothelial diseases in aphakic eyes or those which require IOL exchange for the experienced surgeon. However, when compared with routine Phaco-DMEK, there are higher complication and lower survival rates at 18 months.
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Affiliation(s)
- Larissa Gouvea
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON, Canada
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Phylactou M, Din N, Aiello F, Angunawela R. Corneal Collagen Cross-Linking for Late Onset Progressive Keratoconus in Iridocorneal Endothelial Syndrome. Cornea 2023; 42:1293-1296. [PMID: 37170404 DOI: 10.1097/ico.0000000000003258] [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: 12/16/2022] [Accepted: 01/17/2023] [Indexed: 05/13/2023]
Abstract
PURPOSE The aim of this study was to report the first case of successful use of corneal collagen cross-linking (CXL) to halt the progression of keratoconus in a patient with concurrent iridocorneal endothelial (ICE) syndrome. METHODS A 30-year-old White man was referred to our subspecialty corneal clinic for further investigation of right corectopia. The patient was asymptomatic and was otherwise fit. Slit-lamp examination revealed a right oval-shaped pupil decentered superiorly, a transillumination defect at the 5-o'clock position, minimal gutta-like changes in the corneal endothelium, and few inferior peripheral anterior synechiae. Dilated fundoscopy was normal in both eyes, with healthy optic discs, maculae, and peripheral retinae. Specular microscopy and slit-lamp findings suggested ICE syndrome. Subsequent investigation with corneal tomography showed progressive signs of inferior corneal ectasia with steepening, and thinning in the right eye, consistent with keratoconus. The left eye was unremarkable. RESULTS Epithelium-off accelerated corneal CXL was performed in the affected eye. Early post-CXL follow-up (1 week) was unremarkable, and further follow-ups were arranged at 3, 6, 12, and 24 months, respectively. In subsequent reviews, the patient's vision and corneal tomography findings were stable. CONCLUSIONS We describe the first case of corneal CXL for progressive keratoconus with ICE syndrome. co-existing keratoconus and ICE syndrome can occur, and corneal cross-linking was used successfully in this case to halt keratoconus progression. However, further studies will need to establish the impact of epithelium-off corneal cross-linking, especially in more severely affected eyes.
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Affiliation(s)
- Maria Phylactou
- Department of Cornea and External Diseases, Moorfields Eye Hospital, London, United Kingdom; and
| | - Nizar Din
- Department of Cornea and External Diseases, Moorfields Eye Hospital, London, United Kingdom; and
| | - Francesco Aiello
- Department of Cornea and External Diseases, Moorfields Eye Hospital, London, United Kingdom; and
- Ophthalmology Unit, Department of Experimental Medicine, University of Rome "Tor Vergata," Rome, Italy
| | - Romesh Angunawela
- Department of Cornea and External Diseases, Moorfields Eye Hospital, London, United Kingdom; and
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Balal S, Din N, Ashton C, Ahmad S. Healing of Chemical Injury-Related Persistent Corneal Epithelial Defects With Topical Insulin. Cornea 2023; 42:1000-1004. [PMID: 36729695 DOI: 10.1097/ico.0000000000003145] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [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: 04/13/2022] [Accepted: 08/01/2022] [Indexed: 02/03/2023]
Abstract
PURPOSE The purpose of this study was to evaluate the effectiveness of insulin eye drops for treating refractory persistent epithelial defects (PEDs). METHODS A prospective, single-center, case series was performed from March 2020 to September 2021. All patients were prescribed insulin eye drops for refractory PEDs that failed on maximum standard medical treatment (including serum eye drops). The drops were used 4 times/day. Patients were followed up at 2 weekly intervals with full slitlamp examination and serial anterior segment photography. The primary end point was resolution of the epithelial defect. RESULTS Eleven eyes of 10 patients were treated with insulin eye drops. The mean age of the cohort was 45.4 + 25 years with a mean follow-up of 195.7 + 114.3 days after re-epithelization. The most common causative condition was chemical injury (n = 5, 60%). Mean baseline PED defect was 41.3 + 55.2 mm 2 . Nine of 11 eyes (82%) fully re-epithelized within a mean time of 62.3 + 34.6 days (range 14-112). In 2 patients who did not achieve re-epithelization, one had a reduction in size from 12.25 mm 2 to 4.5 mm 2 and the other had no response. No recurrence in defect was observed in the group that had fully re-epithelized. CONCLUSIONS This study showed that the use of topical insulin eye drops led to a successful resolution of PED in 9 of 11 cases. We demonstrate the use of insulin for closure of PEDs in chemical eye injury. Larger controlled studies are required to further evaluate this novel therapy.
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Affiliation(s)
- Shafi Balal
- Moorfields Eye Hospital, London, United Kingdom; and
- UCL Institute of Ophthalmology, London, United Kingdom
| | - Nizar Din
- Moorfields Eye Hospital, London, United Kingdom; and
| | | | - Sajjad Ahmad
- Moorfields Eye Hospital, London, United Kingdom; and
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Gouvea L, Mimouni M, Alshaker S, Din N, Deangelis DD, Tucker N, Gill H, Slomovic AR, Rootman DS, Chan CC. Clinical features and management of keratoconjunctivitis associated with inadequate tear drainage. Can J Ophthalmol 2023:S0008-4182(23)00108-4. [PMID: 37088101 DOI: 10.1016/j.jcjo.2023.03.020] [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] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 03/12/2023] [Accepted: 03/30/2023] [Indexed: 04/25/2023]
Abstract
PURPOSE To describe clinical features and management of toxic keratoconjunctivitis associated with punctal and (or) canaliculus stenosis (toxic soup syndrome). DESIGN Retrospective observational case series. METHODS Electronic medical record database search for the keywords "toxic soup syndrome" and retrospective chart review were performed. Thirty-five eyes of 25 patients were seen at a tertiary cornea clinic between January 2017 and December 2021. Sex, age, distance-corrected visual acuity, topical medications, symptoms, clinical signs, and outcomes after medical and surgical interventions were analyzed. The main outcome measured was improvement in ocular surface signs and symptoms after interventions. RESULTS Overall, 35 eyes of 25 patients with a mean age of 66.8 ± 12.8 years, of which 72% were female, were included. The primary complaint was hyperemia and epiphora in all patients. Rosacea or meibomian gland disease were present in all patients, 7 (28%) had glaucoma, and 7 (28%) developed limbal stem cell deficiency. Twenty-two patients (88%) were using topical medications on presentation. All eyes had either punctal plugs, cauterized puncta, or punctal and (or) canaliculus stenosis. Management of all patients consisted of suspension of all preserved topical medications and institution of some type of anti-inflammatory therapy. Nineteen patients (76%) improved after improvement of lacrimal drainage. One patient with severe resistance in the canaliculus required ongoing preservative-free topical steroids. CONCLUSIONS Chronic drug-induced or pooled inflammatory mediators causing toxic conjunctivitis may be aggravated by punctal and (or) canaliculus stenosis, leading to toxic soup syndrome. Clearance of punctal obstruction leads to improvement in most patients.
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Affiliation(s)
- Larissa Gouvea
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ont
| | - Michael Mimouni
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ont
| | - Sara Alshaker
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ont
| | - Nizar Din
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ont
| | - Dan D Deangelis
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ont
| | - Nancy Tucker
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ont
| | - Harmeet Gill
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ont
| | - Allan R Slomovic
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ont
| | - David S Rootman
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ont
| | - Clara C Chan
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ont..
