Publications by authors named "Chi C Chan"

16 Publications

  • Page 1 of 1

Psychological Impact of the COVID-19 Pandemic on Frontline Health Care Workers During the Pandemic Surge in New York City.

Chronic Stress (Thousand Oaks) 2021 Jan-Dec;5:2470547020977891. Epub 2021 Feb 1.

Department of Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, NY, USA.

Background: This study sought to assess the magnitude of and factors associated with mental health outcomes among frontline health care workers (FHCWs) providing care during the Spring 2020 COVID-19 pandemic surge in New York City.

Methods: A cross-sectional, survey-based study over 4 weeks during the Spring 2020 pandemic surge was used to assess symptoms of COVID-19-related posttraumatic stress disorder (PTSD), major depressive disorder (MDD), and generalized anxiety disorder (GAD) in 2,579 FHCWs at the Mount Sinai Hospital. Participants were additionally asked about their occupational and personal exposures to COVID-19. Multivariable logistic regression and relative importance analyses were conducted to identify factors associated with these outcomes.

Results: A total of 3,360 of 6,026 individuals completed the survey (55.8% participation), with 2,579 (76.8%) analyzed based on endorsing frontline responsibilities and providing information related to the three outcomes. 1,005 (39.0%) met criteria for symptoms of COVID-19-related PTSD, MDD, or GAD. 599 (23.3%) screened positively for PTSD symptoms, 683 (26.6%) for MDD symptoms, and 642 (25.0%) for GAD symptoms. Multivariable analyses revealed that past-year burnout was associated with the highest risk of developing symptoms for COVID-19-related PTSD (odds ratio [OR] = 2.10), MDD (OR = 2.83), and GAD (OR = 2.68). Higher perceived support from hospital leadership was associated with a lowest risk of all outcomes [PTSD (OR = 0.75), MDD (OR = 0.72), and GAD (OR = 0.76).

Conclusion: In this large sample of FHCWs providing care during the 2020 NYC pandemic surge, 39% experienced symptoms of COVID-19-related PTSD, MDD, and/or GAD and pre-pandemic burnout as well as leadership support were identified as the most highly associated factors. These findings suggest that interventions aimed at reducing burnout and augmenting support from hospital leadership may be appropriate targets to mitigate the risk for developing further psychopathology in this population and others working in the midst of crisis.
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http://dx.doi.org/10.1177/2470547020977891DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7863176PMC
February 2021

Test-retest reliability of a clinical foot assessment device for measuring first metatarsophalangeal joint quasi-stiffness.

Foot (Edinb) 2020 Dec 13;45:101742. Epub 2020 Sep 13.

Podiatry Department, Singapore General Hospital, Diabetes & Metabolism Centre, 168752, Singapore; School of Allied Health & Human Performance, University of South Australia, SA 5001, Australia. Electronic address:

Background: The stiffness of the first metatarsophalangeal joint (MTPJ) is of interest in cases such as hallux rigidus and apropulsive gait. Subjective rating of joint mobility as 'hypermobile, normal, or stiff' is an unreliable method. Previous instruments for the assessment of first MTPJ stiffness can be too hard and uncomfortable for test subjects. Recently, a new device using a load cell and optical fiber with fiber Bragg grating (FBG) sensors was developed to provide a comfortable means of clinical foot assessment. This study aimed to evaluate the test-retest reliability of this FBG-load cell device in measuring the first MTPJ quasi-stiffness.

Methods: The left foot of 13 female subjects were measured twice for their first MTPJ quasi-stiffness, approximately seven days apart. The FBG-load cell device measured the MTPJ range of motion from a resting position to maximum dorsiflexion and then returning to the resting start-position. The force applied by a clinician to displace the toe was simultaneously recorded using the load cell. The quasi-stiffness over the "working range" in loading and unloading directions were determined from the slope of the torque-angular displacement graph. The test-retest reliability of the MTPJ quasi-stiffness was evaluated using intra-class correlation coefficient [ICC (2,1)].

