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Sun MT, Cotton RM, Charoenkijkajorn C, Garcia-Sanchez J, Dalal R, Xia X, Lin JH, Singh K, Goldberg JL, Liu WW. Evaluation of Verteporfin as a Novel Antifibrotic Agent in a Rabbit Model of Glaucoma Filtration Surgery: A Pilot Study. Ophthalmol Sci 2024; 4:100448. [PMID: 38261964 PMCID: PMC10797546 DOI: 10.1016/j.xops.2023.100448] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Revised: 11/20/2023] [Accepted: 12/04/2023] [Indexed: 01/25/2024]
Abstract
Purpose Verteporfin is a benzoporphyrin derivative which is Food and Drug Administration-approved for treatment of choroidal neovascularization in conjunction with photodynamic therapy. It has been shown to prevent fibrosis and scar formation in several organs and represents a promising novel antifibrotic agent for glaucoma surgery. The goal of this study is to determine the effect of verteporfin on wound healing after glaucoma filtration surgery. Design Preclinical study using a rabbit model of glaucoma filtration surgery. Subjects Eight New Zealand white rabbits underwent glaucoma filtration surgery in both eyes. Methods Eyes were randomized into 4 study groups to receive a postoperative subconjunctival injection of 1 mg/mL verteporfin (n = 4), 0.4 mg/mL mitomycin C (MMC; n = 4), 0.4 mg/mL MMC + 1 mg/mL verteporfin (n = 4), or balanced salt solution (BSS) control (n = 4). Bleb survival, vascularity, and morphology were graded using a standard scale over a 30-day period, and intraocular pressure (IOP) was monitored. At 30 days postoperative or surgical failure, histology was performed to evaluate for inflammation, local toxicity, and scarring. Main Outcome Measures The primary outcome measure was bleb survival. Secondary outcome measures were IOP, bleb morphology, and bleb histology. Results Compared to BSS control blebs, verteporfin-treated blebs demonstrated a trend toward increased surgical survival (mean 9.8 vs. 7.3 days, log rank P = 0.08). Mitomycin C-treated blebs survived significantly longer than verteporfin-treated blebs (log rank P = 0.009), with all but 1 MMC-treated bleb still surviving at postoperative day 30. There were no significant differences in survival between blebs treated with combination verteporfin + MMC and MMC alone. Mitomycin C-treated blebs were less vascular than verteporfin-treated blebs (mean vascularity score 0.3 ± 0.5 for MMC vs. 1.0 ± 0.0 for verteporfin, P < 0.01). Bleb histology did not reveal any significant toxicity in verteporfin-treated eyes. There were no significant differences in inflammation or scarring across groups. Conclusions Although verteporfin remained inferior to MMC with regard to surgical survival, there was a trend toward increased survival compared with BSS control and it had an excellent safety profile. Further studies with variations in verteporfin dosage and/or application frequency are needed to assess whether this may be a useful adjunct to glaucoma surgery. Financial Disclosures Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- Michelle T. Sun
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University School of Medicine, Palo Alto, California
| | - Renee M. Cotton
- Department of Comparative Medicine, Stanford University, Palo Alto, California
| | - Chaow Charoenkijkajorn
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University School of Medicine, Palo Alto, California
| | - Julian Garcia-Sanchez
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University School of Medicine, Palo Alto, California
| | - Roopa Dalal
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University School of Medicine, Palo Alto, California
| | - Xin Xia
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University School of Medicine, Palo Alto, California
| | - Jonathan H. Lin
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University School of Medicine, Palo Alto, California
| | - Kuldev Singh
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University School of Medicine, Palo Alto, California
| | - Jeffrey L. Goldberg
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University School of Medicine, Palo Alto, California
| | - Wendy W. Liu
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University School of Medicine, Palo Alto, California
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Gupta A, Huang S, Sun MT, Zamora-Alejo K. Intrastromal Corneal Ring Segment Implantation Followed by Simultaneous Topography-Guided Photorefractive Keratectomy and Corneal Cross-Linking for Contact Lens-Intolerant Keratoconus. Cornea 2024; 43:307-314. [PMID: 37543736 DOI: 10.1097/ico.0000000000003354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 05/29/2023] [Indexed: 08/07/2023]
Abstract
PURPOSE This study aimed to evaluate the efficacy and safety of Keraring implantation followed by simultaneous topography-guided photorefractive keratectomy (TGPRK) and corneal cross-linking (CXL) in the management of keratoconus. METHODS This is a single-center, private practice, retrospective review. Patients with keratoconus who were intolerant to contact lens wear underwent implantation of the Keraring, followed by TGPRK with CXL from 2 to 36 months after implantation. Main outcome measures were uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), refraction (cylinder and spherical equivalent), keratometry (steep, maximum, and central), and central corneal thickness (CCT). Patients were followed up for 3 to 60 months postoperatively. RESULTS Fifty-seven eyes from 45 patients were included. The mean time between Keraring and TGPRK/CXL was 6.0 ± 6.0 months. Patients were followed up for a mean of 28.6 ± 20.1 months after Keraring insertion. At 12-month follow-up, there was a statistically significant improvement in mean UDVA (0.94 ± 0.49-0.35 ± 0.23, P < 0.01), CDVA (0.39 ± 0.26-0.17 ± 0.15, P < 0.01), cylinder (-4.97 ± 2.68 to -1.74 ± 1.25, P < 0.01), steep keratometry (51.25 ± 3.37-45.03 ± 2.27, P < 0.01), central keratometry (52.59 ± 4.98-46.99 ± 3.53, P < 0.01), and maximum keratometry (58.78 ± 4.22-50.76 ± 3.42, P < 0.01). These results were sustained at 48-month follow-up. CCT decreased at 12 months after TGPRK (461.84 ± 27.46-418.94 ± 45.62, P < 0.01) and remained stable at 60 months. Postoperatively, 2 eyes (3.51%) had corneal haze, resulting in decrease in CDVA; 1 was treated successfully with repeat PRK; and 1 patient (1.75%) had wound melt due to partial Keraring extrusion, which settled with repositioning. CONCLUSIONS Keraring implantation followed by simultaneous TGPRK and CXL appears to be effective in the long term in improving UDVA, CDVA, cylinder, CCT, and keratometry in patients with keratoconus who are intolerant to contact lenses.
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Affiliation(s)
- Aanchal Gupta
- South Australian Institute of Ophthalmology, University of Adelaide and Department of Ophthalmology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
- IVISION Laser Eye Surgery, Adelaide, South Australia, Australia; and
| | - Sonia Huang
- South Australian Institute of Ophthalmology, University of Adelaide and Department of Ophthalmology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Michelle T Sun
- South Australian Institute of Ophthalmology, University of Adelaide and Department of Ophthalmology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Katherine Zamora-Alejo
- IVISION Laser Eye Surgery, Adelaide, South Australia, Australia; and
- Department of Ophthalmology, Flinders University, Bedford Park, South Australia, Australia
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Sun MT, Pershing S, Goldberg JL, Wang SY. Impact of Type 2 diabetes mellitus and insulin use on progression to glaucoma surgery in primary open angle glaucoma. Eye (Lond) 2024; 38:558-564. [PMID: 37740048 PMCID: PMC10858255 DOI: 10.1038/s41433-023-02734-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 08/07/2023] [Accepted: 09/07/2023] [Indexed: 09/24/2023] Open
Abstract
PURPOSE To investigate outcomes of primary open-angle glaucoma (POAG) patients with and without type 2 diabetes mellitus (T2DM). METHODS Retrospective observational study using U.S. nationwide healthcare insurance claims database. Patients ≥40 years old with at least one HbA1c within one year of POAG diagnosis were included. Diabetic factors associated with POAG progression requiring glaucoma surgery were evaluated using multivariable Cox proportional hazards regression models adjusted for demographic, diabetic and glaucoma factors. T2DM diagnosis and use of either oral hypoglycaemic agents or insulin therapy were assessed in association with POAG progression requiring glaucoma surgery. RESULTS 104,515 POAG patients were included, of which 70,315 (67%) had T2DM. The mean age was 68.9 years (Standard deviation 9.2) and 55% were female. Of those with T2DM, 93% were taking medication (65,468); 95% (62,412) taking oral hypoglycaemic agents, and 34% (22,028) were on insulin. In multivariable analyses, patients with T2DM had a higher hazard of requiring glaucoma surgery (Hazard ratio, HR 1.15, 95% CI 1.09-1.21, p < 0.001). Higher mean HbA1c was also a significant predictor of progression requiring glaucoma surgery (HR 1.02, 95% CI 1.01-1.03, p < 0.001). When evaluating only patients who were taking antidiabetic medication, after adjusting for confounders, insulin use was associated with a 1.20 higher hazard of requiring glaucoma surgery compared to oral hypoglycaemic agents (95% CI 1.14-1.27, p < 0.001), but when stratified by HbA1c, this effect was only significant for those with HbA1c > 7.5%. CONCLUSIONS Higher baseline HbA1c, particularly in patients taking insulin may be associated with higher rates of glaucoma surgery in POAG.
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Affiliation(s)
- Michelle T Sun
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, CA, USA
| | - Suzann Pershing
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, CA, USA
| | - Jeffrey L Goldberg
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, CA, USA
| | - Sophia Y Wang
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, CA, USA.
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Huang S, Bacchi S, Chan W, Macri C, Selva D, Wong CX, Sun MT. Detection of systemic cardiovascular illnesses and cardiometabolic risk factors with machine learning and optical coherence tomography angiography: a pilot study. Eye (Lond) 2023; 37:3629-3633. [PMID: 37221360 PMCID: PMC10686409 DOI: 10.1038/s41433-023-02570-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 03/27/2023] [Accepted: 04/26/2023] [Indexed: 05/25/2023] Open
Abstract
BACKGROUND/OBJECTIVES Optical coherence tomography angiography (OCTA) has been found to identify changes in the retinal microvasculature of people with various cardiometabolic factors. Machine learning has previously been applied within ophthalmic imaging but has not yet been applied to these risk factors. The study aims to assess the feasibility of predicting the presence or absence of cardiovascular conditions and their associated risk factors using machine learning and OCTA. METHODS Cross-sectional study. Demographic and co-morbidity data was collected for each participant undergoing 3 × 3 mm, 6 × 6 mm and 8 × 8 mm OCTA scanning using the Carl Zeiss CIRRUS HD-OCT model 5000. The data was then pre-processed and randomly split into training and testing datasets (75%/25% split) before being applied to two models (Convolutional Neural Network and MoblieNetV2). Once developed on the training dataset, their performance was assessed on the unseen test dataset. RESULTS Two hundred forty-seven participants were included. Both models performed best in predicting the presence of hyperlipidaemia in 3 × 3 mm scans with an AUC of 0.74 and 0.81, and accuracy of 0.79 for CNN and MobileNetV2 respectively. Modest performance was achieved in the identification of diabetes mellitus, hypertension and congestive heart failure in 3 × 3 mm scans (all with AUC and accuracy >0.5). There was no significant recognition for 6 × 6 and 8 × 8 mm for any cardiometabolic risk factor. CONCLUSION This study demonstrates the strength of ML to identify the presence cardiometabolic factors, in particular hyperlipidaemia, in high-resolution 3 × 3 mm OCTA scans. Early detection of risk factors prior to a clinically significant event, will assist in preventing adverse outcomes for people.