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Sorkin N, Gouvea L, Din N, Mimouni M, Alshaker S, Weill Y, Gendler S, Slomovic AR, Chan CC, Rootman DS. Five-Year Safety and Efficacy of Femtosecond Laser-Assisted Descemet Membrane Endothelial Keratoplasty. Cornea 2023; 42:145-149. [PMID: 35349554 DOI: 10.1097/ico.0000000000003019] [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: 10/19/2021] [Accepted: 01/31/2022] [Indexed: 01/03/2023]
Abstract
PURPOSE The purpose of this study was to evaluate 5-year safety and efficacy outcomes of femtosecond-enabled Descemet membrane endothelial keratoplasty (F-DMEK) in patients with Fuchs' endothelial dystrophy (FED). METHODS This was a retrospective study, including patients with FED and cataract who underwent either F-DMEK (16 eyes of 15 patients) or manual DMEK (M-DMEK) (42 eyes of 37 patients) combined with cataract extraction. Outcome measures included visual acuity, graft detachment, graft survival, and endothelial cell loss. RESULTS The average follow-up in F-DMEK and M-DMEK was 57.1 ± 12.4 months and 58.5 ± 17.3 months, respectively ( P = 0.757). The rates of primary failure (0% vs. 9.5%, P = 0.567), secondary failure (0% for both), and graft rejection (0% vs. 7.1%, P = 0.533) did not differ significantly between the groups. Improvement in best spectacle-corrected visual acuity was similar in F-DMEK and M-DMEK (0.32 ± 0.27 logarithm of the minimum angle of resolution and 0.35 ± 0.44 logarithm of the minimum angle of resolution, respectively, P = 0.165) and persisted at 2, 3, 4, and 5 years and at the last follow-up. The rates of graft detachment and rebubbling were significantly lower with 6.25% in F-DMEK and 33.3% in M-DMEK ( P = 0.035). Cell-loss rates were lower in F-DMEK compared with M-DMEK throughout the follow-up, significantly so up to 2 years with a difference of 8.6% at 1 year ( P = 0.023), 11.8% at 2 years ( P = 0.021), 7.6% at 3 years ( P = 0.088), 5.8% at 4 years ( P = 0.256), 13.6% at 5 years ( P = 0.169), and 7.1% at the final follow-up ( P = 0.341). CONCLUSIONS F-DMEK had an excellent safety and efficacy profile which was maintained over 5 years of follow-up. Lower endothelial cell-loss rates in F-DMEK compared with M-DMEK may help extend the duration of graft survival.
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Affiliation(s)
- Nir Sorkin
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Canada; and
- Department of Ophthalmology, Tel Aviv Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Larissa Gouvea
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Canada; and
| | - Nizar Din
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Canada; and
| | - Michael Mimouni
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Canada; and
| | - Sara Alshaker
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Canada; and
| | - Yishay Weill
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Canada; and
| | - Shai Gendler
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Canada; and
| | - Allan R Slomovic
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Canada; and
| | - Clara C Chan
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Canada; and
| | - David S Rootman
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Canada; and
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Trinh T, Solomon B, Mimouni M, Cohen E, Gouvea L, Santaella G, Sorkin N, Al Shaker S, Din N, Rootman DS. Reply : Outcomes of femtosecond laser-assisted cataract and refractive lens surgery in patients with prior radial keratotomy. J Cataract Refract Surg 2022; 48:1224. [PMID: 35971226 DOI: 10.1097/j.jcrs.0000000000001041] [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] [Indexed: 11/26/2022]
Affiliation(s)
- Tanya Trinh
- From the Department of Ophthalmology and Vision Sciences, The University of Toronto, Toronto, Ontario, Canada (Trinh, Mimouni, Cohen, Gouvea, Santaella, Sorkin, Al Shaker, Din, Rootman); Department of Ophthalmology, Tel Aviv Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (Sorkin); Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada (Solomon); TLC Laser Eye Centre, Toronto, Ontario, Canada (Rootman)
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11
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Din N, Cohen E, Popovic M, Mimouni M, Trinh T, Gouvea L, Alshaker S, Ong Tone S, Chan CC, Slomovic AR. Surgical Management of Fuchs Endothelial Corneal Dystrophy: A Treatment Algorithm and Individual Patient Meta-Analysis of Descemet Stripping Only. Cornea 2022; 41:1188-1195. [PMID: 35942547 DOI: 10.1097/ico.0000000000002975] [Citation(s) in RCA: 6] [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: 08/20/2021] [Accepted: 11/23/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE This study aims to determine predictive factors for success of Descemet stripping only (DSO) in Fuchs corneal endothelial dystrophy and propose a DSO treatment algorithm. METHODS Ovid MEDLINE, Embase, and Cochrane CENTRAL databases were searched to evaluate DSO case series, including combined phacoemulsification and DSO, and the use of Rho-kinase inhibitors (ROC-i). Our primary outcome was success of corneal clearance. Secondary outcomes included the time to corneal clearance, the postoperative endothelial cell count (ECC), and the impact of ROC-i. RESULTS Sixty-eight cases were evaluated with a mean follow-up of 12.4 months. DSO corneal clearance was achieved in 85% (n = 58) with a mean time of 4.9 weeks for the ROC-i group compared with 10.1 weeks in the observation group (P < 0.0001). The mean central ECC postoperatively was higher in the ROC-i group compared with the observation group 1151 ± 245 versus 765 ± 169 cells/mm2, respectively (P < 0.018). The postoperative best-corrected visual acuity (BCVA) improved in 61 eyes (90%), with mean final BCVA of 0.17 (0.26) logMAR (P = 0.001), which was statistically significant compared with preoperative BCVA. Factors influencing success were 4-mm descemetorhexis size, a clear peripheral ECC with no clinical sequelae of decompensation or guttae, and a low central corneal thickness. No intraoperative complications were noted. The commonest postoperative complication was deep corneal stromal scars noted at the descemetorhexis edge (n = 9). CONCLUSIONS DSO has a role in the treatment of a subset of patients with Fuchs corneal endothelial dystrophy and that adjuvant treatment with ROC-i may lead to faster corneal clearance.
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Affiliation(s)
- Nizar Din
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Canada
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Mimouni M, Liu ES, Din N, Gouvea L, AlShaker S, Cohen E, Kim DB, Chan CC. Response to "Comment On Tape Splint Tarsorrhaphy for Persistent Corneal Epithelial Defects". Am J Ophthalmol 2022; 242:253. [PMID: 35750215 DOI: 10.1016/j.ajo.2022.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Accepted: 06/13/2022] [Indexed: 11/16/2022]
Affiliation(s)
- Michael Mimouni
- University of Toronto, Department of Ophthalmology and Vision Sciences, Toronto, Canada; Department of Ophthalmology, Rambam Health Care Campus affiliated with the Bruce and Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Eugene S Liu
- University of Toronto, Department of Ophthalmology and Vision Sciences, Toronto, Canada
| | - Nizar Din
- University of Toronto, Department of Ophthalmology and Vision Sciences, Toronto, Canada
| | - Larissa Gouvea
- University of Toronto, Department of Ophthalmology and Vision Sciences, Toronto, Canada
| | - Sara AlShaker
- University of Toronto, Department of Ophthalmology and Vision Sciences, Toronto, Canada
| | - Eyal Cohen
- University of Toronto, Department of Ophthalmology and Vision Sciences, Toronto, Canada
| | - Dooho B Kim
- Professional Eye Associates, Dalton, Georgia, USA
| | - Clara C Chan
- University of Toronto, Department of Ophthalmology and Vision Sciences, Toronto, Canada.
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Din N, Chan CC, Cohen E, Iovieno A, Dahan A, Rootman DS, Litvin G. Remote Surgeon Virtual Presence: A Novel Telementoring Method for Live Surgical Training. Cornea 2022; 41:385-389. [PMID: 34759203 PMCID: PMC8820774 DOI: 10.1097/ico.0000000000002921] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 09/14/2021] [Accepted: 09/18/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE We describe the first known use of telementoring in corneal surgery and technology combining a 3-dimensional microscope system, 5G live streaming technology, group chat software, and a virtual reality headset for intercontinental surgical supervision. METHODS Three surgeons in Toronto were proctored by a surgeon in Israel in the implantation of a novel keratoprosthesis device (CorNeat KPro; Ra'anana, Israel) into cadaver eyes. In Toronto, the NGENUITY platform (Alcon) transmitted high-definition, 3-dimensional images to the proctor in Israel who viewed the live video through a GOOVIS Virtual Reality headset with subsecond latency. This was made possible by the LiveU technology (Hackensack, NJ), which is a portable device to increase the bandwidth of transmission. The primary outcome was the successful completion of CorNeat KPro implantation. After each procedure, all surgeons completed a Likert scale questionnaire that assessed opinions on telementoring. RESULTS All participants implanted the CorNeat KPro device. There was significant satisfaction reported. A total cumulative score from the questionnaire was 149 of 150 from the operating surgeons, with a score of 135 of 150 by the proctor. All felt that there was excellent AV quality with no lag time and recommended the technology. CONCLUSIONS Telementoring is a promising tool that can traverse large distances for ophthalmic education.