Results: The reliability was almost perfect for MTPJ quasi-stiffness over the loading phase (ICC = 0.814), moderate for MTPJ quasi-stiffness over the unloading phase (ICC = 0.477) and moderate for MTPJ maximum range (ICC = 0.486).

Conclusion: The foot assessment device comprising FBG and load cell was able to reliably measure the first MTPJ quasi-stiffness in a clinical setting. The measurement reliability was higher during the loading phase than the unloading phase.
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http://dx.doi.org/10.1016/j.foot.2020.101742DOI Listing
December 2020

Comparison of self-report and clinician-rated schizotypal traits in schizotypal personality disorder and community controls.

Schizophr Res 2019 07 8;209:263-268. Epub 2019 Jan 8.

Icahn School of Medicine at Mount Sinai, Department of Psychiatry, New York, NY, USA. Electronic address:

Given the common use of self-report questionnaires to assess schizotypy in personality pathology and schizophrenia research, it is important to determine the concordance between self-report and clinician ratings. 250 individuals with schizotypal personality disorder (SPD) and 116 community controls (CTR) were assessed on schizotypal traits using a clinical interview, the Structured Interview for DSM-IV Personality disorders (SIDP), and a self-report questionnaire, the Schizotypal Personality Questionnaire (SPQ). Ordinal logistic regressions examined concordance between self-reported and clinician-rated scores in CTR and SPD separately. Analyses of variance examined how the SPQ performed on differentiating between CTR with low schizotypy, CTR with high schizotypy, and SPD. For both CTR and SPD, higher SPQ subscale scores were significantly associated with higher clinician ratings on the respective SIDP items for the Ideas of Reference, Magical Thinking, Unusual Perceptual Experience, Suspiciousness, and Social Anxiety items, but not the Odd Speech or Limited Affect items. Higher SPQ subscale scores for Odd Behavior and Lack of Close Friends were significantly associated with the clinician-rated SIDP item scores in CTR but not SPD. CTR with low schizotypy scored lower on all SPQ subscales than CTR with high schizotypy, who did not differ from SPD. Self-report ratings are concordant with clinician ratings for positive schizotypal traits, whereas certain disorganization and interpersonal traits are not, particularly for individuals with SPD. The SPQ can differentiate between high and low schizotypy controls, but not between high schizotypy controls and individuals with SPD. Assessment of schizotypal traits should include both self-report questionnaires and clinician ratings.
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http://dx.doi.org/10.1016/j.schres.2018.12.050DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6614007PMC
July 2019

Premorbid adjustment trajectories in schizophrenia and bipolar disorder: A transdiagnostic cluster analysis.

Psychiatry Res 2019 02 31;272:655-662. Epub 2018 Dec 31.

Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA; VISN 2 Mental Illness Research, Education, and Clinical Center, James J. Peters Veterans Affairs Medical Center, Bronx, NY, USA; Brigham and Women's Hospital, Boston, MA, USA. Electronic address:

Despite the overlap between schizophrenia and bipolar disorder, neurodevelopmental abnormalities are thought to be associated primarily with schizophrenia. Transdiagnostic and empirical identification of subgroups based on premorbid adjustment (PMA) may enhance understanding of illness trajectories. 160 patients with bipolar I or II disorder (BD; n = 104) or schizophrenia or schizoaffective disorder (SZ; n = 56) were assessed on PMA course from childhood to late adolescence and current symptoms and functioning. A hierarchical cluster analysis was performed using social and academic PMA scores, resulting in three optimal clusters. Cluster 1 (n = 28 SZ, 65 BD) had normal social and academic PMA, the most education, and mildest current symptoms. Cluster 2 (n = 15 SZ, 24 BD) had normal social PMA but an impaired-declining academic course and had a greater proportion of males than Cluster 1. Cluster 3 (n = 13 SZ, 15 BD) had an impaired-stable social PMA and an impaired-declining academic course and the most severe current negative symptoms and childhood trauma. The proportions of SZ and BD diagnoses, current neurocognition, and functioning did not differ between clusters. These findings suggest shared neurodevelopmental abnormalities between SZ and BD, with subgroups exhibiting distinct PMA trajectories that cut across disorders.
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http://dx.doi.org/10.1016/j.psychres.2018.12.169DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6441475PMC
February 2019

The P1 visual-evoked potential, red light, and transdiagnostic psychiatric symptoms.