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Affiliation(s)
- Sonia Huang
- South Australian Institute of Ophthalmology, The University of Adelaide and Royal Adelaide Hospital, Adelaide, SA, Australia.
| | - Stephen Bacchi
- Department of Neurology, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - WengOnn Chan
- South Australian Institute of Ophthalmology, The University of Adelaide and Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Carmelo Macri
- South Australian Institute of Ophthalmology, The University of Adelaide and Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Dinesh Selva
- South Australian Institute of Ophthalmology, The University of Adelaide and Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Christopher X Wong
- Department of Cardiology, University of Adelaide and Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Michelle T Sun
- South Australian Institute of Ophthalmology, The University of Adelaide and Royal Adelaide Hospital, Adelaide, SA, Australia
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Macri CZ, Teoh SC, Bacchi S, Tan I, Casson R, Sun MT, Selva D, Chan W. A case study in applying artificial intelligence-based named entity recognition to develop an automated ophthalmic disease registry. Graefes Arch Clin Exp Ophthalmol 2023; 261:3335-3344. [PMID: 37535181 PMCID: PMC10587337 DOI: 10.1007/s00417-023-06190-2] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 06/23/2023] [Accepted: 07/23/2023] [Indexed: 08/04/2023] Open
Abstract
PURPOSE Advances in artificial intelligence (AI)-based named entity extraction (NER) have improved the ability to extract diagnostic entities from unstructured, narrative, free-text data in electronic health records. However, there is a lack of ready-to-use tools and workflows to encourage the use among clinicians who often lack experience and training in AI. We sought to demonstrate a case study for developing an automated registry of ophthalmic diseases accompanied by a ready-to-use low-code tool for clinicians. METHODS We extracted deidentified electronic clinical records from a single centre's adult outpatient ophthalmology clinic from November 2019 to May 2022. We used a low-code annotation software tool (Prodigy) to annotate diagnoses and train a bespoke spaCy NER model to extract diagnoses and create an ophthalmic disease registry. RESULTS A total of 123,194 diagnostic entities were extracted from 33,455 clinical records. After decapitalisation and removal of non-alphanumeric characters, there were 5070 distinct extracted diagnostic entities. The NER model achieved a precision of 0.8157, recall of 0.8099, and F score of 0.8128. CONCLUSION We presented a case study using low-code artificial intelligence-based NLP tools to produce an automated ophthalmic disease registry. The workflow created a NER model with a moderate overall ability to extract diagnoses from free-text electronic clinical records. We have produced a ready-to-use tool for clinicians to implement this low-code workflow in their institutions and encourage the uptake of artificial intelligence methods for case finding in electronic health records.
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Affiliation(s)
- Carmelo Z Macri
- Discipline of Ophthalmology and Visual Sciences, The University of Adelaide, Adelaide, South Australia, Australia.
- Department of Ophthalmology, The Royal Adelaide Hospital, Adelaide, South Australia, Australia.
| | - Sheng Chieh Teoh
- Department of Ophthalmology, The Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Stephen Bacchi
- Discipline of Ophthalmology and Visual Sciences, The University of Adelaide, Adelaide, South Australia, Australia
- Department of Ophthalmology, The Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Ian Tan
- Department of Ophthalmology, The Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Robert Casson
- Discipline of Ophthalmology and Visual Sciences, The University of Adelaide, Adelaide, South Australia, Australia
- Department of Ophthalmology, The Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Michelle T Sun
- Discipline of Ophthalmology and Visual Sciences, The University of Adelaide, Adelaide, South Australia, Australia
- Department of Ophthalmology, The Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Dinesh Selva
- Discipline of Ophthalmology and Visual Sciences, The University of Adelaide, Adelaide, South Australia, Australia
- Department of Ophthalmology, The Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - WengOnn Chan
- Discipline of Ophthalmology and Visual Sciences, The University of Adelaide, Adelaide, South Australia, Australia
- Department of Ophthalmology, The Royal Adelaide Hospital, Adelaide, South Australia, Australia
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Sun MT, Singh K, Wang SY. Changes in glaucoma management following visual field testing and optical coherence tomography. Br J Ophthalmol 2023; 107:1119-1124. [PMID: 35450937 PMCID: PMC10108857 DOI: 10.1136/bjophthalmol-2021-321010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 04/11/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Optimal utilisation of investigations in glaucoma management remains unclear. We aimed to assess whether a temporal association exists between such testing and management changes. METHODS Retrospective observational study using nationwide healthcare insurance claims database. Glaucoma outpatient encounters from patients aged ≥40 years with/without Humphrey visual field (HVF) and/or optical coherence tomography (OCT) were identified. An encounter was considered associated with an intervention if surgery occurred within 90 days, or if medication change or laser trabeculoplasty (LT) occurred within 30 days. RESULTS 12 669 324 outpatient encounters of 1 863 748 individuals from 2003 to 2020 were included. HVF and OCT was performed during 32.8% and 22.2% of encounters respectively. Of the 36 763 (0.3%) encounters preceding surgery, 28.1% included HVF, 11.9% had OCT and 8.5% both. 79 181 (0.6%) visits preceded LT, of which 28.2% had HVF, 13.2% OCT and 9.3% both. Of the 515 899 (4.5%) encounters preceding medication changes, 29.1% had HVF, 16.7% OCT and 12.2% both. Compared with encounters with no investigations, those with HVF and/or OCT were associated with a 49% increased odds of a management change (p<0.001). In multivariate analyses, compared with encounters without investigations, visits with HVF alone had higher odds of subsequent surgery and LT, while HVF and/or OCT were associated with higher odds of medication change (p<0.001 for all). CONCLUSION Glaucoma therapeutic changes occurred following approximately 5% of outpatient encounters. Surgery and LT were more likely to occur following a visit with a HVF rather than an OCT, while either investigation was associated with a higher odds of medication change.
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Affiliation(s)
- Michelle T Sun
- Department of Ophthalmology, Stanford University, Palo Alto, California, USA
| | - Kuldev Singh
- Department of Ophthalmology, Stanford University, Palo Alto, California, USA
| | - Sophia Y Wang
- Department of Ophthalmology, Stanford University, Palo Alto, California, USA
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Sun MT, Tran M, Singh K, Chang R, Wang H, Sun Y. Glaucoma and Myopia: Diagnostic Challenges. Biomolecules 2023; 13:biom13030562. [PMID: 36979497 PMCID: PMC10046607 DOI: 10.3390/biom13030562] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 03/06/2023] [Accepted: 03/16/2023] [Indexed: 03/30/2023] Open
Abstract
The rising global prevalence of myopia is a growing concern for clinicians, as it predisposes patients to severe ocular pathologies including glaucoma. High myopia can be associated with clinical features that resemble glaucomatous damage, which make an accurate glaucoma diagnosis challenging, particularly among patients with normal intraocular pressures. These patients may also present with established visual field defects which can mimic glaucoma, and standard imaging technology is less useful in disease detection and monitoring due to the lack of normative data for these anatomically unique eyes. Progression over time remains the most critical factor in facilitating the detection of early glaucomatous changes, and thus careful longitudinal follow-up of high-risk myopic patients is the most important aspect of management. Here, we review our current understanding of the complex relationship between myopia and glaucoma, and the diagnostic challenges and limitations of current testing protocols including visual field, intraocular pressure, and imaging. Furthermore, we discuss the clinical findings of two highly myopic patients with suspected glaucoma.
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Affiliation(s)
- Michelle T Sun
- Department of Ophthalmology, School of Medicine, Stanford University, Palo Alto, CA 94305, USA
| | - Matthew Tran
- Department of Ophthalmology, School of Medicine, Stanford University, Palo Alto, CA 94305, USA
- School of Medicine, University of Nevada, Reno, NV 89557, USA
| | - Kuldev Singh
- Department of Ophthalmology, School of Medicine, Stanford University, Palo Alto, CA 94305, USA
| | - Robert Chang
- Department of Ophthalmology, School of Medicine, Stanford University, Palo Alto, CA 94305, USA
| | - Huaizhou Wang
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
| | - Yang Sun
- Department of Ophthalmology, School of Medicine, Stanford University, Palo Alto, CA 94305, USA
- Palo Alto Veterans Administration, Palo Alto, CA 94304, USA
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Halliday LA, Wood JPM, Chidlow G, Casson RJ, Selva D, Sun MT. Establishing human lacrimal gland cultures from biopsy-sized tissue specimens. Eye (Lond) 2023; 37:62-68. [PMID: 35001090 PMCID: PMC9829670 DOI: 10.1038/s41433-021-01872-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 10/11/2021] [Accepted: 11/19/2021] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVES To establish cultures of human lacrimal gland from patient-derived, biopsy-sized, tissue specimens. METHODS Tissue was obtained after surgical removal from patients without dry eye disease undergoing routine procedures. Samples were subjected to mechanical and enzymatic digestion and resulting cell suspensions were plated onto collagen-coated glass coverslips and grown for up to 21 days. Cultures were analysed by immunocytochemistry and light microscopy, and resultant cellular distributions were compared to those in sections of fixed human lacrimal gland tissue. RESULTS Dissociation of biopsy-sized pieces of human lacrimal gland and seeding onto coated surfaces allowed development of a mixed population of cells in vitro. Within 7-14 days, cellular aggregation was observed and by 21 days many cells had organised themselves into distinct three-dimensional complexes. Immunohistochemistry revealed a heterogeneous population of cells, including epithelial, myoepithelial, mesenchymal and progenitor cells. Some of the epithelia labelled positively for lysozyme and lactoferrin. CONCLUSIONS Collection and dissociation of biopsy-sized pieces of human lacrimal gland leads to a cellular preparation that can proliferate in vitro and organise into three-dimensional structures. This is the first report detailing that biopsy-collected specimens of human lacrimal gland can be used to establish cell cultures.
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Affiliation(s)
- Luke A Halliday
- Discipline of Ophthalmology & Visual Sciences, Level 7 Adelaide Health and Medical Sciences Building, University of Adelaide, North Terrace, Adelaide, SA, 5000, Australia
- South Australian Institute of Ophthalmology, Royal Adelaide Hospital, Port Road, Adelaide, SA, 5000, Australia
| | - John P M Wood
- Discipline of Ophthalmology & Visual Sciences, Level 7 Adelaide Health and Medical Sciences Building, University of Adelaide, North Terrace, Adelaide, SA, 5000, Australia.
- South Australian Institute of Ophthalmology, Royal Adelaide Hospital, Port Road, Adelaide, SA, 5000, Australia.
| | - Glyn Chidlow
- Discipline of Ophthalmology & Visual Sciences, Level 7 Adelaide Health and Medical Sciences Building, University of Adelaide, North Terrace, Adelaide, SA, 5000, Australia
- South Australian Institute of Ophthalmology, Royal Adelaide Hospital, Port Road, Adelaide, SA, 5000, Australia
| | - Robert J Casson
- Discipline of Ophthalmology & Visual Sciences, Level 7 Adelaide Health and Medical Sciences Building, University of Adelaide, North Terrace, Adelaide, SA, 5000, Australia
- South Australian Institute of Ophthalmology, Royal Adelaide Hospital, Port Road, Adelaide, SA, 5000, Australia
| | - Dinesh Selva
- Discipline of Ophthalmology & Visual Sciences, Level 7 Adelaide Health and Medical Sciences Building, University of Adelaide, North Terrace, Adelaide, SA, 5000, Australia
- South Australian Institute of Ophthalmology, Royal Adelaide Hospital, Port Road, Adelaide, SA, 5000, Australia
| | - Michelle T Sun
- Discipline of Ophthalmology & Visual Sciences, Level 7 Adelaide Health and Medical Sciences Building, University of Adelaide, North Terrace, Adelaide, SA, 5000, Australia
- South Australian Institute of Ophthalmology, Royal Adelaide Hospital, Port Road, Adelaide, SA, 5000, Australia
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Abstract
Purpose To investigate the association of systemic blood pressure and incident primary open-angle glaucoma (POAG) using a large open-access database. Methods Prospective cohort study included 484,268 participants from the UK Biobank without glaucoma at enrollment. Incident POAG events were recorded through assessment visits, hospital inpatient admissions, and primary care data. Blood pressure measures included systolic blood pressure (SBP), diastolic blood pressure (DBP), pulse pressure (PP), and mean arterial pressure (MAP). Repeated measurements throughout the study period were analyzed as time-varying covariables. The parameters were modeled as both categorical and continuous nonlinear variables. The primary outcome measure was the relative hazard of incident POAG. Results There were 2390 incident POAG events over 5,715,480 person-years of follow-up. Median follow-up was 12.08 years. In multivariable analyses, compared to SBP and PP in the normal range (SBP, 120-130 mmHg; PP, 40-50 mmHg), higher SBP and PP were associated with an increased risk of incident POAG (linear trend P = 0.038 for SBP, P < 0.001 for PP). Specifically, SBP of 130 to 140 mmHg or 140 to 150 mmHg was associated with a 1.16 higher hazard of incident POAG (95% CI, 1.01-1.32 and 1.01-1.33, respectively), whereas a PP of greater than 70 mmHg was associated with a 1.13 higher hazard of incident glaucoma (95% CI, 1.00-1.29). In multivariable models, no statistically significant associations were found for DBP or MAP with incident glaucoma. These findings were similar when blood pressure measures were modeled as continuous variables. Conclusions Higher SBP and PP were associated with an increased risk of incident POAG. Further studies are required to characterize these relationships better.