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Affiliation(s)
- Nizar Din
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Canada;
| | - Clara C. Chan
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Canada;
| | - Eyal Cohen
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Canada;
| | - Alfonso Iovieno
- Department of Ophthalmology and Visual Sciences, University of British Columbia, Vancouver, Canada; and
| | | | - David S. Rootman
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Canada;
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Roberts HW, Kit V, Phylactou M, Din N, Wilkins MR. 'Posture-Less' DMEK: Is Posturing After Descemet Membrane Endothelial Keratoplasty Actually Necessary? Am J Ophthalmol 2022; 240:23-29. [PMID: 35227697 DOI: 10.1016/j.ajo.2022.02.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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: 11/29/2021] [Revised: 02/07/2022] [Accepted: 02/16/2022] [Indexed: 11/17/2022]
Abstract
PURPOSE To evaluate the clinical results of Descemet membrane endothelial keratoplasty (DMEK) without any intraoperative or postoperative posturing. DESIGN Retrospective, noncomparative, and interventional case series. METHODS One hundred thirty-four (134) consecutive eyes of 101 patients requiring DMEK for any cause of endothelial failure were included. Descemet membrane endothelial keratoplasty was performed with an intraoperative inferior PI. After unscrolling and centration of the graft, the anterior chamber was near completely filled with 20% SF6. After filling the eye with gas there was no intraoperative tamponade time, and patients did not posture postoperatively. Main outcome measures were: graft detachment rate, rebubbling rate, primary and secondary failure rates, rejection rate, intraoperative and postoperative complications, and visual acuity 3 and 12 months after surgery. RESULTS Five of 134 (3.7%) developed graft detachment greater than one-third of the graft area, and 19 of 134 (14.2%) developed graft detachment less than one-third of the graft area. A rebubble procedure was performed in 19 of 134 (14.2%); of those, the average number of rebubbling procedures performed was 1.13 (range, 1-2). Primary failure occurred in 6 of 134 (4.5%).Twelve-month graft survival occurred in 122 of 134 eyes (91.0%), with secondary failure within the first 12 months accounting for failure of 6 of 134 (4.5%). Nine of 134 (6.7%) cases had a recorded episode of endothelial rejection. The average time for rejection episode was 9.5 months (range, 1-20 months) after surgery. CONCLUSIONS A total of 134 'posture-less' DMEKs did not suffer very high rates of graft detachment, rebubbling, or other postoperative complications, even with immediate erect posturing after surgery.
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Affiliation(s)
- Harry W Roberts
- From Corneal and External Diseases Unit, Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom (H.W.R, V.K, M.P, N.D, M.R.W).
| | - Vivienne Kit
- From Corneal and External Diseases Unit, Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom (H.W.R, V.K, M.P, N.D, M.R.W); UCL Institute of Ophthalmology, London, United Kingdom (V.K, M.R.W)
| | - Maria Phylactou
- From Corneal and External Diseases Unit, Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom (H.W.R, V.K, M.P, N.D, M.R.W)
| | - Nizar Din
- From Corneal and External Diseases Unit, Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom (H.W.R, V.K, M.P, N.D, M.R.W)
| | - Mark R Wilkins
- From Corneal and External Diseases Unit, Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom (H.W.R, V.K, M.P, N.D, M.R.W); UCL Institute of Ophthalmology, London, United Kingdom (V.K, M.R.W)
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Din N, Mimouni M, Slomovic J, Aldrees S, Trinh T, Cohen E, Gouvea L, Alshaker S, Chan CC, Chew HF, Singal N, Rootman DS, Slomovic AR. Comparative evaluation of four Descemet membrane endothelial keratoplasty graft preparation techniques. Canadian Journal of Ophthalmology 2022; 58:191-197. [PMID: 35151620 DOI: 10.1016/j.jcjo.2022.01.017] [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] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Revised: 11/03/2021] [Accepted: 01/13/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To compare subjective and objective outcomes of 4 different Descemet membrane endothelial keratoplasty (DMEK) peeling techniques performed by novice surgeons at different stages in their surgical career. DESIGN An ex vivo prospective study. METHODS In the first round, 2 DMEK peeling techniques were pitched against each other: the peripheral scoring and Sinskey dissection technique with the peripheral scoring and microhoe dissection and the peripheral blunt microhoe dissection against the scleral spurectomy and microhoe dissection. Three surgeons with different operative experience performed the peeling. Outcome measures included graft peeling time, surgeon's peeling difficulty grading (on a scale of 1-10, 1 being the easiest and 10 the hardest), number of radial and circumferential tears before and after trephination, and tissue loss. The 2 techniques that performed the best from the first round proceeded to the final round to identify the best overall technique. RESULTS In total, 90 tissues (45 pairs) were peeled by 3 surgeons. Following the first-round results, the peripheral scoring and Sinskey dissection and peripheral blunt microhoe dissection proceeded to the final round. There were no significant differences between the groups in terms of peeling times, subjective feeling of difficulty, post-trephination tears, and peeling success rates (P > 0.05 for all). However, the peripheral scoring and Sinskey dissection technique had significantly fewer pretrephination radial tears (1.3 ± 1.3 vs 6.1 ± 5.2, P = 0.007) and circumferential tears (0.6 ± 0.9 vs 1.8 ± 2.1, P = 0.02). CONCLUSIONS This study demonstrates that the learning curve can be overcome quickly with appropriate DMEK peeling techniques. The peripheral scoring and Sinskey dissection peeling technique allows efficient peeling with fewer related tears.
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Affiliation(s)
- Nizar Din
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON..
| | - Michael Mimouni
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON
| | - Jacqueline Slomovic
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON
| | - Sultan Aldrees
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON
| | - Tanya Trinh
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON
| | - Eyal Cohen
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON
| | - Larissa Gouvea
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON
| | - Sara Alshaker
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON
| | - Clara C Chan
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON
| | - Hall F Chew
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON
| | - Neera Singal
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON
| | - David S Rootman
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON
| | - Allan R Slomovic
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON
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Jabbour S, Din N, Logeswaran A, Taberno Sanchez S, Ahmad S. Clinical Characteristics of Patients With Chronic Stevens-Johnson Syndrome Treated at a Major Tertiary Eye Hospital Within the United Kingdom. Front Med (Lausanne) 2021; 8:644795. [PMID: 34109192 PMCID: PMC8180599 DOI: 10.3389/fmed.2021.644795] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 05/03/2021] [Indexed: 11/13/2022] Open
Abstract
The purpose of this study is to provide a comprehensive review of the clinical characteristics in chronic Stevens-Johnson syndrome (SJS) patients within the United Kingdom population, their causative factors, treatment profile and prognosis. This retrospective series included 91 patients with chronic SJS treated at Moorfields Eye Hospital (London, United Kingdom). A chart review included visual acuity and presence of clinical findings (including lid abnormalities and ocular surface findings). All medical and surgical treatments were also recorded. Approximately a half of patients were White British but there were significant numbers of patients from other ethnic groups, South Asian and Black in particular. Oral antibiotics were the causative agent in almost a half of the patients with SJS, systemic infections in 14%, non-steroidal anti-inflammatory drugs in 8% and anticonvulsants in 7%. The age of onset was varied but a significant proportion of patients developed acute SJS in childhood. There was a significant correlation between visual acuity at initial referral to final recorded vision. Vision was found to continue to significantly deteriorate over time despite therapeutic interventions. Our regression model shows that ~62% of the variance in final vision can be explained by the initial vision and duration disease. The majority of our patients were on advanced ocular surface treatments including serum drops, topical ciclosporin and retinoic acid drops. Of particular significance, approximately a third of our patient cohort was also on systemic immune suppression. In conclusion, chronic SJS within the UK population under tertiary care remains an area of unmet clinical need. Current medical and surgical modalities prevent worsening of vision in severe ocular disease from SJS.