Brain Res 2018 05 3;1687:144-154. Epub 2018 Mar 3.

Department of Psychology, University of Central Florida, Orlando, FL, USA.

A reduced P1 visual-evoked potential amplitude has been reported across several psychiatric disorders, including schizophrenia-spectrum, bipolar, and depressive disorders. In addition, a difference in P1 amplitude change to a red background compared to its opponent color, green, has been found in schizophrenia-spectrum samples. The current study examined whether specific psychiatric symptoms that related to these P1 abnormalities in earlier studies would be replicated when using a broad transdiagnostic sample. The final sample consisted of 135 participants: 26 with bipolar disorders, 25 with schizophrenia-spectrum disorders, 19 with unipolar depression, 62 with no current psychiatric disorder, and 3 with disorders in other categories. Low (8%) and high (64%) contrast check arrays were presented on gray, green, and red background conditions during electroencephalogram, while an eye tracker monitored visual fixation on the stimuli. Linear regressions across the entire sample (N = 135) found that greater severity of both clinician-rated and self-reported delusions/magical thinking correlated with a reduced P1 amplitude on the low contrast gray (neutral) background condition. In addition, across the entire sample, higher self-reported constricted affect was associated with a larger decrease in P1 amplitude (averaged across contrast conditions) to the red, compared to green, background. All relationships remained statistically significant after covarying for diagnostic class, suggesting that they are relatively transdiagnostic in nature. These findings indicate that early visual processing abnormalities may be more directly related to specific transdiagnostic symptoms such as delusions and constricted affect rather than specific psychiatric diagnoses or broad symptom factor scales.
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http://dx.doi.org/10.1016/j.brainres.2018.03.002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5882500PMC
May 2018

Frontal and temporal cortical volume, white matter tract integrity, and hemispheric asymmetry in schizotypal personality disorder.

Schizophr Res 2018 07 14;197:226-232. Epub 2018 Feb 14.

VISN 2 Mental Illness Research, Education, and Clinical Center, James J. Peters Veterans Affairs Medical Center, Bronx, NY, USA; Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA.

Abnormalities in temporal and frontal cortical volume, white matter tract integrity, and hemispheric asymmetry have been implicated in schizophrenia-spectrum disorders. Schizotypal personality disorder can provide insight into vulnerability and protective factors in these disorders without the confounds associated with chronic psychosis. However, multimodal imaging and asymmetry studies in SPD are sparse. Thirty-seven individuals with SPD and 29 healthy controls (HC) received clinical interviews and 3T magnetic resonance T1-weighted and diffusion tensor imaging scans. Mixed ANOVAs were performed on gray matter volumes of the lateral temporal regions involved in auditory and language processing and dorsolateral prefrontal cortex involved in executive functioning, as well as fractional anisotropy (FA) of prominent white matter tracts that connect frontal and temporal lobes. In the temporal lobe regions, there were no group differences in volume, but SPD had reduced right>left middle temporal gyrus volume asymmetry compared to HC and lacked the right>left asymmetry in the inferior temporal gyrus volume seen in HC. In the frontal regions, there were no differences between groups on volume or asymmetry. In the white matter tracts, SPD had reduced FA in the left sagittal stratum and superior longitudinal fasciculus, and increased right>left asymmetry in sagittal stratum FA compared to HC. In the SPD group, lower left superior longitudinal fasciculus FA was associated with greater severity of disorganization symptoms. Findings suggest that abnormities in structure and asymmetry of temporal regions and frontotemporal white matter tract integrity are implicated in SPD pathology.
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http://dx.doi.org/10.1016/j.schres.2018.01.025DOI Listing
July 2018

Transdiagnostic Psychiatric Symptoms and Event-Related Potentials following Rewarding and Aversive Outcomes.

PLoS One 2016 14;11(6):e0157084. Epub 2016 Jun 14.