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Affiliation(s)
- Carmelo Macri
- Discipline of Ophthalmology and Visual Sciences, The University of Adelaide and Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Christopher X Wong
- Department of Cardiology, The University of Adelaide and Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Samuel J Tu
- Department of Cardiology, The University of Adelaide and Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Robert Casson
- Discipline of Ophthalmology and Visual Sciences, The University of Adelaide and Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Kuldev Singh
- Department of Ophthalmology, Byers Eye Institute, Stanford University, Palo Alto, California, United States
| | - Sophia Y Wang
- Department of Ophthalmology, Byers Eye Institute, Stanford University, Palo Alto, California, United States
| | - Michelle T Sun
- Discipline of Ophthalmology and Visual Sciences, The University of Adelaide and Royal Adelaide Hospital, Adelaide, South Australia, Australia.,Department of Ophthalmology, Byers Eye Institute, Stanford University, Palo Alto, California, United States
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Sun MT, Singh K, Wang SY. Real-World Outcomes of Glaucoma Filtration Surgery Using Electronic Health Records: An Informatics Study. J Glaucoma 2022; 31:847-853. [PMID: 36223316 PMCID: PMC9633387 DOI: 10.1097/ijg.0000000000002122] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 08/25/2022] [Indexed: 11/06/2022]
Abstract
PRCIS Utilizing an automated pipeline for data extraction from electronic health records provides real-world information on the success of various glaucoma procedures, with tube shunt implantation associated with increased failure rates compared with trabeculectomy. BACKGROUND We aimed to evaluate the long-term survival of glaucoma surgeries using an automated pipeline for extraction of outcomes from electronic health records. METHODS A retrospective observational study from a single academic center. Patients undergoing trabeculectomy, Ex-PRESS shunt, Baerveldt, and Ahmed tube shunt insertion from 2009 to 2018 were identified from electronic health record procedure codes. Patient characteristics were identified from structured and unstructured fields using a previously validated natural language processing pipeline. RESULTS Five hundred twelve patients underwent 711 glaucoma surgeries: 287 trabeculectomies, 47 Ex-PRESS shunts, 274 Baerveldt and 103 Ahmed tube implantations. The Median follow-up was 359 days. The mean baseline IOP was 24.4 mm Hg (SD 10.9), and 73.1% were on ≥3 medications. Compared with trabeculectomy, tube shunt surgery had a higher risk of failure (Baerveldt: Hazard Ratio (HR) 1.44, 95% CI 1.02 to 2.02; Ahmed: HR 2.01, 95% CI 1.28 to 3.17). Previous glaucoma surgery was associated with increased failure (≥2 previous surgeries: HR 2.74, 95% CI 1.62 to 4.64), as were fewer baseline medications (<3 medications: HR 2.96, 95% CI 2.12 to 4.13) and male sex (HR 1.40, 95% CI 1.03 to 1.90). At 1 year, tube shunt patients had a 2.53 mm Hg ( P =0.002) higher IOP compared with trabeculectomy patients. CONCLUSIONS Baerveldt and Ahmed tube shunt implantation was associated with increased failure compared with trabeculectomy. Fewer baseline medications, previous glaucoma surgeries, and male sex were also risk factors for failure. These results demonstrate the utility of applying an informatics pipeline to electronic health records to investigate key clinical questions using real-world evidence.
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Kumawat M, Juniat V, Sun MT, Bajic N, Selva D. Traumatic direct carotid cavernous fistula following partial maxillectomy. Can J Ophthalmol 2022; 57:e171-e172. [PMID: 35120909 DOI: 10.1016/j.jcjo.2022.01.009] [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: 10/19/2021] [Revised: 12/07/2021] [Accepted: 01/05/2022] [Indexed: 11/16/2022]
Affiliation(s)
- Medhir Kumawat
- University of Adelaide and the South Australian Institute of Ophthalmology, Adelaide, Australia.
| | - Valerie Juniat
- University of Adelaide and the South Australian Institute of Ophthalmology, Adelaide, Australia
| | - Michelle T Sun
- University of Adelaide and the South Australian Institute of Ophthalmology, Adelaide, Australia
| | | | - Dinesh Selva
- University of Adelaide and the South Australian Institute of Ophthalmology, Adelaide, Australia
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Huang S, Sun MT, Mallipatna A, Carrillo C, Tang YF, Nweni K, Win T, Aung TH, Lin N, Win Y, Griffiths A, Holmes M, Thapaw NM, Hlaing S, Casson R, Muecke J. A survey of visual impairment and blindness in children attending eight schools for the blind in Myanmar: An update. Indian J Ophthalmol 2021; 69:2034-2039. [PMID: 34304173 PMCID: PMC8482937 DOI: 10.4103/ijo.ijo_3534_20] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Purpose: To determine the causes of visual impairment (VI) and blindness among children in schools for the blind in Myanmar; to identify the avoidable causes of VI and blindness; to provide spectacles, low-vision aids, and ophthalmic treatment where indicated; to provide an update of the 2007 survey performed and identify any major epidemiological changes. Methods: Two hundred and ninety children under 16 years of age from all eight schools for the blind in Myanmar were examined and the data entered into the World Health Organization Prevention of Blindness Examination Record for Childhood Blindness. Results: In total, 271 children (93.4%) were blind (visual acuity [VA] <3/60 in the better eye) and 15 (5.17%) had severe visual impairment (SVI = VA <6/60 to 3/60 in the better eye). Most children had whole globe as the major anatomical site of SVI or blindness (105, 36.6%). The cause was unknown in the majority of these (155, 54.0%). One hundred and twelve children had avoidable causes of blindness and SVI (39.0%). Forty children (13.9%) required an optical device and 10.1% required surgical or medical attention, with a potential for visual improvement through intervention in 3.48%. Conclusion: In all, 39.0% of children had potentially avoidable causes of SVI and blindness with cataracts and measles being the commonest causes. This follow-up survey performed after the first one completed in Myanmar in 2007 demonstrates a change in the major site of abnormality from the cornea to whole globe and a reduction in avoidable blindness but highlights the ongoing burden of measles.
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Affiliation(s)
- Sonia Huang
- South Australian Institute of Ophthalmology, The University of Adelaide and Royal Adelaide Hospital, Adelaide, South Australia
| | - Michelle T Sun
- South Australian Institute of Ophthalmology, The University of Adelaide and Royal Adelaide Hospital; Sight for All, Adelaide, Australia
| | - Ashwin Mallipatna
- Sight for All; Department of Ophthalmology, Women's and Children's Hospital, Adelaide, South Australia, Australia
| | - Cesar Carrillo
- South Australian Institute of Ophthalmology, The University of Adelaide and Royal Adelaide Hospital; Sight for All, Adelaide, Australia
| | - Yi Fan Tang
- South Australian Institute of Ophthalmology, The University of Adelaide and Royal Adelaide Hospital, Adelaide, South Australia
| | - Khine Nweni
- Department of Ophthalmology, Yangon Eye Hospital, Yangon, Myanmar
| | - Tin Win
- Department of Ophthalmology, Yangon Eye Hospital, Yangon, Myanmar
| | - Than Htun Aung
- Department of Ophthalmology, Yangon Eye Hospital, Yangon, Myanmar
| | - Naing Lin
- Department of Ophthalmology, Yangon Eye Hospital, Yangon, Myanmar
| | - Ye Win
- Sight for All, Adelaide, Australia
| | | | | | | | - Soe Hlaing
- Department of Ophthalmology, Yangon Eye Hospital, Yangon, Myanmar
| | - Robert Casson
- South Australian Institute of Ophthalmology, The University of Adelaide and Royal Adelaide Hospital; Sight for All, Adelaide, Australia
| | - James Muecke
- South Australian Institute of Ophthalmology, The University of Adelaide and Royal Adelaide Hospital; Sight for All, Adelaide, Australia
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Tan Y, Fukutomi A, Sun MT, Durkin S, Gilhotra J, Chan WO. Anti-VEGF crunch syndrome in proliferative diabetic retinopathy: A review. Surv Ophthalmol 2021; 66:926-932. [PMID: 33705807 DOI: 10.1016/j.survophthal.2021.03.001] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [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: 09/18/2019] [Revised: 02/23/2021] [Accepted: 03/01/2021] [Indexed: 10/22/2022]
Abstract
Anti-vascular endothelial growth factor (anti-VEGF) crunch syndrome describes the progression to tractional retinal detachment following intravitreal anti-VEGF therapy in an eye with proliferative diabetic retinopathy . We reviewed the literature on the anti-VEGF crunch using the PubMed and Cochrane databases. Anti-VEGF crunch typically manifests as sudden vision loss in the affected eye between 1 and 6 weeks following intravitreal anti-VEGF injection, with a mean onset of 13 days. Risk factors for crunch development include the use of a higher anti-VEGF dose and increased severity of diabetic retinopathy with fibrosis. Our review found that intravitreal anti-VEGF, in particular bevacizumab, should be used with caution when treating patients with severe proliferative diabetic retinopathy and pre-existing intraocular fibrosis. In patients where anti-VEGF is used before a planned vitrectomy, we recommend close monitoring for crunch symptoms and proceeding promptly with surgery if there is new or progression of tractional retinal detachment. For eyes with minimal preexisting traction that develop crunch after anti-VEGF treatment, surgeons should proceed to vitrectomy within 7 days. The existing literature on the anti-VEGF crunch is limited by heterogeneity in the way crunch is documented and characterized and the presence of panretinal photocoagulation as a confounding factor. Because of these methodological flaws, the relative frequency of the anti-VEGF crunch cannot be accurately estimated.
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Affiliation(s)
- Yiran Tan
- South Australian Institute of Ophthalmology, Royal Adelaide Hospital, Adelaide, Australia; Department of Ophthalmology and Visual Sciences, University of Adelaide, Adelaide, Australia.
| | - Akira Fukutomi
- Department of Ophthalmology, Aichi Medical University, Nagakute, Japan
| | - Michelle T Sun
- South Australian Institute of Ophthalmology, Royal Adelaide Hospital, Adelaide, Australia; Department of Ophthalmology and Visual Sciences, University of Adelaide, Adelaide, Australia
| | - Shane Durkin
- South Australian Institute of Ophthalmology, Royal Adelaide Hospital, Adelaide, Australia; Department of Ophthalmology and Visual Sciences, University of Adelaide, Adelaide, Australia
| | - Jagjit Gilhotra
- South Australian Institute of Ophthalmology, Royal Adelaide Hospital, Adelaide, Australia; Department of Ophthalmology and Visual Sciences, University of Adelaide, Adelaide, Australia
| | - Weng Onn Chan
- South Australian Institute of Ophthalmology, Royal Adelaide Hospital, Adelaide, Australia; Department of Ophthalmology and Visual Sciences, University of Adelaide, Adelaide, Australia
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Sun MT, Huang S, Chan W, Craig JE, Knight LSW, Sanders P, Newland H, Casson R, Selva D, Wong CX. Impact of cardiometabolic factors on retinal vasculature: A 3 × 3, 6 × 6 and 8 × 8-mm ocular coherence tomography angiography study. Clin Exp Ophthalmol 2021; 49:260-269. [PMID: 33655679 DOI: 10.1111/ceo.13913] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [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: 11/14/2020] [Revised: 02/11/2021] [Accepted: 02/22/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Ocular coherence tomography angiography (OCTA) is available in varying size and resolution. We sought to characterise associations of cardiometabolic factors with retinal microvascular changes using 3 × 3, 6 × 6 and 8 × 8-mm OCTA scans to determine differences in detection with varying scan size. METHODS Cross-sectional study of 247 cardiovascular patients from a single-centre tertiary-care hospital. Demographic, comorbidity and medication data were obtained. Patients underwent 3 × 3, 6 × 6 and 8 × 8-mm macula OCTA scanning using Carl Zeiss CIRRUS HD-OCT Model 5000. Angioplex and AngioTool software was used to quantify vascular parameters in the superficial capillary plexus. RESULTS Increasing age, hypertension, dyslipidaemia, diabetes, chronic kidney disease, coronary artery disease and peripheral vascular disease were associated with reductions in vessel density, vessel perfusion, average vessel length and/or junction density in 3 × 3-mm OCTA (P < .05 for all). Conversely, smoking was associated with increased vessel density, vessel length and junction density in 3 × 3-mm OCTA (P < .05 for all). Associations of vessel abnormalities with cardiometabolic factors were progressively weakened and statistically attenuated in 6 × 6 and 8 × 8-mm OCTA scans. In multivariate analyses, dyslipidaemia remained an independent predictor of reduced vessel density, average vessel length and junction density (P < .05). CONCLUSIONS Cardiometabolic factors are associated with multiple retinal microvascular changes in 3 × 3-mm OCTA scans. These associations were weakened and progressively attenuated in OCTA scans of larger 6 × 6 and 8 × 8-mm size. These findings advance our understanding of microcirculatory dysfunction and may have future implications for the screening and management of patients with cardiometabolic risk factors. Additional studies are required to further investigate these important associations.