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Affiliation(s)
| | - Nizar Din
- Moorfields Eye Hospital, London, United Kingdom
| | | | | | - Sajjad Ahmad
- Moorfields Eye Hospital, London, United Kingdom.,Department of Cornea & External Diseases, Institute of Ophthalmology, University College London, London, United Kingdom
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Din N, Phylactou M, Fajardo-Sanchez J, Watson M, Ahmad S. The Impact of COVID-19 on Acute and Elective Corneal Surgery at Moorfields Eye Hospital London. Clin Ophthalmol 2021; 15:1639-1645. [PMID: 33986586 PMCID: PMC8110251 DOI: 10.2147/opth.s302576] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 04/07/2021] [Indexed: 01/27/2023] Open
Abstract
Purpose Moorfields Eye Hospital sits as a major tertiary centre for ophthalmic care in the United Kingdom and became a central hub to provide safe and effective ophthalmic care across London and surrounding regions during the COVID-19 pandemic. We explore the impact on both the acute and elective corneal services during the first wave of this pandemic. Methods A retrospective review of the proportion of corneal transplants and anterior segment trauma repairs was performed during the period of March 23rd to July 1st 2020 compared with an identical period in 2019. Data were acquired from our in-house electronic patient records. Results A 92% reduction in corneal elective work was observed during the lockdown period compared with an identical period in 2019, with only 10 elective cases in total being performed. In addition, 91 corneal cross-linking and 76 therapeutic lasers were cancelled. There were 15 cases of primary repair for anterior segment trauma compared with 6 cases pre-COVID-19. A similar scenario occurs with removal of foreign body (4 cases during COVID-19 period versus no cases during pre-COVID-19 era) and with traumatic lens aspirations (6 cases during COVID-19 compared with 2 pre-COVID-19). Interestingly, a statistical difference (p=0.03) was found in the time interval from presentation of symptoms to emergency corneal surgery. During the COVID-19 period, a delay of 1.5 days ± 2.29 (range 0–10 days) occurred compared with 0.8 days ± 1.54 (range 0–6 days) pre-COVID-19. Conclusion Stringent risk stratification reduced elective corneal surgery capacity during the lockdown thereby preserving social distancing requirements. However, an apparent increase in emergency corneal surgery seen is likely attributed to centralisation of ophthalmic services during the pandemic crisis, alongside increased domestic injuries. Despite the challenges posed, successful delivery of corneal surgery occurred whilst helping to identify lessons in preparations for future pandemics and current inefficiencies in healthcare delivery.
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Affiliation(s)
- Nizar Din
- Cornea and External Eye Disease Service, Moorfields Eye Hospital, London, UK
| | - Maria Phylactou
- Cornea and External Eye Disease Service, Moorfields Eye Hospital, London, UK
| | | | - Martin Watson
- Cornea and External Eye Disease Service, Moorfields Eye Hospital, London, UK
| | - Sajjad Ahmad
- Cornea and External Eye Disease Service, Moorfields Eye Hospital, London, UK.,Institute of Ophthalmology, University College London, London, UK
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Phylactou M, Matarazzo F, Din N, Maurino V. Descemet membrane endothelial keratoplasty in vitrectomized eyes: a case series of outcomes and complications. Int Ophthalmol 2021; 41:2425-2432. [PMID: 33751304 DOI: 10.1007/s10792-021-01797-y] [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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 03/06/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND The aim of this study was to evaluate the clinical outcomes of Descemet membrane endothelial keratoplasty (DMEK) in vitrectomized eyes. METHODS A multi-surgeon, retrospective case series of previously vitrectomized eyes that underwent DMEK between 2013 and 2018 at Moorfields Eye Hospital. Patients' demographics, preoperative, intraoperative and postoperative data were collected. RESULTS In total, 14 eyes of 13 patients, aged 63 ± 14.6 years were included. Three eyes had intraoperative posterior dislocation of the DMEK graft into the vitreous cavity, two of these were aphakic and one had an unstable PCIOL. Postoperatively, one graft had a total detachment and required repeat keratoplasty for primary failure, two grafts had visually significant partial detachment and needed rebubbling. Three patients developed high intraocular pressure (IOP) and one required an urgent glaucoma drainage device 1-month post-DMEK. The mean corrected distance visual acuity was 0.81 ± 0.42 logMAR preoperatively, and postoperatively was 0.6 ± 0.51 at 3 months (p = 0.414); 0.69 ± 0.81 at 6 months (p = 0.684); and 0.7 ± 0.8 at 12 months (p = 0.658). CONCLUSIONS DMEK in vitrectomized eyes has unique challenges that necessitate careful preoperative planning. We observed a significant proportion of dislocated grafts in vitrectomized eyes with either unstable IOL or aphakic. Moreover, vitrectomized eyes with secondary glaucoma may be particularly vulnerable to uncontrolled IOP postoperatively and close monitoring is essential to prevent worsening of visual acuity. We recommend that DMEK may not be a feasible option in eyes that are prone to collapse, in particular aphakic vitrectomized eyes, as opposed to DSAEK or penetrating keratoplasty.
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Affiliation(s)
- Maria Phylactou
- Cornea and External Diseases, Moorfields Eye Hospital, 162 City Road, London, EC1V 2PD, UK.
| | - Francesco Matarazzo
- Cornea and External Diseases, Moorfields Eye Hospital, 162 City Road, London, EC1V 2PD, UK
| | - Nizar Din
- Cornea and External Diseases, Moorfields Eye Hospital, 162 City Road, London, EC1V 2PD, UK
| | - Vincenzo Maurino
- Cornea and External Diseases, Moorfields Eye Hospital, 162 City Road, London, EC1V 2PD, UK
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Din N, Chew HF. Blossoming vision: unusual donor tissue configuration in a jaundiced cornea tissue. Can J Ophthalmol 2020; 56:147. [PMID: 33039323 DOI: 10.1016/j.jcjo.2020.09.009] [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: 08/06/2020] [Accepted: 09/09/2020] [Indexed: 11/19/2022]
Affiliation(s)
- Nizar Din
- Division of Ophthalmology and Visual Sciences, University of Toronto Toronto Western Hospital 399 Bathurst St, Toronto, ON M5T 2S8
| | - Hall F Chew
- Division of Ophthalmology and Visual Sciences, University of Toronto Toronto Western Hospital 399 Bathurst St, Toronto, ON M5T 2S8
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Din N, Shahid SM, Wagner SK, Bourkiza R. Insidious transpalpebral fistula secondary to scleral buckle. Can J Ophthalmol 2020; 55:467-468. [PMID: 32409001 DOI: 10.1016/j.jcjo.2020.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Accepted: 03/01/2020] [Indexed: 11/16/2022]
Affiliation(s)
- Nizar Din
- Moorfields Eye Hospital, London, England.
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21
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Din N, Vasquez-Perez A, Ezra DG, Tuft SJ. Serious corneal complications and undiagnosed floppy eyelid syndrome; A case series and a 10-year retrospective review. J Curr Ophthalmol 2019; 31:225-228. [PMID: 31317105 PMCID: PMC6611970 DOI: 10.1016/j.joco.2019.03.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 11/26/2018] [Revised: 01/24/2019] [Accepted: 03/10/2019] [Indexed: 11/28/2022] Open
Abstract
Purpose To describe three individuals with severe keratitis and a substantial delay before floppy associated eyelid syndrome (FES) was identified, and to estimate the prevalence of severe corneal disease in individuals with FES. Methods We defined severe keratitis as corneal ulceration, vascularization or scar that affected vision. We recorded the clinical characteristics, the duration of symptoms before the diagnosis of FES, subsequent management and outcome. Then, to determine the proportion of individuals with FES who had severe corneal disease, we interrogated the Moorfields Eye Hospital electronic patient record (EPR) for the diagnosis of FES made in the ten-year interval from 2008. Results Three individuals presented with severe progressive keratitis (median duration of symptoms 19 months, range 2-48 months). All were male and with a high body mass index (BMI, range 38.9-41.2). In each the etiology of the keratitis was unclear before FES was identified. All had very lax lids and were aware they had periods of lid malposition during sleep. None mentioned symptoms of obstructive sleep apnoea (OSA) until they or their partner were directly questioned. The management of keratitis included both medical and surgical corneal treatments, with tarsorrhaphy and lid shortening surgery. We identified an additional 104 cases of FES from the EPR, of which 4 (3.8%) had severe keratitis. Conclusions FES can be missed unless signs of lid laxity are directly elicited. A delay in diagnosis can result in clinical deterioration, with unnecessary investigations and treatments. An assessment for FES should be included as part of the evaluation of individuals with severe or chronic keratitis.