Department of Psychology, University of Central Florida, Orlando, Florida, United States of America.

There is a need for a better understanding of transdiagnostic psychiatric symptoms that relate to neurophysiological abnormalities following rewarding and aversive feedback in order to inform development of novel targeted treatments. To address this need, we examined a transdiagnostic sample of 44 adults (mean age: 35.52; 57% female), which consisted of individuals with broadly-defined schizophrenia-spectrum disorders (n = 16), bipolar disorders (n = 10), other mood and anxiety disorders (n = 5), and no history of a psychiatric disorder (n = 13). Participants completed a Pavlovian monetary reward prediction task during 32-channel electroencephalogram recording. We assessed the event-related potentials (ERPs) of feedback-related negativity (FRN), feedback-related positivity (FRP), and the late positive potential (LPP), following better and worse than expected outcomes. Examination of symptom relationships using stepwise regressions across the entire sample revealed that an increase in the clinician-rated Negative Symptoms factor score from the Positive and Negative Syndrome Scale, was related to a decreased LPP amplitude during better than expected (i.e., rewarding) outcomes. We also found that increased self-reported scores on the Schizotypal Personality Questionnaire (Brief-Revised) Disorganized factor related to an increased FRN amplitude during worse than expected (i.e., aversive) outcomes. Across the entire sample, the FRP component amplitudes did not show significant relationships to any of the symptoms examined. Analyses of the three diagnostic groups of schizophrenia-spectrum disorders, bipolar disorders, and nonpsychiatric controls did not reveal any statistically significant differences across the ERP amplitudes and conditions. These findings suggest relationships between specific neurophysiological abnormalities following rewarding and aversive outcomes and particular transdiagnostic psychiatric symptoms.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0157084PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4907473PMC
July 2017

Transdiagnostic psychiatric symptoms related to visual evoked potential abnormalities.

Psychiatry Res 2015 Dec 8;230(2):262-70. Epub 2015 Sep 8.

Department of Psychology, University of Central Florida, Orlando, FL, USA.

Visual processing abnormalities have been reported across a range of psychotic and mood disorders, but are typically examined within a particular disorder. The current study used a novel transdiagnostic approach to examine diagnostic classes, clinician-rated current symptoms, and self-reported personality traits in relation to visual processing abnormalities. We examined transient visual-evoked potentials (VEPs) from 48 adults (56% female), representing a wide range of psychotic and mood disorders, as well as individuals with no history of psychiatric disorder. Stimuli were low contrast check arrays presented on green and red backgrounds. Pairwise comparisons between individuals with schizophrenia-spectrum disorders (SSD), chronic mood disorders (CMD), and nonpsychiatric controls (NC) revealed no overall differences for either P1 or N1 amplitude. However, there was a significant interaction with the color background in which the NC group showed a significant increase in P1 amplitude to the red, vs. green, background, while the SSD group showed no change. This was related to an increase in social anhedonia and general negative symptoms. Stepwise regressions across the entire sample revealed that individuals with greater apathy and/or eccentric behavior had a reduced P1 amplitude. These relationships provide clues for uncovering the underlying causal pathology for these transdiagnostic symptoms.
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http://dx.doi.org/10.1016/j.psychres.2015.09.004DOI Listing
December 2015

Metacognitive processes in psychometrically defined schizotypy.

Psychiatry Res 2015 Dec 8;230(2):279-86. Epub 2015 Sep 8.

Department of Psychology, University of Central Florida, Orlando, FL, USA.

Metacognitive abnormalities have been implicated in the experience of psychotic symptoms; however, the process through which this occurs remains unclear. The aim of this study was to clarify the association of self-reported schizotypy with metacognitive beliefs and neural activity related to higher-order cognition. Event-related potentials (ERPs) including the error-related negativity (ERN) and error positivity (Pe) were recorded during a Flanker task in 20 controls and 22 individuals with high self-reported schizotypy on the Schizotypal Personality Questionnaire-Brief Revised (SPQ-BR). Participants continuously evaluated their task performance and completed the Metacognitions Questionnaire-30 (MCQ-30). The high schizotypy group demonstrated higher scores on all subscales of the MCQ-30. In contrast, task performance, accuracy of self-performance evaluation, and amplitudes of the ERN and Pe did not differ between groups. The MCQ-30 factors that measure cognitive confidence and positive beliefs about worry significantly predicted SPQ-BR total score, whereas ERPs did not. High self-reported schizotypy appears to be more associated with dysfunctional metacognitive beliefs than physiological abnormalities in brain areas related to metacognition.
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http://dx.doi.org/10.1016/j.psychres.2015.09.006DOI Listing
December 2015