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Affiliation(s)
- Michelle T Sun
- South Australian Institute of Ophthalmology, The University of Adelaide and Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Sonia Huang
- South Australian Institute of Ophthalmology, The University of Adelaide and Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - WengOnn Chan
- South Australian Institute of Ophthalmology, The University of Adelaide and Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Jamie E Craig
- Department of Ophthalmology, Flinders University, Adelaide, South Australia, Australia
| | - Lachlan S W Knight
- Department of Ophthalmology, Flinders University, Adelaide, South Australia, Australia
| | - Prashanthan Sanders
- Department of Cardiology, The University of Adelaide and Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Henry Newland
- South Australian Institute of Ophthalmology, The University of Adelaide and Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Robert Casson
- South Australian Institute of Ophthalmology, The University of Adelaide and Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Dinesh Selva
- South Australian Institute of Ophthalmology, The University of Adelaide and Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Christopher X Wong
- Department of Cardiology, The University of Adelaide and Royal Adelaide Hospital, Adelaide, South Australia, Australia
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Sun MT, Madike R, Huang S, Cameron C, Selva D, Casson RJ, Wong CX. Changing trends in glaucoma surgery within Australia. Br J Ophthalmol 2021; 106:957-961. [PMID: 33597199 DOI: 10.1136/bjophthalmol-2020-318701] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 01/19/2021] [Accepted: 01/30/2021] [Indexed: 01/22/2023]
Abstract
BACKGROUND Limited data are available on glaucoma surgical trends in Australia. METHODS Nationwide study of glaucoma surgery in Australia over 17-year period from 2001 to 2018. The Australian Institute of Health, Welfare and Ageing hospitalisation database was used to review age- and gender-specific trends in glaucoma surgeries from 2001 to 2018 in Australian public and private hospitals. RESULTS Although there was an increase in the absolute number of trabeculectomy procedures from 2926 to 3244 over the 17-year study period, this represented a decline in the age-standardised and gender-standardised number of trabeculectomy procedures from 15.1 to 13.2 procedures per 100 000 persons. However, during this same period, there was a dramatic increase in the number of glaucoma drainage devices (GDD) from 119 to 3262 procedures, representing an age-standardised and gender-standardised increase from 0.6 to 13.3 procedures per 100 000 persons. Negative binomial regression analysis revealed a decrease in trabeculectomy procedures of 1.1% per year, while there was increase in GDD insertions of 16.3% per year (p<0.001 for both). When stratified by age group, there was a statistically significant interaction in both trabeculectomy and GDD rates by age groups over time (p<0.001 for both). Trabeculectomy procedures decreased to a greater extent in those aged >60 years, compared with stable or increasing rates in younger age groups. GDD insertion rates demonstrated a progressively greater increase in older compared with younger age groups. CONCLUSION Our findings demonstrate changing trends in the surgical management of advanced glaucoma in Australia, likely reflecting updated evidence regarding the role of GDD surgeries.
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Affiliation(s)
- Michelle T Sun
- South Australian Institute of Ophthalmology, The University of Adelaide and Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Reema Madike
- South Australian Institute of Ophthalmology, The University of Adelaide and Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Sonia Huang
- South Australian Institute of Ophthalmology, The University of Adelaide and Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Cassie Cameron
- South Australian Institute of Ophthalmology, The University of Adelaide and Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Dinesh Selva
- South Australian Institute of Ophthalmology, The University of Adelaide and Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Robert J Casson
- South Australian Institute of Ophthalmology, The University of Adelaide and Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Christopher X Wong
- School of Medicine, The University of Adelaide and Royal Adelaide Hospital, Adelaide, South Australia, Australia
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Zhan YJ, Zhang LX, Sun MT, Li XM, Wang Y, Li MZ, Tao DD, Sun ET. [DNA barcoding of 4 species of cheyletid mites based on COI and 18S rRNA gene sequences]. Zhongguo Xue Xi Chong Bing Fang Zhi Za Zhi 2020; 33:66-70. [PMID: 33660477 DOI: 10.16250/j.32.1374.2020154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To analyze the sequences of mitochondrial cytochrome C oxidase subunit I gene (COI) and 18S ribosomal RNA gene (18S rRNA), so as to identify the feasible DNA barcodes for 4 species of cheyletid mites and improve the DNA barcoding database for cheyletid mites. METHODS Cheyletid mite samples were collected from small-scale flour mills in Fuyang, Wuhu and Tongling cities of Anhui Province from May 2018 to July 2019, extracted and morphologically identified. Then, genomic DNA was extracted from a single cheyletid mite, and the COI and 18S rRNA gene sequences were obtained by PCR amplification, cloning and sequencing. The obtained sequences were aligned using the BLAST software. Multiple sequence alignment was done using the software ClustalX version 1.83 using the known gene sequences from cheyletid mites. The genetic distance was calculated using the software MEGA X, and the phylogenetic tree was created using the maximum likelihood method. RESULTS The DNA barcoding results of Cheyletus malaccensis, C. carnifex and Cheletomorpha lepidopterorum were consistent with the morphological identification, while no sequences pertaining to Eucheyletia reticulate were retrieved in the GenBank database. The proportions of A + T were 69.6% and 55.1% in the COI and 18S rRNA sequences of 4 cheyletid mites species, respectively, and the numbers of base substitutions were 137 and 46, respectively. There were 154 to 321 and 58 to 99 inter-species variation loci in the COI and 18S rRNA gene sequences of 4 cheyletid mites species, respectively, and the intra-species genetic distance was all 0.020 or less in the COI and 18S rRNA gene sequences of 4 cheyletid mites species, with inter-species genetic distance of 0.235 to 0.583 and 0.078 to 0.114, respectively. Phylogenetic analysis based on COI and 18S rRNA genes showed that all four species of cheyletid mites were clustered into a branch with a 100% supportive rate, which was consistent with the morphological identification. CONCLUSIONS Mitochondrial COI gene is superior to 18S rRNA gene as DNA barcodes for 4 species of cheyletid mites, which is more suitable to be used to investigate the phylogenetic relationship of at genus and species levels.
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Affiliation(s)
- Y J Zhan
- Department of Hygiene Inspection and Quarantine, Wannan Medical College, Wuhu 241002, China
| | - L X Zhang
- Department of Hygiene Inspection and Quarantine, Wannan Medical College, Wuhu 241002, China
| | - M T Sun
- Department of Hygiene Inspection and Quarantine, Wannan Medical College, Wuhu 241002, China
| | - X M Li
- Department of Hygiene Inspection and Quarantine, Wannan Medical College, Wuhu 241002, China
| | - Y Wang
- Department of Hygiene Inspection and Quarantine, Wannan Medical College, Wuhu 241002, China
| | - M Z Li
- Department of Hygiene Inspection and Quarantine, Wannan Medical College, Wuhu 241002, China
| | - D D Tao
- Department of Hygiene Inspection and Quarantine, Wannan Medical College, Wuhu 241002, China
| | - E T Sun
- Department of Hygiene Inspection and Quarantine, Wannan Medical College, Wuhu 241002, China
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Sun MT, Huang S, Wiviott SD, Antman EM, Roe MT, Ohman EM, Neely M, Wallentin L, Wong CX. Meta-Analysis of Intraocular Bleeding With Dual Antiplatelet Therapy Using P2Y12 Inhibitors Prasugrel or Ticagrelor. Am J Cardiol 2020; 125:1280-1283. [PMID: 32081368 DOI: 10.1016/j.amjcard.2020.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Revised: 01/04/2020] [Accepted: 01/10/2020] [Indexed: 10/25/2022]
Abstract
Intraocular bleeding is a devastating clinical event due to its potentially blinding nature. It is not known if determine if dual antiplatelet therapy using aspirin and potent P2Y12 inhibitors increases this risk. We searched MEDLINE and ClinicalTrials.gov for randomized controlled trials that were phase III, randomly assigned patients to dual antiplatelet therapy with either aspirin and a potent P2Y12 inhibitor or aspirin and clopidogrel, had follow-up of 6 months, and at least 200 patients. Corresponding authors were contacted for intraocular bleeding data. Inverse-variance, weighted, fixed-effects meta-analysis was undertaken, with random-effects meta-analysis performed as a sensitivity analysis. Four trials enrolling 42,850 patients were included. The median follow-up ranged from 12 to 14 months. There was overall low risk of bias. Pooled analysis demonstrated no statistically significant increase in the risk of intraocular bleeding with dual antiplatelet therapy using potent P2Y12 inhibitors compared with clopidogrel (risk ratio 0.89, 95% confidence interval 0.58 to 1.36). There was no significant heterogeneity observed across trials (I2 statistic 0%, p = 0.98). The use of random-effects meta-analysis did not change the effect estimate or confidence intervals, and the results appeared similar when stratified by potent P2Y12 inhibitor (p = 0.97). In conclusion, this collaborative meta-analysis of dual antiplatelet trials does not suggest that the risk of intraocular bleeding is increased with the use of potent P2Y12 inhibitors compared with clopidogrel. Our results suggest that these potent P2Y12 inhibitors may continue to be used cautiously where indicated as part of dual antiplatelet therapy, even in those at high risk of spontaneous intraocular bleeding.
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Watson A, Sun MT, Curragh D, Selva D. Peripunctal oncocytoma of the eyelid. Clin Exp Ophthalmol 2020; 48:535-536. [PMID: 32011066 DOI: 10.1111/ceo.13722] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 12/18/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Alexander Watson
- Discipline of Ophthalmology and Visual Sciences, The University of Adelaide and the South Australian Institute of Ophthalmology, Adelaide, South Australia, Australia
| | - Michelle T Sun
- Discipline of Ophthalmology and Visual Sciences, The University of Adelaide and the South Australian Institute of Ophthalmology, Adelaide, South Australia, Australia
| | - David Curragh
- Discipline of Ophthalmology and Visual Sciences, The University of Adelaide and the South Australian Institute of Ophthalmology, Adelaide, South Australia, Australia
| | - Dinesh Selva
- Discipline of Ophthalmology and Visual Sciences, The University of Adelaide and the South Australian Institute of Ophthalmology, Adelaide, South Australia, Australia
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Sun MT, O’Connor AJ, Milne I, Biswas D, Casson R, Wood J, Selva D. Development of Macroporous Chitosan Scaffolds for Eyelid Tarsus Tissue Engineering. Tissue Eng Regen Med 2019; 16:595-604. [PMID: 31824822 PMCID: PMC6879684 DOI: 10.1007/s13770-019-00201-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 10/30/2018] [Revised: 06/11/2019] [Accepted: 06/13/2019] [Indexed: 10/26/2022] Open
Abstract
Background Reconstruction of large eyelid defects remains challenging due to the lack of suitable eyelid tarsus tissue substitutes. We aimed to evaluate a novel bioengineered chitosan scaffold for use as an eyelid tarsus substitute. Methods Three-dimensional macroporous chitosan hydrogel scaffold were produced via cryogelation with specific biomechanical properties designed to directly match characteristics of native eyelid tarsus tissue. Scaffolds were characterized by confocal microscopy and tensile mechanical testing. To optimise biocompatibility, human eyelid skin fibroblasts were cultured from biopsy-sized samples of fresh eyelid skin. Immunological and gene expression analysis including specific fibroblast-specific markers were used to determine the rate of fibroblast de-differentiation in vitro and characterize cells cultured. Eyelid skin fibroblasts were then cultured over the chitosan scaffolds and the resultant adhesion and growth of cells were characterized using immunocytochemical staining. Results The chitosan scaffolds were shown to support the attachment and proliferation of NIH 3T3 mouse fibroblasts and human orbital skin fibroblasts in vitro. Our novel bioengineered chitosan scaffold has demonstrated biomechanical compatibility and has the ability to support human eyelid skin fibroblast growth and proliferation. Conclusions This bioengineered tissue has the potential to be used as a tarsus substitute during eyelid reconstruction, offering the opportunity to pre-seed the patient's own cells and represents a truly personalised approach to tissue engineering.