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Rajput R, Sachdev A, Din N, Damato EM, Murray A. False positive acetylcholine receptor antibodies in a case of unilateral chronic progressive external ophthalmoplegia: case report and review of literature. Orbit 2018; 37:385-388. [PMID: 29333908 DOI: 10.1080/01676830.2017.1423350] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
METHODS We present a rare case with atypical presenting features of unilateral CPEO with a false positive Acetylcholine Receptor Antibody (AchRA) test resulting in diagnostic delay. We illustrate the unilateral nature of this case and demonstrate the caveats of performing myogenic ptosis correction in such patients. We also discuss the differential diagnosis of false positive AchRA, a test commonly performed in the investigation of ptosis. RESULTS A 34-year old female presented with a more than 3-year history of slowly-progressive, unilateral, right-sided restriction in eye movements and ptosis. Clinical examination showed EOM were grossly restricted in the right eye with a ptosis and normal in the left eye. Serum AchRA was positive on serum enzyme-linked immunosorbent assay (ELISA) however, following two months of oral pyridostigmine therapy there were no signs of clinical improvement. The initial serum sample sent was retested for AchRA by radio-immunoassay (RIA) which came back negative. Subsequently a muscle biopsy was requested which showed the presence of ragged red fibres. CONCLUSION Unilateral ptosis and ophthalmoplegia is an unusual presentation for CPEO which characteristically produces bilateral symmetrical motility defects. In addition to Myasthenia Gravis elevated AchRA levels have been reported in other autoimmune conditions such as Primary biliary cirrhosis, Eaton Lambert syndrome and Graves's ophthalmopathy. We also highlight the superiority of RIA versus ELISA in the detection of AchRA and illustrate the diagnostic challenge of investigating and managing myogenic ptosis in this complex cohort of patients.
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Affiliation(s)
- Rehan Rajput
- a Birmingham Midland Eye Centre , Sandwell and West Birmingham Hospitals NHS Trust , Birmingham , UK
| | - Amun Sachdev
- a Birmingham Midland Eye Centre , Sandwell and West Birmingham Hospitals NHS Trust , Birmingham , UK
| | - Nizar Din
- b Ophthalmology Department, Whipps Cross University Hospital , London , UK
| | - Erika Marie Damato
- a Birmingham Midland Eye Centre , Sandwell and West Birmingham Hospitals NHS Trust , Birmingham , UK
| | - Aidan Murray
- a Birmingham Midland Eye Centre , Sandwell and West Birmingham Hospitals NHS Trust , Birmingham , UK
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Charles J, Roberts J, Din N, Williams N, Yeo S, Edwards R. Preferences of older patients regarding hip fracture rehabilitation service configuration: A feasibility discrete choice experiment. J Rehabil Med 2018; 50:636-642. [DOI: 10.2340/16501977-2350] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Alzahrani K, Din N, Brahma A, Carley F, Hillarby M. Corneal clarity measurements in patients with myopia undergoing laser assisted in situ keratomileusis and laser assisted sub-epithelial keratectomy. Acta Ophthalmol 2017. [DOI: 10.1111/j.1755-3768.2017.0s034] [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: 11/29/2022]
Affiliation(s)
- K. Alzahrani
- Division of Pharmacy and Optometry- School of Health Sciences; University of Manchester; Manchester UK
| | - N. Din
- Division of Pharmacy and Optometry- School of Health Sciences; University of Manchester; Manchester UK
| | - A. Brahma
- Manchester Royal Eye Hospital, Cornea; Manchester UK
| | - F. Carley
- Manchester Royal Eye Hospital, Cornea; Manchester UK
| | - M.C. Hillarby
- Division of Pharmacy and Optometry- School of Health Sciences; University of Manchester; Manchester UK
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Ashiru-Oredope D, Budd EL, Bhattacharya A, Din N, McNulty CAM, Micallef C, Ladenheim D, Beech E, Murdan S, Hopkins S. Implementation of antimicrobial stewardship interventions recommended by national toolkits in primary and secondary healthcare sectors in England: TARGET and Start Smart Then Focus. J Antimicrob Chemother 2016; 71:1408-14. [PMID: 26869693 DOI: 10.1093/jac/dkv492] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Accepted: 12/22/2015] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES To assess and compare the implementation of antimicrobial stewardship (AMS) interventions recommended within the national AMS toolkits, TARGET and Start Smart Then Focus, in English primary and secondary healthcare settings in 2014, to determine the prevalence of cross-sector engagement to drive AMS interventions and to propose next steps to improve implementation of AMS. METHODS Electronic surveys were circulated to all 211 clinical commissioning groups (CCGs; primary sector) and to 146 (out of the 159) acute trusts (secondary sector) in England. Response rates were 39% and 63% for the primary and secondary sectors, respectively. RESULTS The majority of CCGs and acute trusts reported reviewing national AMS toolkits formally or informally (60% and 87%, respectively). However, only 13% of CCGs and 46% of acute trusts had developed an action plan for the implementation of these toolkits. Only 5% of CCGs had antimicrobial pharmacists in post; however, the role of specialist antimicrobial pharmacists continued to remain embedded within acute trusts, with 83% of responding trusts having an antimicrobial pharmacist at a senior grade. CONCLUSIONS The majority of healthcare organizations review national AMS toolkits; however, implementation of the toolkits, through the development of action plans to deliver AMS interventions, requires improvement. For the first time, we report the extent of cross-sector and multidisciplinary collaboration to deliver AMS interventions in both primary and secondary care sectors in England. Results highlight that further qualitative and quantitative work is required to explore mutual benefits and promote best practice. Antimicrobial pharmacists remain leaders for implementing AMS interventions across both primary and secondary healthcare sectors.
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Affiliation(s)
- D Ashiru-Oredope
- Antimicrobial Resistance Programme, Public Health England, London, UK
| | - E L Budd
- Antimicrobial Resistance Programme, Public Health England, London, UK
| | - A Bhattacharya
- Antimicrobial Resistance Programme, Public Health England, London, UK
| | - N Din
- Department of Pharmaceutics, UCL School of Pharmacy, UCL, London, UK
| | - C A M McNulty
- Primary Care Unit, Public Health England, Gloucester Royal Hospital, Gloucester, UK
| | - C Micallef
- Pharmacy Department, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK National Institute for Health Research Health Protection Research Unit, Healthcare Associated Infection and Antimicrobial Resistance, Imperial College London, Hammersmith Campus, London, UK
| | - D Ladenheim
- Pharmacy Department, East & North Herts NHS Trust, Hertford, UK
| | - E Beech
- NHS Bath and North East Somerset Clinical Commissioning Group, Bath, UK NHS England Patient Safety Domain 5, London, UK
| | - S Murdan
- Department of Pharmaceutics, UCL School of Pharmacy, UCL, London, UK
| | - S Hopkins
- Antimicrobial Resistance Programme, Public Health England, London, UK
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Tah V, Orlans HO, Hyer J, Casswell E, Din N, Sri Shanmuganathan V, Ramskold L, Pasu S. Anti-VEGF Therapy and the Retina: An Update. J Ophthalmol 2015; 2015:627674. [PMID: 26417453 PMCID: PMC4568374 DOI: 10.1155/2015/627674] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Revised: 06/28/2015] [Accepted: 07/05/2015] [Indexed: 01/31/2023] Open
Abstract
Ocular angiogenesis and macular oedema are major causes of sight loss across the world. Aberrant neovascularisation, which may arise secondary to numerous disease processes, can result in reduced vision as a result of oedema, haemorrhage, and scarring. The development of antivascular endothelial growth factor (anti-VEGF) agents has revolutionised the treatment of retinal vasogenic conditions. These drugs are now commonly employed for the treatment of a plethora of ocular pathologies including choroidal neovascularisation, diabetic macular oedema, and retinal vein occlusion to name a few. In this paper, we will explore the current use of anti-VEGF in a variety of retinal diseases and the impact that these medications have had on visual outcome for patients.