An event-related potential investigation of error monitoring in adults with a history of psychosis.

Clin Neurophysiol 2015 Sep 28;126(9):1717-26. Epub 2014 Nov 28.

Department of Psychology, University of Central Florida, Orlando, FL, USA.

Objective: Previous research suggests that deficits in error monitoring contribute to psychosis and poor functioning. Consistent with the NIMH Research Domain Criteria initiative, this study examined electrophysiological brain activity, appraisal of self-performance, and personality traits related to psychosis during error monitoring in individuals with and without a history of psychosis across disorders.

Methods: Error-related negativity (ERN), correct response negativity (CRN), error positivity (Pe), and correct response positivity (Pc) were recorded in 14 individuals with a history of psychosis (PSY) and 12 individuals with no history of psychosis (CTR) during a flanker task. Participants continuously rated their performance and completed the Schizotypal Personality Questionnaire-Brief Revised (SPQ-BR).

Results: Compared with CTR, PSY exhibited reduced ERN and Pe amplitudes and was also less accurate at evaluating their performance. Group differences were specific to error trials. Across all participants, smaller Pe amplitudes were associated with greater scores on the SPQ-BR Cognitive-Perceptual factor and less accuracy in subjective identification of errors.

Conclusions: Individuals with a history of psychosis, regardless of diagnosis, demonstrated abnormal neural activity and imprecise confidence in response during error monitoring.

Significance: Results suggest that disruptions in neural circuitry may underlie specific clinical symptoms across diagnostic categories.
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http://dx.doi.org/10.1016/j.clinph.2014.11.016DOI Listing
September 2015

Anhedonia in the age of RDoC.

Schizophr Res 2014 Dec 10;160(1-3):226-7. Epub 2014 Nov 10.

Department of Psychology, University of Central Florida, Orlando, FL USA.

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http://dx.doi.org/10.1016/j.schres.2014.10.028DOI Listing
December 2014

The magnocellular visual pathway and facial emotion misattribution errors in schizophrenia.

Prog Neuropsychopharmacol Biol Psychiatry 2013 Jul 28;44:88-93. Epub 2013 Jan 28.

Department of Psychology, 4000 Central Florida Blvd., University of Central Florida, Orlando, FL 32816-1390, USA.

Many individuals with schizophrenia show impairment in labeling the emotion depicted by faces, and tend to ascribe anger or fear to neutral expressions. Preliminary research has linked some of these difficulties to dysfunction in the magnocellular (M) visual pathway, which has direct projections to subcortical emotion processing regions. The current study attempted to clarify these relationships using a novel paradigm that included a red background. Diffuse red light is known to suppress the M-pathway in nonpsychiatric adults, and there is preliminary evidence that it may have the opposite (stimulating) effect in schizophrenia-spectrum disorders (SSDs). Twenty-five individuals with SSDs were compared with 31 nonpsychiatric controls using a facial emotion identification task depicting happy, angry, fearful, and sad emotions on red, green, and gray backgrounds. There was a robust interaction of group by change in errors to the red (vs. green) background for misattributing fear expressions as depicting anger (p=.001, ή(2)=.18). Specifically, controls showed a significant decrease in this type of error with the red background (p=.003, d=0.77), while the SSD group tended to increase this type of error (p=.07, d=0.54). These findings suggest that the well-established M-pathway abnormalities in SSDs may contribute to the heightened misperception of other emotions such as anger, which in turn may cause social misperceptions in the environment and elicit symptoms such as paranoia and social withdrawal. As the ventral striatum plays a primary role in identifying anger and receives efferent input from the M-pathway, it may serve as the neuroanatomical substrate in the perception of anger.
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http://dx.doi.org/10.1016/j.pnpbp.2013.01.015DOI Listing
July 2013

Changes in the visual-evoked P1 potential as a function of schizotypy and background color in healthy young adults.