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Affiliation(s)
- Michelle T. Sun
- Discipline of Ophthalmology and Visual Sciences, South Australian Institute of Ophthalmology, The University of Adelaide and Royal Adelaide Hospital, North Terrace, Adelaide, SA 5000 Australia
| | - Andrea J. O’Connor
- Department of Biomedical Engineering, Particulate Fluids Processing Centre, The University of Melbourne, Monash Road, Victoria, 3010 Australia
| | - Imogen Milne
- Department of Biomedical Engineering, Particulate Fluids Processing Centre, The University of Melbourne, Monash Road, Victoria, 3010 Australia
| | - Dhee Biswas
- Department of Biomedical Engineering, Particulate Fluids Processing Centre, The University of Melbourne, Monash Road, Victoria, 3010 Australia
| | - Robert Casson
- Discipline of Ophthalmology and Visual Sciences, South Australian Institute of Ophthalmology, The University of Adelaide and Royal Adelaide Hospital, North Terrace, Adelaide, SA 5000 Australia
| | - John Wood
- Discipline of Ophthalmology and Visual Sciences, South Australian Institute of Ophthalmology, The University of Adelaide and Royal Adelaide Hospital, North Terrace, Adelaide, SA 5000 Australia
| | - Dinesh Selva
- Discipline of Ophthalmology and Visual Sciences, South Australian Institute of Ophthalmology, The University of Adelaide and Royal Adelaide Hospital, North Terrace, Adelaide, SA 5000 Australia
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Abstract
BACKGROUND Patients with eyelid lesions often present in the primary healthcare setting. Although most eyelid lumps are benign, accurate diagnosis and early recognition of sinister lesions leads to improved patient outcomes. OBJECTIVE The aim of this article is to provide an overview of common eyelid lesions presenting to the general practitioner. DISCUSSION The majority of eyelid lesions are benign, ranging from innocuous cysts (cysts of Moll, Zeis and epidermoid cyst) and chalazion/hordeolum to naevi and papillomas. Key features that should prompt further investigation include gradual enlargement, central ulceration or induration, irregular borders, eyelid margin destruction or loss of lashes, and telangiectasia. The presence of these features should prompt referral to an ophthalmologist for further evaluation.
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Affiliation(s)
- Michelle T Sun
- MBBS, PhD, Clinical Lecturer, South Australian Institute of Ophthalmology, The University of Adelaide, SA; ophthalmology registrar, Royal Adelaide Hospital, SA
| | - Sonia Huang
- Ophthalmic research student, South Australian Institute of Ophthalmology, SA; medical student, The University of Adelaide, SA; Royal Adelaide Hospital, SA
| | - Shyamala C Huilgol
- MBBS(Hons) FACD, Consultant Dermatologist, Department of Dermatology, Royal Adelaide Hospital, SA; Clinical Professor, The University of Adelaide, SA
| | - Dinesh Selva
- DHSc FRANZCO, Chairman, South Australian Institute of Ophthalmology, SA; Foundation Chair, The University of Adelaide, SA; Consultant Oculoplastic Ophthalmologist, Royal Adelaide Hospital, SA
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Kakoki M, Bahnson EM, Hagaman JR, Siletzky RM, Grant R, Kayashima Y, Li F, Lee EY, Sun MT, Taylor JM, Rice JC, Almeida MF, Bahr BA, Jennette JC, Smithies O, Maeda-Smithies N. Engulfment and cell motility protein 1 potentiates diabetic cardiomyopathy via Rac-dependent and Rac-independent ROS production. JCI Insight 2019; 4:127660. [PMID: 31217360 DOI: 10.1172/jci.insight.127660] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 01/22/2019] [Accepted: 05/08/2019] [Indexed: 01/31/2023] Open
Abstract
Engulfment and cell motility protein 1 (ELMO1) is part of a guanine nucleotide exchange factor for Ras-related C3 botulinum toxin substrate (Rac), and ELMO1 polymorphisms were identified to be associated with diabetic nephropathy in genome-wide association studies. We generated a set of Akita Ins2C96Y diabetic mice having 5 graded cardiac mRNA levels of ELMO1 from 30% to 200% of normal and found that severe dilated cardiomyopathy develops in ELMO1-hypermorphic mice independent of renal function at age 16 weeks, whereas ELMO1-hypomorphic mice were completely protected. As ELMO1 expression increased, reactive oxygen species indicators, dissociation of the intercalated disc, mitochondrial fragmentation/dysfunction, cleaved caspase-3 levels, and actin polymerization increased in hearts from Akita mice. Cardiomyocyte-specific overexpression in otherwise ELMO1-hypomorphic Akita mice was sufficient to promote cardiomyopathy. Cardiac Rac1 activity was positively correlated with the ELMO1 levels, and oral administration of a pan-Rac inhibitor, EHT1864, partially mitigated cardiomyopathy of the ELMO1 hypermorphs. Disrupting Nox4, a Rac-independent NADPH oxidase, also partially mitigated it. In contrast, a pan-NADPH oxidase inhibitor, VAS3947, markedly prevented cardiomyopathy. Our data demonstrate that in diabetes mellitus ELMO1 is the "rate-limiting" factor of reactive oxygen species production via both Rac-dependent and Rac-independent NADPH oxidases, which in turn trigger cellular signaling cascades toward cardiomyopathy.
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Affiliation(s)
- Masao Kakoki
- Department of Pathology and Laboratory Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Edward M Bahnson
- Department of Pathology and Laboratory Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Department of Surgery, Division of Vascular Surgery, and Department of Cell Biology and Physiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - John R Hagaman
- Department of Pathology and Laboratory Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Robin M Siletzky
- Department of Surgery, Division of Vascular Surgery, and Department of Cell Biology and Physiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Ruriko Grant
- Department of Pathology and Laboratory Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Yukako Kayashima
- Department of Pathology and Laboratory Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Feng Li
- Department of Pathology and Laboratory Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Esther Y Lee
- Department of Pathology and Laboratory Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Michelle T Sun
- Department of Pathology and Laboratory Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Joan M Taylor
- Department of Pathology and Laboratory Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Jessica C Rice
- Biotechnology Research and Training Center, University of North Carolina at Pembroke, Pembroke, North Carolina, USA
| | - Michael F Almeida
- Biotechnology Research and Training Center, University of North Carolina at Pembroke, Pembroke, North Carolina, USA
| | - Ben A Bahr
- Biotechnology Research and Training Center, University of North Carolina at Pembroke, Pembroke, North Carolina, USA
| | - J Charles Jennette
- Department of Pathology and Laboratory Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Oliver Smithies
- Department of Pathology and Laboratory Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Nobuyo Maeda-Smithies
- Department of Pathology and Laboratory Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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Botha VE, Chow KTK, Salmon PJM, El-Khayat RH, Sun MT, Selva D, Ng SGJ. Periorbital desmoplastic squamous cell carcinoma. Orbit 2018; 38:240-243. [PMID: 29985722 DOI: 10.1080/01676830.2018.1490438] [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] [Indexed: 10/28/2022]
Abstract
Desmoplasia is the formation of a dense collagenous stroma around a neoplasm. It occurs in a variety of malignancies including squamous cell carcinoma (SCC). While desmoplasia is uncommonly seen in cutaneous SCC, it is an independent risk factor for recurrence and metastasis. We report a case series of desmoplastic SCC in the periorbital region. Seven cases were identified: the median age was 68, four were men. The mean follow-up was 48 months. Two patients (29%) had aggressive local recurrence: one required salvage surgery including orbital exenteration, parotidectomy, and neck dissection to excise involved parotid and cervical lymph nodes; the other required repeat excision and adjuvant radiotherapy. Desmoplastic SCC is an uncommon but highly aggressive subtype. In the periorbital region, due to the high risk of orbital invasion, it is potentially sight and life-threatening.
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Affiliation(s)
- Verona E Botha
- a Department of Ophthalmology , Waikato Hospital , Hamilton , New Zealand
| | - Kent T K Chow
- a Department of Ophthalmology , Waikato Hospital , Hamilton , New Zealand
| | | | | | - Michelle T Sun
- c South Australian Institute of Ophthalmology, Royal Adelaide Hospital , University of Adelaide , Adelaide , South Australia , Australia
| | - Dinesh Selva
- c South Australian Institute of Ophthalmology, Royal Adelaide Hospital , University of Adelaide , Adelaide , South Australia , Australia
| | - Stephen G J Ng
- a Department of Ophthalmology , Waikato Hospital , Hamilton , New Zealand
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Affiliation(s)
- Albert Wu
- Department of Dermatology; Royal Adelaide Hospital; Adelaide South Australia Australia
| | - Michelle T Sun
- South Australian Institute of Ophthalmology; University of Adelaide; Adelaide South Australia Australia
| | - Sophia Otto
- Department of Surgical Pathology; SA Pathology; Adelaide South Australia Australia
| | - Shyamala C Huilgol
- Department of Dermatology; Royal Adelaide Hospital; Adelaide South Australia Australia
| | - Dinesh Selva
- South Australian Institute of Ophthalmology; University of Adelaide; Adelaide South Australia Australia
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Huang S, Sun MT, Davis G, Fitzgerald J, Selva D, Henderson T. Bilateral orbital compartment syndrome in a patient with disseminated intravascular coagulation. Orbit 2018; 37:361-363. [PMID: 29308942 DOI: 10.1080/01676830.2017.1423359] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
A 39-year-old male developed bilateral periorbital oedema and tense orbits in keeping with orbital compartment syndrome (OCS) shortly after presenting to the emergency department for uncontrollable epistaxis. Bilateral lateral canthotomy and inferior cantholysis was performed within 30 minutes of onset, with the left side further decompressed via superior cantholysis. Computed tomography demonstrated bilateral proptosis and optic nerve stretch, but no intraorbital haemorrhage or haematoma. Laboratory findings were consistent with disseminated intravascular coagulation (DIC) and sepsis of unknown origin. The right visual acuity recovered to 6/6 -2 from counting fingers, but the left eye failed to improve beyond light perception. This unique case of OCS is the first associated with DIC which had no evidence of intraorbital haemorrhage.
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Affiliation(s)
- Sonia Huang
- a Discipline of Ophthalmology and Visual Sciences , The University of Adelaide and the South Australian Institute of Ophthalmology , Adelaide , Australia
| | - Michelle T Sun
- a Discipline of Ophthalmology and Visual Sciences , The University of Adelaide and the South Australian Institute of Ophthalmology , Adelaide , Australia
| | - Garry Davis
- a Discipline of Ophthalmology and Visual Sciences , The University of Adelaide and the South Australian Institute of Ophthalmology , Adelaide , Australia
| | - Jude Fitzgerald
- b Department of Ophthalmology , Alice Springs Hospital , Alice Springs , Australia
| | - Dinesh Selva
- a Discipline of Ophthalmology and Visual Sciences , The University of Adelaide and the South Australian Institute of Ophthalmology , Adelaide , Australia
| | - Tim Henderson
- b Department of Ophthalmology , Alice Springs Hospital , Alice Springs , Australia
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25
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Affiliation(s)
- Michelle T Sun
- South Australian Institute of Ophthalmology, The University of Adelaide and Royal Adelaide Hospital, Adelaide, South Australia
| | - Christopher X Wong
- Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia.,Clinical Trial Service Unit and Epidemiological Studies Unit, University of Oxford, Oxford, United Kingdom
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Abstract
The authors report a case of neurotropic nondesmoplastic melanoma involving the ophthalmic division of the trigeminal nerve and the cavernous sinus in a patient with recurrent scalp melanoma. This case highlights the importance of earlier diagnosis of local recurrence of melanoma and the rare association of neurotropic melanoma and orbital metastasis.