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Affiliation(s)
- Vikas Tah
- The Royal Berkshire NHS Foundation Trust, Craven Road, Reading RG1 5AN, UK
| | - Harry O. Orlans
- Moorfields Eye Hospital NHS Foundation Trust, 162 City Road, London EC1V 2PD, UK
| | - Jonathan Hyer
- Moorfields Eye Hospital NHS Foundation Trust, 162 City Road, London EC1V 2PD, UK
| | - Edward Casswell
- Moorfields Eye Hospital NHS Foundation Trust, 162 City Road, London EC1V 2PD, UK
| | - Nizar Din
- Moorfields Eye Hospital NHS Foundation Trust, 162 City Road, London EC1V 2PD, UK
| | | | - Louise Ramskold
- Moorfields Eye Hospital NHS Foundation Trust, 162 City Road, London EC1V 2PD, UK
| | - Saruban Pasu
- Moorfields Eye Hospital NHS Foundation Trust, 162 City Road, London EC1V 2PD, UK
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A S, Rahim S, Bhatti KH, Khan A, Din N, Imran M, Mohsin M, Ishtiaq M, Nabila A, Ansari A, Hussain S, Zafar M, Mushtaq M, Mumtaz E, Iqbal J. Ethnobotanical study and conservation status of trees in the district Sargodha, Punjab, Pakistan. ACTA ACUST UNITED AC 2015. [DOI: 10.32604/phyton.2015.84.034] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Abstract
BACKGROUND Intermittent exotropia (IXT) is one of the most common strabismus entities worldwide, but it remains poorly understood. Investigators differ regarding which parameters should be used to characterize IXT and to evaluate interventions. Surgery is an established treatment option but problems can arise when comparing surgical effectiveness if there is a wide range of different outcome measures that can be used. This study aimed to assess the extent of standardization of reported outcomes in studies of surgery for IXT. METHODS With institutional R&D committee approval, we conducted, according to a predefined protocol, a systematic literature review of outcomes of surgery for IXT published in the last 10 years. The databases used were Medline and EMBASE. Two analysts independently performed the searches. The separate lists were then compared and collated to maximize our return rate for included papers and allow evaluation of our strategies. RESULTS Fifty-six studies met our inclusion criteria. Thirty-two were retrospective and twenty-four prospective. Outcome measures varied widely between studies and variously included ocular alignment, stereopsis, visual acuity, re-operation rate, and postoperative drift. Even for ocular alignment, there was no agreed definition of postoperative success. Time frames for assessing outcomes ranged from two months to two years after surgery. CONCLUSIONS The lack of harmony in outcome reporting for studies of surgery for IXT is counterproductive. We suggest 4 core outcomes for all future studies, which have already been incorporated into two current randomized trials: alignment, near stereoacuity, control score, and quality of life score.
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Din N, Ghaderi S, O'Connell R, Johnson T. Strengthening surgical handover: Developing and evaluating the effectiveness of a handover tool to improve patient safety. BMJ Qual Improv Rep 2012; 1:bmjquality_u492_w164. [PMID: 26734154 PMCID: PMC4652679 DOI: 10.1136/bmjquality.u492.w164] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The European Working Time Directive and economic challenges have led to a paradigm of shift-work becoming common, and yet the continuation of high-quality patient care remains paramount. Effective and safe transfer of clinical information is critical as emphasised by the Royal College of Surgeons document ‘Safe handover: Guidance from the Working Time Directive working party (March 2007)’. The aim of this project was to design and implement a handover proforma in order to deliver a more efficient and safer system for patient care over the weekend. The surgical weekend handover proforma was designed following consultation with nursing and medical colleagues. It included a traffic light scoring system to alert the on-call team of the urgency of clinical review. An educational session was delivered to junior doctors on the surgical rotation to ensure accurate completion of the proforma. All trainee surgical doctors from Foundation Year 1 to Specialist Registrars were asked to complete a pre- and post-intervention questionnaire. Improvement was noted in all categories measured. 85% of the firms were using the new surgical weekend handover sheet. 78% of junior doctors were confident in understanding the patient's condition and executing the clinical jobs faster, with ward rounds lasting less than 3 hours. On average, 20% of patients were discharged per weekend during the trial period. Robust patient handover is vital to maintain patient safety and avoid adverse events. Our findings support the use of a surgical proforma to provide a consistent and structured approach to inpatient handover during the weekend.
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Affiliation(s)
- Nizar Din
- Ashford and St Peter's NHS Foundation Trust
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31
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Affiliation(s)
- Nizar Din
- Ashford and St Peter's Hospitals Foundation Trust
| | - NN Patel
- Barts and the London School of Medicine and Dentistry
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O'Connell R, Din N, Shrotria S. 563 Oncological Safety of the Peri-areolar Incision for Wire Guided Excisions of Breast Lesions. Eur J Cancer 2012. [DOI: 10.1016/s0959-8049(12)70628-7] [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: 10/28/2022]
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Lewis R, Williams N, Matar HE, Din N, Fitzsimmons D, Phillips C, Jones M, Sutton A, Burton K, Nafees S, Hendry M, Rickard I, Chakraverty R, Wilkinson C. The clinical effectiveness and cost-effectiveness of management strategies for sciatica: systematic review and economic model. Health Technol Assess 2012; 15:1-578. [PMID: 22078311 DOI: 10.3310/hta15390] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- R Lewis
- Department of Primary Care and Public Health, Cardiff University, School of Medicine, North Wales Clinical School, Wrexham, UK
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Mansour S, Ratnasingham K, Din N, Vasilikostas G, Reddy M, Wan A. The impact of the laparoscopic skills course in surgical training. Int J Surg 2011. [DOI: 10.1016/j.ijsu.2011.07.135] [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: 10/17/2022]
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Song Y, Luboz V, Din N, King D, Gould D, Bello F, Bulpitt A. Segmentation of 3D vasculatures for interventional radiology simulation. Stud Health Technol Inform 2011; 163:599-605. [PMID: 21335864] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Training in interventional radiology is slowly shifting towards simulation which allows the repetition of many interventions without putting the patient at risk. Accurate segmentation of anatomical structures is a prerequisite of realistic surgical simulation. Therefore, our aim is to develop a generic approach to provide fast and precise segmentation of various virtual anatomies covering a wide range of pathology, directly from patient CT/MRA images. This paper presents a segmentation framework including two segmentation methods: region model based level set segmentation and hierarchical segmentation. We compare them to an open source application ITK-SNAP which provides similar approaches. The subjective human influence such as inconsistent inter-observer errors and aliasing artifacts etc. are analysed. The proposed segmentation techniques have been successfully applied to create a database of various anatomies with different pathologies, which is used in computer-based simulation for interventional radiology training.
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Affiliation(s)
- Yi Song
- School of Computing, University of Leeds, UK.
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Dibong SD, Engone Obiang NL, Din N, Priso RJ, Taffouo V, Fankem H, Salle G, Akoa A. Les Loranthaceae : un atout pour l’essor de la pharmacopée traditionnelle au Cameroun. ACTA ACUST UNITED AC 2009. [DOI: 10.4314/ijbcs.v3i4.47185] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Johansen T, Richelsen B, Hansen HS, Din N, Malmlöf K. Growth hormone-mediated breakdown of body fat: effects of GH on lipases in adipose tissue and skeletal muscle of old rats fed different diets. Horm Metab Res 2003; 35:243-50. [PMID: 12778368 DOI: 10.1055/s-2003-39481] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [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] [Indexed: 10/27/2022]
Abstract
Lipid storage and breakdown is mainly controlled by lipoprotein lipase and hormone-sensitive lipase. The aim of this work was to elucidate whether growth hormone mediated loss of adipose tissue involves a concerted action on tissue lipases, and to what degree such events are modulated by dietary regimen. Twelve-month-old rats fed first a high-fat diet or a low-fat diet for 14 weeks were injected with saline or growth hormone (4 mg/kg/d) for four days or three weeks in different combinations with either high- or low-fat diets. In adipose tissue, growth hormone generally inhibited lipoprotein lipase and also attenuated the inhibiting effect of insulin on hormone-sensitive lipase activity. Growth hormone treatment combined with restricted high-fat feeding reduced the activity of both lipases in adipose tissue and stimulated hormone-sensitive lipase in muscle. Generally, plasma levels of free fatty acids, glycerol and cholesterol were reduced by growth hormone, and in combination with restricted high-fat feeding, triglyceride levels improved too. We conclude that growth hormone inhibits lipid storage in adipose tissue by reducing both lipoprotein lipase activity and insulin's inhibitory action on hormone-sensitive lipase. We also propose that growth hormone's effects on tissue lipases and blood lipids are modulated by dietary regimen.