J Psychiatr Res 2013 Apr 29;47(4):542-7. Epub 2013 Jan 29.

Department of Psychology, University of Central Florida, 4000 Central Florida Blvd., Orlando, FL 32816-1390, USA.

Research has suggested a hypoactive visual magnocellular (M) pathway in individuals with schizophrenia-spectrum disorders and traits, along with a unique response of this pathway to red light. As these abnormalities only appear in a subset of these samples, they may reflect unknown subtypes with unique etiologies and corresponding neuropathologies. The P1 transient visual-evoked component has been found to be influenced by M-pathway activity; therefore, the current study assessed the P1 component in response to a 64% contrast checker stimulus on white, red, and green background conditions. The sample consisted of 28 undergraduate participants (61% male) who endorsed a continuous range of total scores from the Schizotypal Personality Questionnaire (SPQ). Participants with higher total SPQ scores had a reduced P1 mean amplitude with the white (baseline) background, which was primarily related to the SPQ Magical Thinking subscale score. In addition, while participants with lower total SPQ scores showed the expected reduction in P1 amplitude to the red (vs. green) background, participants with higher total SPQ scores showed no change, which was primarily related to the SPQ Ideas of Reference subscale. This differential change to the red background remained after covarying for the P1 amplitude to the green background, thus representing a relatively independent effect. Further confirmation of these early visual processing relationships to particular clusters of symptoms in related psychiatric samples may assist in revealing unique, currently unknown, subtypes of particular psychiatric disorders such as schizophrenia. This can direct treatment efforts toward more homogeneous neuropathology targets.
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http://dx.doi.org/10.1016/j.jpsychires.2012.12.012DOI Listing
April 2013

IL-10 measurement in aqueous humor for screening patients with suspicion of primary intraocular lymphoma.

Invest Ophthalmol Vis Sci 2007 Jul;48(7):3253-9

Department of Ophthalmology, Hopital Pitié-Salpêtrière, Paris, France.

Purpose: To determine the value of IL-10 measurement in aqueous humor (AH) for screening in primary intraocular lymphoma (PIOL).

Methods: One hundred consecutive diagnostic or therapeutic vitrectomies were performed in patients with uveitis. During surgery, 100 microL of both AH and pure vitreous was taken. IL-10 levels were determined with a standard quantitative sandwich enzyme immunoassay technique. Patients were distributed in two groups: 51 patients with proven PIOL, 108 patients with uveitis divided into 74 with uveitis of proven etiology and 34 with idiopathic uveitis. Groups were compared by ANOVA and the Tukey-Kramer test or nonparametric Wilcoxon test. Distributions were compared by using the chi(2) test. Segmentation was derived from the ROC curves by choosing a tradeoff between sensitivity and specificity.

Results: In patients with PIOL, IL-10 mean values were 2205.5 pg/mL (median: 1467 pg/mL) in the vitreous and 543.4 pg/mL (median: 424 pg/mL) in AH. In patients with uveitis (idiopathic and diagnostic uveitis), mean values were 26.6 pg/mL (median: 8 pg/mL) in the vitreous, and 21.9 pg/mL (median: 8 pg/mL) in AH. IL-10 mean values were significantly different between patients with PIOL and patients with uveitis (P < 10(-3)). The areas under the curves were 0.989 and 0.962 for vitreous and AH, respectively. A cutoff of 50 pg/mL in the AH was associated with a sensitivity of 0.89 and a specificity of 0.93. In the vitreous, a cutoff value of 400 pg/mL yielded a specificity of 0.99 and a sensitivity of 0.8.

Conclusions: Diagnosis of PIOL is often made months or years after the initial onset of ocular symptoms. Cytology remains the gold standard for diagnosis. However, measurement of IL-10 in the AH is a good screening test to reduce diagnostic delays.
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http://dx.doi.org/10.1167/iovs.06-0031DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2078609PMC
July 2007

Tarsal-conjunctival disease associated with Wegener's granulomatosis.