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Affiliation(s)
- Su Jen Chua
- Discipline of Ophthalmology and Visual Sciences, The University of Adelaide and the South Australian Institute of Ophthalmology, Adelaide, Australia
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27
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Sun MT, Wood MK, Chan W, Selva D, Sanders P, Casson RJ, Wong CX. Risk of Intraocular Bleeding With Novel Oral Anticoagulants Compared With Warfarin: A Systematic Review and Meta-analysis. JAMA Ophthalmol 2017; 135:864-870. [PMID: 28687831 PMCID: PMC5710315 DOI: 10.1001/jamaophthalmol.2017.2199] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [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: 01/17/2017] [Accepted: 05/22/2017] [Indexed: 12/11/2022]
Abstract
Importance It is unclear if the risk of intraocular bleeding with novel oral anticoagulants differs compared with warfarin. Objective To characterize the risk of intraocular bleeding with novel oral anticoagulants compared with warfarin. Data Sources A systematic review and meta-analysis was undertaken in an academic medical setting. MEDLINE and ClinicalTrials.gov were searched for randomized clinical trials published up until August 2016. This search was supplemented by manual bibliography searches of identified trials and other review articles. Study Selection Studies were eligible for inclusion if they were phase 3 randomized clinical trials, enrolled patients with atrial fibrillation or venous thromboembolism, compared a novel oral anticoagulant (dabigatran, rivaroxaban, apixaban, or edoxaban) with warfarin, and recorded event data on intraocular bleeding. Data on intraocular bleeding were pooled using inverse-variance, weighted, fixed-effects meta-analysis. Data Extraction and Synthesis The PRISMA guidelines were used for abstracting data and assessing quality. Independent extraction was performed by 2 investigators. Main Outcomes and Measures Intraocular bleeding events and associated risk ratio for novel oral anticoagulants compared with warfarin. Results Twelve trials investigating 102 627 patients were included. Randomization to novel oral anticoagulants was associated with a 22% relative reduction in intraocular bleeding compared with warfarin (risk ratio, 0.78; 95% CI, 0.61-0.99). There was no significant heterogeneity observed (I2 = 4.8%, P = .40). Comparably lower risks of intraocular bleeding with novel oral anticoagulants were seen in subgroup analyses, with no significant difference according to the indication for anticoagulation (P for heterogeneity = .49) or the novel oral anticoagulant type (P for heterogeneity = .15). Summary estimates did not differ materially when random-effects meta-analytic techniques were used. Conclusions and Relevance These results suggest that novel oral anticoagulants reduce the risk of intraocular bleeding by approximately one-fifth compared with warfarin. Similar benefits were seen in both patients with atrial fibrillation and venous thromboembolism. Our data have particular relevance for patients at higher risk of spontaneous retinal and subretinal bleeding. These findings may also have important implications in the perioperative period, in which the use of novel oral anticoagulants may be superior. Future studies are required to better characterize the optimal management of patients with both ophthalmic disease and cardiovascular comorbidities requiring anticoagulation.
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Affiliation(s)
- Michelle T. Sun
- South Australian Institute of Ophthalmology, The University of Adelaide and Royal Adelaide Hospital, Adelaide
| | - Megan K. Wood
- South Australian Institute of Ophthalmology, The University of Adelaide and Royal Adelaide Hospital, Adelaide
| | - WengOnn Chan
- South Australian Institute of Ophthalmology, The University of Adelaide and Royal Adelaide Hospital, Adelaide
| | - Dinesh Selva
- South Australian Institute of Ophthalmology, The University of Adelaide and Royal Adelaide Hospital, Adelaide
| | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, The University of Adelaide and Royal Adelaide Hospital, Adelaide
| | - Robert J. Casson
- South Australian Institute of Ophthalmology, The University of Adelaide and Royal Adelaide Hospital, Adelaide
| | - Christopher X. Wong
- Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, The University of Adelaide and Royal Adelaide Hospital, Adelaide
- Clinical Trial Service Unit and Epidemiological Studies Unit, University of Oxford, Oxford, England
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Sun MT, Rajak S, James C, Huilgol SC, Selva D. Pigmented squamous cell carcinoma in situ of the eyelid. Australas J Dermatol 2017; 58:e275-e276. [PMID: 28660705 DOI: 10.1111/ajd.12550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Michelle T Sun
- South Australian Institute of Ophthalmology, The University of Adelaide and Royal Adelaide Hospital, Adelaide, South Australia, Austraia
| | - Saul Rajak
- South Australian Institute of Ophthalmology, The University of Adelaide and Royal Adelaide Hospital, Adelaide, South Australia, Austraia
| | - Craig James
- Department of Histopathology, Adelaide Pathology Partners/Clinpath, Adelaide, South Australia, Austraia
| | - Shyamala C Huilgol
- Department of Dermatology, Royal Adelaide Hospital, University of Adelaide, Adelaide, South Australia, Austraia
| | - Dinesh Selva
- South Australian Institute of Ophthalmology, The University of Adelaide and Royal Adelaide Hospital, Adelaide, South Australia, Austraia
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29
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Affiliation(s)
- Michelle T Sun
- Discipline of Ophthalmology and Visual Sciences, University of Adelaide and The South Australian Institute of Ophthalmology, Adelaide, South Australia, Australia
| | - Saul Rajak
- Discipline of Ophthalmology and Visual Sciences, University of Adelaide and The South Australian Institute of Ophthalmology, Adelaide, South Australia, Australia
| | - Craig James
- Department of Histopathology, Adelaide Pathology Partners/Clinpath, Adelaide, South Australia, Australia
| | - Shyamala C Huilgol
- Department of Dermatology, Royal Adelaide Hospital, University of Adelaide, Adelaide, South Australia, Australia
| | - Dinesh Selva
- Discipline of Ophthalmology and Visual Sciences, University of Adelaide and The South Australian Institute of Ophthalmology, Adelaide, South Australia, Australia
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30
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Sun MT, Rajak S, Selva D, Smith H. Periocular basal cell carcinoma: a comprehensive review. Expert Review of Ophthalmology 2017. [DOI: 10.1080/17469899.2017.1318066] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Wong CX, Sun MT, Odutayo A, Emdin CA, Mahajan R, Lau DH, Pathak RK, Wong DT, Selvanayagam JB, Sanders P, Clarke R. Associations of Epicardial, Abdominal, and Overall Adiposity With Atrial Fibrillation. Circ Arrhythm Electrophysiol 2016; 9:CIRCEP.116.004378. [DOI: 10.1161/circep.116.004378] [Citation(s) in RCA: 93] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Accepted: 11/03/2016] [Indexed: 01/06/2023]
Abstract
Background—
Although adiposity is increasingly recognized as a risk factor for atrial fibrillation (AF), the importance of epicardial fat compared with other adipose tissue depots remains uncertain. We sought to characterize and compare the associations of AF with epicardial fat and measures of abdominal and overall adiposity.
Methods and Results—
We conducted a meta-analysis of 63 observational studies including 352 275 individuals, comparing AF risk for 1-SD increases in epicardial fat, waist circumference, waist/hip ratio, and body mass index. A 1-SD higher epicardial fat volume was associated with a 2.6-fold higher odds of AF (odds ratio, 2.61; 95% confidence interval [CI], 1.89–3.60), 2.1-fold higher odds of paroxysmal AF (odds ratio, 2.14; 95% CI, 1.45–3.16) and, 5.4-fold higher odds of persistent AF (odds ratio, 5.43; 95% CI, 3.24–9.12) compared with sinus rhythm. Likewise, a 1-SD higher epicardial fat volume was associated with 2.2-fold higher odds of persistent compared with paroxysmal AF (odds ratio, 2.19; 95% CI, 1.66–2.88). Similar associations existed for postablation, postoperative, and postcardioversion AF. In contrast, associations of abdominal and overall adiposity with AF were less extreme, with relative risks per 1-SD higher values of 1.32 (95% CI, 1.25–1.41) for waist circumference, 1.11 (95% CI, 1.08–1.14) for waist/hip ratio, and 1.22 (95% CI, 1.17–1.27) for body mass index.
Conclusions—
Strong and graded associations were observed between increasing epicardial fat and AF. Moreover, the strength of associations of AF with epicardial fat is greater than for measures of abdominal or overall adiposity. Further studies are needed to assess the mechanisms and clinical relevance of epicardial fat.
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Affiliation(s)
- Christopher X. Wong
- From the Clinical Trial Service Unit and Epidemiological Studies Unit (C.X.W., R.C.), George Institute for Global Health (C.A.E.), Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (A.O.), University of Oxford, United Kingdom; Churchill Hospital, Oxford University Hospitals NHS Trust, United Kingdom (M.T.S.); Faculty of Medicine, University of Toronto, Ontario, Canada (A.O.); Centre for Heart Rhythm Disorders, South Australian Health
| | - Michelle T. Sun
- From the Clinical Trial Service Unit and Epidemiological Studies Unit (C.X.W., R.C.), George Institute for Global Health (C.A.E.), Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (A.O.), University of Oxford, United Kingdom; Churchill Hospital, Oxford University Hospitals NHS Trust, United Kingdom (M.T.S.); Faculty of Medicine, University of Toronto, Ontario, Canada (A.O.); Centre for Heart Rhythm Disorders, South Australian Health
| | - Ayodele Odutayo
- From the Clinical Trial Service Unit and Epidemiological Studies Unit (C.X.W., R.C.), George Institute for Global Health (C.A.E.), Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (A.O.), University of Oxford, United Kingdom; Churchill Hospital, Oxford University Hospitals NHS Trust, United Kingdom (M.T.S.); Faculty of Medicine, University of Toronto, Ontario, Canada (A.O.); Centre for Heart Rhythm Disorders, South Australian Health
| | - Connor A. Emdin
- From the Clinical Trial Service Unit and Epidemiological Studies Unit (C.X.W., R.C.), George Institute for Global Health (C.A.E.), Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (A.O.), University of Oxford, United Kingdom; Churchill Hospital, Oxford University Hospitals NHS Trust, United Kingdom (M.T.S.); Faculty of Medicine, University of Toronto, Ontario, Canada (A.O.); Centre for Heart Rhythm Disorders, South Australian Health
| | - Rajiv Mahajan
- From the Clinical Trial Service Unit and Epidemiological Studies Unit (C.X.W., R.C.), George Institute for Global Health (C.A.E.), Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (A.O.), University of Oxford, United Kingdom; Churchill Hospital, Oxford University Hospitals NHS Trust, United Kingdom (M.T.S.); Faculty of Medicine, University of Toronto, Ontario, Canada (A.O.); Centre for Heart Rhythm Disorders, South Australian Health
| | - Dennis H. Lau
- From the Clinical Trial Service Unit and Epidemiological Studies Unit (C.X.W., R.C.), George Institute for Global Health (C.A.E.), Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (A.O.), University of Oxford, United Kingdom; Churchill Hospital, Oxford University Hospitals NHS Trust, United Kingdom (M.T.S.); Faculty of Medicine, University of Toronto, Ontario, Canada (A.O.); Centre for Heart Rhythm Disorders, South Australian Health
| | - Rajeev K. Pathak
- From the Clinical Trial Service Unit and Epidemiological Studies Unit (C.X.W., R.C.), George Institute for Global Health (C.A.E.), Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (A.O.), University of Oxford, United Kingdom; Churchill Hospital, Oxford University Hospitals NHS Trust, United Kingdom (M.T.S.); Faculty of Medicine, University of Toronto, Ontario, Canada (A.O.); Centre for Heart Rhythm Disorders, South Australian Health
| | - Dennis T. Wong
- From the Clinical Trial Service Unit and Epidemiological Studies Unit (C.X.W., R.C.), George Institute for Global Health (C.A.E.), Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (A.O.), University of Oxford, United Kingdom; Churchill Hospital, Oxford University Hospitals NHS Trust, United Kingdom (M.T.S.); Faculty of Medicine, University of Toronto, Ontario, Canada (A.O.); Centre for Heart Rhythm Disorders, South Australian Health
| | - Joseph B. Selvanayagam
- From the Clinical Trial Service Unit and Epidemiological Studies Unit (C.X.W., R.C.), George Institute for Global Health (C.A.E.), Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (A.O.), University of Oxford, United Kingdom; Churchill Hospital, Oxford University Hospitals NHS Trust, United Kingdom (M.T.S.); Faculty of Medicine, University of Toronto, Ontario, Canada (A.O.); Centre for Heart Rhythm Disorders, South Australian Health
| | - Prashanthan Sanders
- From the Clinical Trial Service Unit and Epidemiological Studies Unit (C.X.W., R.C.), George Institute for Global Health (C.A.E.), Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (A.O.), University of Oxford, United Kingdom; Churchill Hospital, Oxford University Hospitals NHS Trust, United Kingdom (M.T.S.); Faculty of Medicine, University of Toronto, Ontario, Canada (A.O.); Centre for Heart Rhythm Disorders, South Australian Health
| | - Robert Clarke
- From the Clinical Trial Service Unit and Epidemiological Studies Unit (C.X.W., R.C.), George Institute for Global Health (C.A.E.), Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (A.O.), University of Oxford, United Kingdom; Churchill Hospital, Oxford University Hospitals NHS Trust, United Kingdom (M.T.S.); Faculty of Medicine, University of Toronto, Ontario, Canada (A.O.); Centre for Heart Rhythm Disorders, South Australian Health
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Sun MT, Wood M, Chan W, Casson R. Pressures generated during corneal wound hydration. J Cataract Refract Surg 2016; 42:1383-1384. [PMID: 27697259 DOI: 10.1016/j.jcrs.2016.07.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Accepted: 07/20/2016] [Indexed: 11/29/2022]
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Watanabe A, Wu A, Sun MT, Inatani M, Katori N, Selva D. Haemangiopericytoma of the lacrimal sac. Orbit 2016; 35:233-5. [PMID: 27322416 DOI: 10.1080/01676830.2016.1176208] [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] [Indexed: 10/21/2022]
Abstract
Haemangiopericytomas (HPCs) are rare tumours which infrequently occur in the lacrimal sac. Only 8 cases of lacrimal sac HPC have previously been reported. The authors report 2 additional cases presenting clinically with epiphora and a mass. One case recurred 3 times during an 18-year period. The other case did not recur during 51 months of follow-up. The tumours showed immunohistochemical features consistent with a diagnosis of HPC. The authors recommend wide excision for these tumours and careful long-term follow-up to detect recurrence which is not uncommon.