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Affiliation(s)
- T Johansen
- Dept. of Pharmacology 3, Novo Nordisk, Malov, Denmark.
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39
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Din N, Qureshi NS. Causation--or the great western cowboy "random chance" at work? Fertil Steril 2001; 76:635-6. [PMID: 11570366 DOI: 10.1016/s0015-0282(01)01948-3] [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: 10/18/2022]
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40
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Abstract
Swarmer cells of Caulobacter crescentus are devoid of the cell division initiation protein FtsZ and do not replicate DNA. FtsZ is synthesized during the differentiation of swarmer cells into replicating stalked cells. We show that FtsZ first localizes at the incipient stalked pole in differentiating swarmer cells. FtsZ subsequently localizes at the mid-cell early in the cell cycle. In an effort to understand whether Z-ring formation and cell constriction are driven solely by the cell cycle-regulated increase in FtsZ concentration, FtsZ was artificially expressed in swarmer cells at a level equivalent to that found in predivisional cells. Immunofluorescence microscopy showed that, in these swarmer cells, simply increasing FtsZ concentration was not sufficient for Z-ring formation; Z-ring formation took place only in stalked cells. Expression of FtsZ in swarmer cells did not alter the timing of cell constriction initiation during the cell cycle but, instead, caused additional constrictions and a delay in cell separation. These additional constrictions were confined to sites close to the original mid-cell constriction. These results suggest that the timing and placement of Z-rings is tightly coupled to an early cell cycle event and that cell constriction is not solely dependent on a threshold level of FtsZ.
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Affiliation(s)
- E M Quardokus
- Department of Biology, Jordan Hall 142, Indiana University, 1001 E. 3rd St., Bloomington, IN 47405-3700, USA
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Cadenas S, Buckingham JA, Samec S, Seydoux J, Din N, Dulloo AG, Brand MD. UCP2 and UCP3 rise in starved rat skeletal muscle but mitochondrial proton conductance is unchanged. FEBS Lett 1999; 462:257-60. [PMID: 10622707 DOI: 10.1016/s0014-5793(99)01540-9] [Citation(s) in RCA: 183] [Impact Index Per Article: 7.3] [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: 11/24/2022]
Abstract
The relationship between UCP2 and UCP3 expression and mitochondrial proton conductance of rat skeletal muscle was examined. Rats were starved for 24 h and the levels of UCP2 and UCP3 mRNA and UCP3 protein were determined by Northern and Western blots. Proton conductance was measured by titrating mitochondrial respiration rate and membrane potential with malonate. Starvation increased UCP2 and UCP3 mRNA levels more than 5-fold and 4-fold, respectively, and UCP3 protein levels by 2-fold. However, proton conductance remained unchanged. These results suggest either that Northern and Western blots do not reflect the levels of active protein or that these UCPs do not catalyse the basal proton conductance in skeletal muscle mitochondria.
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Affiliation(s)
- S Cadenas
- Department of Biochemistry, University of Cambridge, UK
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42
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Abstract
Over-expression of the yeast PEP4 gene encoding the vacuolar aspartic protease proteinase A (PrA) leads to saturation of the vacuolar targeting system of the cell and missorting of PrA to the growth medium. In a screen for genes affecting the secretion of over-expressed PrA we found that multiple copies of the open reading frame (ORF) YAL048c enhanced PrA secretion. Since no function has hitherto been ascribed to YAL048c, we undertook further studies of this ORF. Deletion of YAL048c resulted in slightly reduced secretion of over-produced PrA. Furthermore, strains deleted for YAL048c showed a growth inhibition phenotype resulting in wrinkled colony morphology when grown on rich medium containing high concentrations of calcium. YAL048c is predicted to encode a polypeptide of 662 amino acid residues containing two consensus ATP/GTP-binding site motifs and a putative carboxy-terminal transmembrane region. In addition, the amino acid sequence contains two putative calcium-binding domains. The YAL048c protein may be evolutionarily conserved, as homologues exist in humans and Caenorhabditis elegans. We suggest that the YAL048c protein is involved in vesicle transport in the secretory pathway.
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Affiliation(s)
- A M Wolff
- Department of Molecular Genetics, Novo Nordisk A/S, Bagsvaerd, Denmark
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43
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Kelly AJ, Sackett MJ, Din N, Quardokus E, Brun YV. Cell cycle-dependent transcriptional and proteolytic regulation of FtsZ in Caulobacter. Genes Dev 1998; 12:880-93. [PMID: 9512521 PMCID: PMC316630 DOI: 10.1101/gad.12.6.880] [Citation(s) in RCA: 183] [Impact Index Per Article: 7.0] [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: 12/22/1997] [Accepted: 01/23/1998] [Indexed: 02/06/2023]
Abstract
In the differentiating bacterium Caulobacter crescentus, the cell division initiation protein FtsZ is present in only one of the two cell types. Stalked cells initiate a new round of DNA replication immediately after cell division and contain FtsZ, whereas the progeny swarmer cells are unable to initiate DNA replication and do not contain FtsZ. We show that FtsZ expression is controlled by cell cycle-dependent transcription and proteolysis. Transcription of ftsZ is repressed in swarmer cells and is activated concurrently with the initiation of DNA replication. At the end of the DNA replication period, transcription of ftsZ decreases substantially. We show that the global cell cycle regulator CtrA is involved in the cell cycle control of ftsZ transcription. CtrA binds to a site that overlaps the ftsZ transcription start site. Removal of the CtrA-binding site results in transcription of the ftsZ promoter in swarmer cells. Decreasing the cellular concentration of CtrA increases ftsZ transcription and conversely, increasing the concentration of CtrA decreases ftsZ transcription. Because CtrA is present in swarmer cells, is degraded at the same time as ftsZ transcription begins, and reappears when ftsZ transcription decreases at the end of the cell cycle, we propose that CtrA is a repressor of ftsZ transcription. We show that proteolysis is an important determinant of cell type-specific distribution and cell cycle variation of FtsZ. FtsZ is stable when it is synthesized and assembles into the cytokinetic ring at the beginning of the cell cycle. After the initiation of cell division, the rate of FtsZ degradation increases as both the constriction site and the FtsZ ring decrease in diameter. When ftsZ is expressed constitutively from inducible promoters, the abundance of FtsZ still varies during the cell cycle. The coupling of transcription and proteolysis to cell division ensures that FtsZ is inherited only by the progeny cell that will begin DNA replication immediately after cell division.
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Affiliation(s)
- A J Kelly
- Department of Biology, Indiana University, Bloomington, Indiana 47405, USA
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44
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Din N, Quardokus EM, Sackett MJ, Brun YV. Dominant C-terminal deletions of FtsZ that affect its ability to localize in Caulobacter and its interaction with FtsA. Mol Microbiol 1998; 27:1051-63. [PMID: 9535094 DOI: 10.1046/j.1365-2958.1998.00752.x] [Citation(s) in RCA: 105] [Impact Index Per Article: 4.0] [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: 02/07/2023]
Abstract
The cell division protein FtsZ is composed of three regions based on sequence similarity: a highly conserved N-terminal region of approximately 320 amino acids; a variable spacer region; and a conserved C-terminal region of eight amino acids. We show that FtsZ mutants missing different C-terminal fragments have dominant lethal effects because they block cell division in Caulobacter crescentus by two different mechanisms. Removal of the C-terminal conserved region, the linker, and 40 amino acids from the end of the N-terminal conserved region (FtsZdeltaC281) prevents the localization or the polymerization of FtsZ. Because two-hybrid analysis indicates that FtsZdeltaC281 does not interact with FtsZ, we hypothesize that FtsZdeltaC281 blocks cell division by competing with a factor required for FtsZ localization or that it titrates a factor required for the stability of the FtsZ ring. The removal of 24 amino acids from the C-terminus of FtsZ (FtsZdeltaC485) causes a punctate pattern of FtsZ localization and affects its interaction with FtsA. This suggests that the conserved C-terminal region of FtsZ is required for proper polymerization of FtsZ in Caulobacter and for its interaction with FtsA.