Ophthalmology 2003 Sep;110(9):1770-80

National Eye Institute, National Institutes of Health, Bethesda, Maryland, USA.

Objective: To describe the clinical characteristics of tarsal-conjunctival disease in a cohort of patients with Wegener's granulomatosis (WG).

Design: Retrospective, case-controlled study.

Participants: The medical records of 82 consecutive WG patients who underwent an eye examination between January 1996 and June 2002 at the National Institutes of Health were reviewed.

Methods: Details of the ophthalmic examination, results of medical therapy, and histopathologic analysis results were recorded. Tarsal-conjunctival disease was defined by (1). conjunctival hyperemia and granuloma formation, areas of necrosis, or active fibrovascular changes in the tarsus or conjunctiva, or (2). evidence of inactive fibrovascular scar. The association of tarsal-conjunctival disease with major organ system involvement was assessed using Bayesian methods.

Main Outcome Measures: The occurrence and clinical characteristics of tarsal-conjunctival disease in a cohort of patients with WG and associations with major organ system involvement.

Results: Tarsal-conjunctival disease occurred in 13 of 82 patients (16%) with WG examined over a 6.5-year period. The palpebral surface of the upper lid was involved most commonly, showing conjunctival hyperemia in seven patients, granulomatous lesions in three patients, tarsal-conjunctival necrosis in four patients, active fibrovascular proliferation in six patients, and inactive fibrous scar tissue in seven patients. Histopathologic analysis of eyelid biopsy specimens showed granulomatous inflammation, focal necrosis, and areas of occlusive vasculitis in the tarsus and conjunctiva. In reviewing the patterns of organ involvement in patients with and without tarsal-conjunctival disease, the association of subglottic stenosis and nasolacrimal duct obstruction with tarsal-conjunctival disease showed a high probability of clinical significance.

Conclusions: Tarsal-conjunctival disease, a previously uncommon finding in patients with WG, was characterized by inflammation of the palpebral conjunctiva and tarsus followed by a fibrovascular proliferation and scar formation. Because of the important association of tarsal-conjunctival disease with subglottic stenosis, which can progress and lead to laryngeal obstruction and respiratory failure, patients with tarsal-conjunctival disease should be referred to an otolaryngologist for evaluation.
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http://dx.doi.org/10.1016/S0161-6420(03)00616-XDOI Listing
September 2003

Microdissection combined with the polymerase chain reaction to identify potentiating viral co-infection in patients with HIV/AIDS with ocular infection.

Can J Ophthalmol 2003 Apr;38(3):207-13

Department of Ophthalmology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.

Background: In the presence of several coexisting infections, superimposed tissue necrosis or tissue metaplasia, it may be difficult to recognize standard histologic morphology on hematoxylin-eosin slides. Tissue microdissection combined with the polymerase chain reaction (PCR-MD) offers the advantages of high specificity and relative speed. The objective of this study was to describe the use of PCR-MD in identifying potentiating viral co-infection in patients with HIV/AIDS with retinitis and choroiditis.

Methods: Eyes from two patients with HIV/AIDS with several ocular infections were studied by a variety of techniques, including standard histologic examination, immunochemistry, electron microscopy and in situ hybridization. PCR-MD was used to identify coexisting viral infections.

Results: Histologic examination showed cytomegalovirus retinitis in both cases. Use of PCR-MD allowed the identification of Epstein-Barr virus within a zone of fulminant varicella-zoster virus retinitis in one patient. PCR-MD confirmed the presence of human herpesvirus 8 in the second patient, who had ocular lymphoma.

Interpretation: PCR-MD can be used to demonstrate coexisting viral infection in ocular specimens from patients with unusually fulminant courses. Co-infections may contribute to the observed clinical course and should be considered in patients with rapid progression or unusual presentation.
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http://dx.doi.org/10.1016/s0008-4182(03)80062-5DOI Listing
April 2003