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Affiliation(s)
- Akihide Watanabe
- a Department of Ophthalmology , Kyoto Prefectural University of Medicine , Kyoto , Japan
| | - Albert Wu
- b South Australian Institute of Ophthalmology, University of Adelaide , Adelaide , Australia
| | - Michelle T Sun
- b South Australian Institute of Ophthalmology, University of Adelaide , Adelaide , Australia
| | - Masaru Inatani
- c Department of Ophthalmology , Fukui University , Fukui , Japan
| | - Nobutada Katori
- d Department of Oculoplastic and Orbital Surgery , Seirei Hamamatsu Hospital , Shizuoka , Japan
| | - Dinesh Selva
- b South Australian Institute of Ophthalmology, University of Adelaide , Adelaide , Australia
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Abstract
Basal cell carcinoma (BCC) is the most common eyelid malignancy; however, orbital invasion by periocular BCC is rare, and management remains challenging. Established risk factors for orbital invasion by BCC include male gender, advanced age, medial canthal location, previous recurrences, large tumor size, aggressive histologic subtype and perineural invasion. Management requires a multidisciplinary approach with orbital exenteration remaining the treatment of choice. Globe-sparing treatment may be appropriate in selected patients and radiotherapy and chemotherapy are often used as adjuvant therapies for advanced or inoperable cases, although the evidence remains limited. We aim to summarize the presentation and treatment of BCC with orbital invasion to better guide the management of this complex condition.
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Affiliation(s)
- Michelle T Sun
- South Australian Institute of Ophthalmology, Royal Adelaide Hospital & University of Adelaide, Adelaide, South Australia 5000, Australia
| | - Albert Wu
- South Australian Institute of Ophthalmology, Royal Adelaide Hospital & University of Adelaide, Adelaide, South Australia 5000, Australia
| | - Edwin Figueira
- South Australian Institute of Ophthalmology, Royal Adelaide Hospital & University of Adelaide, Adelaide, South Australia 5000, Australia
| | - Shyamala Huilgol
- Department of Dermatology, Royal Adelaide Hospital & University of Adelaide, Adelaide, South Australia 5000, Australia
| | - Dinesh Selva
- South Australian Institute of Ophthalmology, Royal Adelaide Hospital & University of Adelaide, Adelaide, South Australia 5000, Australia
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35
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Collinson AC, Sun MT, James C, Huilgol SC, Selva D. Endocrine mucin-producing sweat gland carcinoma of the eyelid. Int Ophthalmol 2015; 35:883-6. [DOI: 10.1007/s10792-015-0127-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Accepted: 09/12/2015] [Indexed: 10/23/2022]
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36
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Wong CX, Sullivan T, Sun MT, Mahajan R, Pathak RK, Middeldorp M, Twomey D, Ganesan AN, Rangnekar G, Roberts-Thomson KC, Lau DH, Sanders P. Obesity and the Risk of Incident, Post-Operative, and Post-Ablation Atrial Fibrillation. JACC Clin Electrophysiol 2015; 1:139-152. [DOI: 10.1016/j.jacep.2015.04.004] [Citation(s) in RCA: 128] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Revised: 03/13/2015] [Accepted: 04/09/2015] [Indexed: 01/22/2023]
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Sun MT, Andrew NH, O'Donnell B, McNab A, Huilgol SC, Selva D. Periocular Squamous Cell Carcinoma: TNM Staging and Recurrence. Ophthalmology 2015; 122:1512-6. [PMID: 25972255 DOI: 10.1016/j.ophtha.2015.04.002] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Revised: 04/03/2015] [Accepted: 04/03/2015] [Indexed: 10/23/2022] Open
Abstract
PURPOSE To analyze the TNM stage, management, and recurrence rates of patients with histologically confirmed squamous cell carcinoma (SCC) of the eyelid. DESIGN Retrospective case series from 3 Australian centers. PARTICIPANTS A total of 254 cases of eyelid SCC from 254 patients (median age, 73 years; range, 28-102 years; 159 were male). METHODS Tumors were staged according to The American Joint Committee on Cancer 7th edition TNM criteria for eyelid carcinoma. MAIN OUTCOME MEASURES Outcomes and recurrence rates according to TNM stage at presentation. RESULTS A total of 25 cases (9.8%) were recurrent tumors. TNM classifications were as follows: T1N0M0, 74 patients (29.1%); T2aN0M0, 92 patients (36.2%); T2bN0M0, 50 patients (19.7%); T3aN0M0, 31 patients (12.2%); T3bN0M0, 5 patients (2.0%); T2bN0M1, 1 patient (0.4%); and T3bN1M1, 1 patient (0.4%). Perineural invasion (PNI) was present histologically in 8.3% of cases. Treatment modalities included Mohs microsurgery (31.1%), wide local excision (WLE) with paraffin section control (21.7%), WLE with frozen-section control (19.3%), and excision without margin control (24.4%). Three cases did not receive treatment. Median follow-up was 40 months (range, <1-132 months). Local recurrence occurred in 17 treated patients (6.8%). The recurrence rate was 5.3% (12/226 patients) for primary tumors and 20% (5/25 patients) for recurrent tumors (P = 0.019). Four patients (1.6%) died of their disease during follow-up. Higher T stage was significantly associated with both PNI (P = 0.035) and local recurrence (P < 0.001). We could not identify a T-stage threshold below which there was no risk of recurrence, as evidenced by 3 T1 primary tumors that recurred. CONCLUSIONS Higher T stage was significantly associated with local recurrence, and recurrent tumors had a 4-fold increased risk of further recurrence compared with primary tumors. Therefore, it may be reasonable to consider sentinel lymph node biopsy or close nodal surveillance and follow-up for patients with recurrent or high T-stage tumors. Of note, we could not identify a T-stage threshold below which there was no risk of recurrences; therefore, clinicians should be aware of the potential for low T-stage tumors to recur.
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Affiliation(s)
- Michelle T Sun
- South Australian Institute of Ophthalmology, University of Adelaide, Adelaide, South Australia, Australia.
| | - Nicholas H Andrew
- South Australian Institute of Ophthalmology, University of Adelaide, Adelaide, South Australia, Australia
| | - Brett O'Donnell
- Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Alan McNab
- Orbital Plastic and Lacrimal Clinic, Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia
| | - Shyamala C Huilgol
- Department of Dermatology, Royal Adelaide Hospital, University of Adelaide, Adelaide, South Australia, Australia
| | - Dinesh Selva
- South Australian Institute of Ophthalmology, University of Adelaide, Adelaide, South Australia, Australia
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Sun MT, Pirbhai A, Selva D. Bacterial biofilms associated with ocular prostheses. Clin Exp Ophthalmol 2015; 43:602-3. [PMID: 25727693 DOI: 10.1111/ceo.12514] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Accepted: 02/20/2015] [Indexed: 11/27/2022]
Affiliation(s)
- Michelle T Sun
- Discipline of Ophthalmology and Visual Sciences, South Australian Institute of Ophthalmology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Adnan Pirbhai
- Discipline of Ophthalmology and Visual Sciences, South Australian Institute of Ophthalmology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Dinesh Selva
- Discipline of Ophthalmology and Visual Sciences, South Australian Institute of Ophthalmology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
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Wu W, Selva D, Bian Y, Wang X, Sun MT, Kong Q, Yan W. Endoscopic medial orbital fat decompression for proptosis in type 1 graves orbitopathy. Am J Ophthalmol 2015; 159:277-84. [PMID: 25448997 DOI: 10.1016/j.ajo.2014.10.029] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Revised: 10/26/2014] [Accepted: 10/27/2014] [Indexed: 11/29/2022]
Abstract
PURPOSE To describe the surgical technique for endoscopic medial orbital fat decompression in type 1 (lipogenic) Graves orbitopathy and report outcomes. DESIGN Retrospective interventional case review. METHODS We reviewed 108 patients (206 orbits) with inactive, type 1 Graves orbitopathy without diplopia, who underwent endoscopic medial orbital fat decompression solely for proptosis reduction. Following endoscopic transethmoid medial orbital wall decompression, extraconal and intraconal orbital fat was removed with a low-suction cutting instrument. All patients were followed up for at least 12 months. Surgical time, preoperative and postoperative Hertel exophthalmometry, incidence of postoperative diplopia within 30-degree visual field in the primary gaze, and other complications were analyzed. RESULTS The mean surgical time was 97.7 ± 16.7 minutes (67-136 minutes). The mean follow-up was 16.0 ± 4.2 months (12-24 months). Preoperative and postoperative proptosis values at final review were 21.1 ± 2.3 mm (17-26 mm) and 13.0 ± 0.9 mm (12-15 mm), respectively (P < .001). Median reduction in proptosis was 8.0 mm with mean of 8.2 ± 1.8 mm (4-11 mm). Symmetry to within 2 mm was achieved in 106 of 108 patients (98.1%). Twenty-five of 108 patients (23.1%) had diplopia within 30-degree visual field of the gaze, and 23 of these had complete resolution within 3 months, while the remaining 2 patients required squint surgery. CONCLUSIONS Endoscopic medial orbital fat decompression may be an effective technique for proptosis in selected patients with type 1 Graves orbitopathy and is associated with a low rate of surgically induced diplopia.
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Affiliation(s)
- Wencan Wu
- Department of Orbital & Oculoplastic Surgery, The Eye Hospital of Wenzhou Medical University, Wenzhou, China.
| | - Dinesh Selva
- Discipline of Ophthalmology & Visual Sciences, University of Adelaide and South Australian Institute of Ophthalmology, Adelaide, Australia
| | - Yang Bian
- Department of Orbital & Oculoplastic Surgery, The Eye Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xiaopeng Wang
- Department of Ophthalmology, Jinhua Center Hospital, Jinhua, China
| | - Michelle T Sun
- Discipline of Ophthalmology & Visual Sciences, University of Adelaide and South Australian Institute of Ophthalmology, Adelaide, Australia
| | - Qiao Kong
- Department of Ophthalmology, Lihuili Hospital, Ningbo, China
| | - Wentao Yan
- Department of Orbital & Oculoplastic Surgery, The Eye Hospital of Wenzhou Medical University, Wenzhou, China
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Sun MT, Wu W, Watanabe A, Kakizaki H, Chen B, Ueda K, Katori N, Takahashi Y, Selva D. Orbital blowout fracture location in Japanese and Chinese patients. Jpn J Ophthalmol 2014; 59:65-9. [PMID: 25377495 DOI: 10.1007/s10384-014-0357-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [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: 04/05/2014] [Accepted: 09/05/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE To characterize the location of orbital blowout fractures in Asian individuals. METHODS This was a retrospective review of 470 consecutive Asian patients with orbital blowout fractures who presented to four tertiary care hospitals in Japan and China. Computed tomography (CT) characterized the location and severity of fractures involving the medial wall, the orbital floor, and/or the maxilloethmoidal strut. RESULTS A total of 475 orbital blowout fractures were identified. More than one fracture location was involved in 19% of all cases. The medial orbital wall was the most commonly involved location, presenting in 29 cases (61%), of which 204 (43%) were isolated medial blowout fractures. The orbital floor was the second most common location involved, present in 226 cases (48%) with 150 isolated orbital floor fractures (32%), while the maxilloethmoidal strut was involved in 45 cases (9%) with 30 of those being isolated strut fractures (6%). The majority of fractures (62%) were classified as moderately severe, whilst 14% were mild, and 24% were severe. Associated nasal fractures were present in 16% of the cases. CONCLUSIONS Orbital blowout fractures in Japanese and Chinese individuals occur most commonly in the medial wall. This is in contrast to previous reports on white individuals, who tend to sustain fractures involving the orbital floor rather than the medial wall.