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Affiliation(s)
- N Din
- Department of Biology, Indiana University, Bloomington 47405, USA
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45
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Rourke IJ, Johnsen AH, Din N, Petersen JG, Rehfeld JF. Heterologous expression of human cholecystokinin in Saccharomyces cerevisiae. Evidence for a lysine-specific endopeptidase in the yeast secretory pathway. J Biol Chem 1997; 272:9720-7. [PMID: 9092503 DOI: 10.1074/jbc.272.15.9720] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.8] [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] Open
Abstract
Precursors of the human regulatory peptide cholecystokinin (CCK) have been expressed in Saccharomyces cerevisiae, and the post-translational processing of secreted CCK-related products analyzed. Recombinant plasmids expressing native human prepro-CCK and a hybrid molecule encompassing the prepro leader of the yeast alpha-mating pheromone fused to pro-CCK were examined. The latter construct resulted in considerably higher levels of pro-CCK secretion and was therefore analyzed in more detail. Two of the protein modifications essential for CCK bioactivity, C-terminal alpha-amidation and tyrosyl sulfation, were not detected in S. cerevisiae. Proteolytic cleavage of pro-CCK occurred C-terminally of three basic sites; (i) Arg105-Arg106 which, upon exposure to carboxypeptidase activity, leads to the production of glycine-extended CCK; (ii) Arg95 to produce CCK-8 related processing intermediates; and (iii) Lys81 resulting in CCK-22 related products. To elucidate which protease(s) are involved in these endoproteolytic cleavage events, pro-CCK was expressed in yeast mutants lacking various combinations of the Mkc7, Yap3, and Kex2 proteases. Only in S. cerevisiae strains deficient in Kex2 function was any of the above mentioned pro-CCK cleavages abolished, namely processing at the Arg105-Arg106 and Arg95 sites. This suggests that mammalian Kex2-like serine proteases may process pro-CCK at single arginine residues. Our data suggests that an as yet uncharacterized endopeptidase(s) in the S. cerevisiae secretory pathway is responsible for the lysine-specific cleavage of pro-CCK.
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Affiliation(s)
- I J Rourke
- Department of Clinical Biochemistry, Rigshospitalet, University of Copenhagen, Copenhagen O, Denmark.
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Abstract
An investigation is reported of factors affecting the supercritical fluid extraction of sulphamethazine and five of its metabolites from spiked meat (swine liver and kidney). The addition of the polar modifier methanol to the carbon dioxide extracting fluid was found to generally enhance recoveries under subcritical and supercritical conditions. Recoveries of the ionic metabolites were increased by up to 72% when employing tetramethylammonium hydroxide for ion pairing in situ with the supercritical fluid extraction. Extraction efficiency is demonstrated to be dependent on the matrix. Extractions of the less polar compounds from the kidney are more successful than from the liver, which corresponds to their partitioning into the supercritical fluid and/or the greater fraction of highly extractable fatty materials. The kidney was more retentive than liver for the relatively more polar compounds, which suggests that the liver offers a less polar environment under the same extraction conditions.
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Affiliation(s)
- N Din
- School of Chemistry, University of Leeds, United Kingdom
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Abstract
The vacuolar aspartyl protease proteinase A (PrA) of Saccharomyces cerevisiae is encoded as a preproenzyme by the PEP4 gene and transported to the vacuole via the secretory route. Upon arrival of the proenzyme proPrA to the vacuole, active mature 42 kDa PrA is generated by specific proteolysis involving the vacuolar endoprotease proteinase B (PrB). Vacuolar activation of proPrA can also take place in mutants lacking PrB activity (prb1). Here an active 43 kDa species termed pseudoPrA is formed, probably by an autocatalytic process. When the PEP4 gene is overexpressed in wild-type cells, mature PrA can be found in the growth medium. We have found that prb1 strains overexpressing PEP4 can form pseudoPrA extracellularly. N-terminal amino acid sequence determination of extracellular, as well as vacuolar pseudoPrA showed that it contains nine amino acids of the propeptide, indicating a cleavage between Phe67 and Ser68 of the preproenzyme. This cleavage site is in accordance with the known substrate preference for PrA, supporting the notion that pseudoPrA is formed by autoactivation. When a multicopy PEP4 transformant of a prb1 mutant was grown in the presence of the aspartyl protease inhibitor pepstatin A, a significant level of proPrA was found in the growth medium. Our analyses show that overexpression of PEP4 leads to the secretion of proPrA to the growth medium where the zymogen is converted to pseudoPrA or mature PrA in a manner similar to the vacuolar processing reactions. Amino acid sequencing of secreted proPrA confirmed the predicted cleavage by signal peptidase between Ala22 and Lys23 of the preproenzyme.
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Affiliation(s)
- A M Wolff
- Novo Nordisk A/S, Novo Allé, Bagsvaerd, Denmark
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Quardokus E, Din N, Brun YV. Cell cycle regulation and cell type-specific localization of the FtsZ division initiation protein in Caulobacter. Proc Natl Acad Sci U S A 1996; 93:6314-9. [PMID: 8692812 PMCID: PMC39019 DOI: 10.1073/pnas.93.13.6314] [Citation(s) in RCA: 96] [Impact Index Per Article: 3.4] [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: 02/01/2023] Open
Abstract
Many genes involved in cell division and DNA replication and their protein products have been identified in bacteria; however, little is known about the cell cycle regulation of the intracellular concentration of these proteins. It has been shown that the level of the tubulin-like GTPase FtsZ is critical for the initiation of cell division in bacteria. We show that the concentration of FtsZ varies dramatically during the cell cycle of Caulobacter crescentus. Caulobacter produce two different cell types at each cell division: (i) a sessile stalked cell that can initiate DNA replication immediately after cell division and (ii) a motile swarmer cell in which DNA replication is blocked. After cell division, only the stalked cell contains FtsZ. FtsZ is synthesized slightly before the swarmer cells differentiate into stalked cells and the intracellular concentration of FtsZ is maximal at the beginning of cell division. Late in the cell cycle, after the completion of chromosome replication, the level of FtsZ decreases dramatically. This decrease is probably mostly due to the degradation of FtsZ in the swarmer compartment of the predivisional cell. Thus, the variation of FtsZ concentration parallels the pattern of DNA synthesis. Constitutive expression of FtsZ leads to defects in stalk biosynthesis suggesting a role for FtsZ in this developmental process in addition to its role in cell division.
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Affiliation(s)
- E Quardokus
- Department of Biology, Indiana University, Bloomington 47405-6801, USA
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Affiliation(s)
- A A Jensen
- Department of Molecular Pharmacology, Novo Nordisk, Drug Discovery, Bagsvaerd, Denmark
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50
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Abstract
To assess the importance of the cysteine residues Cys347 and Cys351 in the carboxylic tail in the human D1 dopamine receptor, seven mutant receptors were constructed by PCR. The pharmacological and functional properties of the wild-type and mutant receptors were assessed following transient expression in COS-7 cells. Affinities for [3H]SCH 23390 of mutant S347 (Cys347-->Gly), T348 (Tyr348-->stop), S351 (Cys351-->Gly), T351 (Cys351-->stop), T352 (Pro352-->stop), and S347/S351 (Cys347-->Gly and Cys351-->Gly) were similar to that of wild-type receptor, whereas the expression levels were reduced up to 80%. The potency of dopaminergic antagonists for these mutant receptors was very similar to that of the wild-type receptor. However, mutant T347 (Cys347-->stop) showed a 15-25-fold reduced affinity for the antagonists SCH 23390, (+)-butaclamol, and cis-flupentixol, thus not allowing radioligand analysis. Wild-type and mutant receptors responded dose-dependently with similar potency to dopamine and SKF 38393 with an increased adenylyl cyclase activity. However, mutant receptors with the Cys347 residue changed or removed displayed a diminished ability to activate adenylyl cyclase. Dopamine preexposure desensitized wild-type and mutant S351 receptors. However, mutant receptors with Cys347 replaced or the distal part of the carboxyl tail removed were unable to desensitize. Thus, Cys347 in the cytoplasmic tail of the human D1 dopamine receptor is important for the receptor in maintaining the conformation for antagonist binding, to play a crucial role in activation of adenylyl cyclase, and to be essential for agonist-induced desensitization.
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Affiliation(s)
- A A Jensen
- Department of Molecular Pharmacology, Novo Nordisk, Bagsvaerd, Denmark
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