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Affiliation(s)
- Michelle T Sun
- Discipline of Ophthalmology and Visual Sciences, The University of Adelaide, South Australian Institute of Ophthalmology and Royal Adelaide Hospital, Adelaide, Australia,
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Li YQ, Ma FC, Sun MT. Accurate ab initio-based adiabatic global potential energy surface for the 2(2)A" state of NH2 by extrapolation to the complete basis set limit. J Chem Phys 2014; 139:154305. [PMID: 24160511 DOI: 10.1063/1.4824188] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
A full three-dimensional global potential energy surface is reported first time for the title system, which is important for the photodissociation processes. It is obtained using double many-body expansion theory and an extensive set of accurate ab initio energies extrapolated to the complete basis set limit. Such a work can be recommended for dynamics studies of the N((2)D) + H2 reaction, a reliable theoretical treatment of the photodissociation dynamics and as building blocks for constructing the double many-body expansion potential energy surface of larger nitrogen/hydrogen containing systems. In turn, a preliminary theoretical study of the reaction N((2)D)+H2(X(1)Σg (+))(ν=0,j=0)→NH(a(1)Δ)+H((2)S) has been carried out with the method of quasi-classical trajectory on the new potential energy surface. Integral cross sections and thermal rate constants have been calculated, providing perhaps the most reliable estimate of the integral cross sections and the rate constants known thus far for such a reaction.
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Affiliation(s)
- Y Q Li
- Department of Physics, Liaoning University, Shenyang 110036, China
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Sun MT, Chan WO, Selva D. Traumatic orbital compartment syndrome: Importance of the lateral canthomy and cantholysis. Emerg Med Australas 2014; 26:274-8. [DOI: 10.1111/1742-6723.12236] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/23/2014] [Indexed: 11/28/2022]
Affiliation(s)
- Michelle T Sun
- Discipline of Ophthalmology and Visual Sciences; South Australian Institute of Ophthalmology and Royal Adelaide Hospital; Adelaide South Australia Australia
| | - Weng Onn Chan
- Discipline of Ophthalmology and Visual Sciences; South Australian Institute of Ophthalmology and Royal Adelaide Hospital; Adelaide South Australia Australia
| | - Dinesh Selva
- Discipline of Ophthalmology and Visual Sciences; South Australian Institute of Ophthalmology and Royal Adelaide Hospital; Adelaide South Australia Australia
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Wu A, Sun MT, Huilgol SC, Madge S, Selva D. Histological subtypes of periocular basal cell carcinoma. Clin Exp Ophthalmol 2014; 42:603-7. [DOI: 10.1111/ceo.12298] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2013] [Accepted: 01/16/2014] [Indexed: 12/29/2022]
Affiliation(s)
- Albert Wu
- South Australian Institute of Ophthalmology; University of Adelaide; Adelaide South Australia Australia
| | - Michelle T Sun
- South Australian Institute of Ophthalmology; University of Adelaide; Adelaide South Australia Australia
| | - Shyamala C Huilgol
- Department of Dermatology; Royal Adelaide Hospital; University of Adelaide; Adelaide South Australia Australia
| | - Simon Madge
- South Australian Institute of Ophthalmology; University of Adelaide; Adelaide South Australia Australia
- Department of Ophthalmology; Hereford County Hospital; Hereford UK
| | - Dinesh Selva
- South Australian Institute of Ophthalmology; University of Adelaide; Adelaide South Australia Australia
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Herbert HM, Sun MT, Selva D, Fernando B, Saleh GM, Beaconsfield M, Collin R, Uddin J, Meligonis G, Leatherbarrow B, Ataullah S, Irion L, Mclean CJ, Huilgol SC, Davis G, Sullivan TJ. Merkel Cell Carcinoma of the Eyelid. JAMA Ophthalmol 2014; 132:197-204. [DOI: 10.1001/jamaophthalmol.2013.6077] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
| | - Michelle T. Sun
- South Australian Institute of Ophthalmology, Royal Adelaide Hospital, University of Adelaide, South Australia, Australia
| | - Dinesh Selva
- South Australian Institute of Ophthalmology, Royal Adelaide Hospital, University of Adelaide, South Australia, Australia
| | - Bertie Fernando
- Manchester Royal Eye Hospital, Manchester, Manchester, England
| | - George M. Saleh
- Moorfields Eye Hospital, London, England4National Institute for Health Research Biomedical Research Centre at Moorfields Eye Hospital and University College London Institute of Ophthalmology, London, England5Department of Ophthalmology, Royal Surrey Count
| | | | | | | | | | | | - Sajid Ataullah
- Manchester Royal Eye Hospital, Manchester, Manchester, England
| | - Lucianne Irion
- Manchester Royal Eye Hospital, Manchester, Manchester, England
| | - Chris J. Mclean
- Department of Ophthalmology, Royal Surrey County Hospital, Guildford, Surrey, England
| | - Shyamala C. Huilgol
- Department of Dermatology, Royal Adelaide Hospital, University of Adelaide, Adelaide, South Australia, Australia
| | - Garry Davis
- South Australian Institute of Ophthalmology, Royal Adelaide Hospital, University of Adelaide, South Australia, Australia
| | - Timothy J. Sullivan
- Department of Ophthalmology, Royal Brisbane Hospital Herston, Queensland, Australia
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Affiliation(s)
- Michelle T Sun
- South Australian Institute of Ophthalmology, University of Adelaide, , South Australia, Australia
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46
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Affiliation(s)
- Michelle T Sun
- South Australian Institute of Ophthalmology, University of Adelaide, , Adelaide, South Australia, Australia
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Watanabe A, Sun MT, Pirbhai A, Ueda K, Katori N, Selva D. Sebaceous carcinoma in Japanese patients: clinical presentation, staging and outcomes. Br J Ophthalmol 2013; 97:1459-63. [DOI: 10.1136/bjophthalmol-2013-303758] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Wu W, Selva D, Jiang F, Jing W, Tu Y, Chen B, Shi J, Sun MT, Qu J. Endoscopic transethmoidal approach with or without medial rectus detachment for orbital apical cavernous hemangiomas. Am J Ophthalmol 2013; 156:593-599. [PMID: 23810472 DOI: 10.1016/j.ajo.2013.05.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2013] [Revised: 05/02/2013] [Accepted: 05/02/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE To determine the indications for the addition of a transcaruncular approach along with detachment of the medial rectus muscle during the removal of small apical cavernous hemangiomas using an endoscopic transethmoidal approach. DESIGN Retrospective, noncomparative case series. METHODS Multicenter study of 12 patients with apical orbital tumors removed using an endoscopic transethmoidal approach. The decision to detach the medial rectus muscle with the addition of a transcaruncular approach was made during surgery for tumors largely lateral to the medial rectus muscle. Tumors adjacent to the medial orbital wall were removed via an endoscopic transethmoidal approach alone. RESULTS Seven tumors were removed via an endoscopic transethmoidal approach combined with medial rectus muscle detachment, whereas 5 patients underwent removal without detachment of the medial rectus. All patients had visual impairment. Complete excision of the hemangiomas was achieved in all patients and tumor size ranged from 6 × 5 mm to 20 × 12 mm. The mean postoperative follow-up time was 11.8 ± 4.3 months. At final follow-up, the best-corrected visual acuity improved in 11 patients. Three patients had transient horizontal diplopia resulting from partial paralysis of the medial rectus muscle after detachment during surgery. CONCLUSIONS The endoscopic transethmoidal approach with or without medial rectus detachment is a promising approach for selected small cavernous hemangiomas located at the deep medial orbital apex. Detachment of the medial rectus muscle can be a useful technique for tumors located largely lateral to the medial rectus muscle. Further studies will be required to demonstrate the safety and efficacy of this technique.
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Wong CX, Sun MT, Cheng YH, Dang J, Barlow DS, Chia NH, Wong NX, Wong MX, Lau DH, Brooks AG, Roberts-Thomson KC, Sanders P. Temporal and comparative outcomes of cardiac electrophysiology abstracts. Am J Cardiol 2013; 112:251-4. [PMID: 23582627 DOI: 10.1016/j.amjcard.2013.03.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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] [Received: 12/23/2012] [Revised: 03/08/2013] [Accepted: 03/08/2013] [Indexed: 11/19/2022]
Abstract
Although conferences are important vehicles for discussing scientific findings, the translation of presented research into peer-reviewed manuscripts is a crucial subsequent step in the research process. Given the evolving subspecialization of cardiology, we sought to characterize the temporal and comparative outcomes of abstracts presented at a subspecialty cardiac electrophysiology conference. Abstracts presented at the Heart Rhythm Society conference (1994 through 2006; HRS abstracts) and abstracts presented at the American Heart Association conference (2003; AHA abstracts) were studied. Subsequent publications, impact factors, and citation rates were determined. A total of 3,850 HRS and 1,000 AHA abstracts were studied. More human abstracts were presented at HRS than AHA (p <0.05). Compared with HRS abstracts, more AHA abstracts were published (p <0.001) and had higher impact factors and citation rates (p <0.001 for both). These differences were attributable in part to the greater proportion of human HRS abstracts. Compared with HRS abstracts, electrophysiology-related AHA abstracts were published less (p <0.001), and these publications had similar impact factors (p = 0.38) although greater citation rates (p = 0.001). The number and publication rate of HRS abstracts increased over the 15-year period, as did their publication impact factors and citation rates (p <0.001 for all). In conclusion, there are significant differences between AHA and HRS abstracts. Although AHA abstracts were more likely to be published overall, the publication rate and impact of electrophysiology abstracts presented at both a subspecialty (HRS) and a major cardiovascular conference (AHA) were comparable. There has also been a growth in the number and impact of cardiac electrophysiology abstracts presented at HRS in recent years.
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Affiliation(s)
- Christopher X Wong
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia.
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Wong CX, Brooks AG, Lau DH, Leong DP, Sun MT, Sullivan T, Roberts-Thomson KC, Sanders P. Factors associated with the epidemic of hospitalizations due to atrial fibrillation. Am J Cardiol 2012; 110:1496-9. [PMID: 22883163 DOI: 10.1016/j.amjcard.2012.07.011] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2012] [Revised: 07/04/2012] [Accepted: 07/04/2012] [Indexed: 11/28/2022]
Abstract
Recent reports have described that hospitalizations for atrial fibrillation (AF) are continuing to increase. Given that hospitalizations are responsible for most of the economic burden associated with AF, the aim of this study was to characterize the impact of age and how changing procedural practices may be contributing to the increasing rates of AF hospitalizations. The annual age- and gender-specific incidence of hospitalizations for AF, electrical cardioversions, electrophysiologic studies, and radiofrequency ablation procedures in Australia were determined from 1993 to 2007 inclusive. Over this 15-year follow-up period spanning almost 300 million person-years, a total of 473,501 hospitalizations for AF were identified. There was a relative increase in AF hospitalizations of 203% over the study period, in contrast to an increase for all hospitalizations of only 71%. Whereas the gender-specific incidence of hospitalizations remained stable, the age-specific incidence increased significantly over the study period, particularly in older age groups. AF hospitalizations associated with electrical cardioversions decreased from 27% to 14% over the study period. Electrophysiologic studies and radiofrequency ablation procedures contributed minimally to the overall increase in AF hospitalizations observed. In conclusion, in addition to the growing prevalence of AF because of the aging population, there is an increasing age-specific incidence of hospitalizations for AF, particularly in older age groups. In contrast, changing procedural trends have contributed minimally to the increasing number of AF-associated hospitalizations. Greater attention to older patients with AF is required to develop strategies to prevent hospitalizations and contain the growing burden on health care systems.
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Affiliation(s)
- Christopher X Wong
- Centre for Heart Rhythm Disorders, University of Adelaide and the Royal Adelaide Hospital, Adelaide, Australia.
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