Publications by authors named "Diana K Lee"

13 Publications

  • Page 1 of 1

Myopathic Blepharoptoses: A New Classification System.

Ophthalmic Plast Reconstr Surg 2019 Nov/Dec;35(6):525-534

Department of Ophthalmology, USC Roski Eye Institute, Keck School of Medicine of USC, Los Angeles, California, U.S.A.

Purpose: Myopathic blepharoptoses (ptoses) is a complex group of disorders. To date, no formal categorization scheme has been developed based on associated ocular and systemic findings, genetic fingerprint, treatment, and prognosis for each ptosis in this group. We report a new classification scheme for myopathic ptoses.

Methods: Literature review and classification development.

Results: A new classification scheme of myopathic ptoses includes isolated static myopathic ptosis (congenital ptosis), static myopathic ptosis associated with aberrant innervation and those associated with periocular abnormalities, and progressive myopathic ptoses that affect the levator muscle and other muscle groups in childhood and adulthood.

Conclusions: Making the distinction of myopathic ptosis type early will maximize patient outcomes by optimizing surgical and systemic management and facilitating the recruitment of subspecialists to care for patients with these challenging conditions.The authors present a comprehensive and effective myopathic ptosis classification scheme to optimize surgical management and facilitate subspecialty care.
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http://dx.doi.org/10.1097/IOP.0000000000001405DOI Listing
January 2020

Incidence of Femoral Component Malrotation Using Posterior Condylar Referencing in Total Knee Arthroplasty.

J Knee Surg 2020 Oct 20;33(10):971-977. Epub 2019 May 20.

Department of Orthopaedic Surgery, Center for Hip and Knee Replacement (CHKR), NewYork-Presbyterian Hospital at Columbia University Medical Center, New York.

Proper femoral component rotation in total knee arthroplasty (TKA) is important, given the prognostic impact of a poorly positioned component. The purpose of this observational study was to determine the incidence of femoral component malrotation using posterior condylar axis (PCA) referencing. A total of 100 knees in 92 patients with varus gonarthritis of the knee undergoing primary TKA using a standard medial parapatellar approach were evaluated intraoperatively. After distal femoral resection, the standard femoral sizing guide referencing the posterior condylar axis was used to set femoral component rotation. This was then compared with both the transepicondylar (TEA) and trochlear anteroposterior axes (TRAx). Disparites were recorded and corrected in line with the epicondylar axis. Rotational adjustment for addition of further external rotation was made in 13 (13.0%) cases. In seven cases, the medial pin sites were raised between 1 and 3 mm, and in six cases, the lateral pin site was lowered between 1 and 3 mm (based on risk of notching the femoral cortex). It is critical to not rely exclusively on the PCA to confirm rotational positioning of the femoral component as predicted by posterior condylar referencing guides. Intraoperative adjustment and confirmation using the TEA and TRAx occurred in 13% of primary TKA cases, which might have, otherwise, had a significant effect on the clinical outcome.
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http://dx.doi.org/10.1055/s-0039-1688931DOI Listing
October 2020

Rabbit model of ocular indirect photodynamic therapy using a retinoblastoma xenograft.

Graefes Arch Clin Exp Ophthalmol 2017 Dec 2;255(12):2363-2373. Epub 2017 Oct 2.

Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA, USA.

Purpose: The goal of this project was to demonstrate the feasibility of coupling the indirect ophthalmoscope laser delivery system with the 690 nm wavelength diode laser used to perform photodynamic therapy (PDT) in the treatment of retinoblastoma.

Methods: For phase 1, a total of six pigmented rabbits were treated with the indirect laser delivery system. The laser source was provided by the Lumenis Opal 690 nm laser unit, delivered through a 810 nm Indirect ophthalmoscope headpiece and a hand-held 28-diopter indirect lens (1.0 mm spot size). Four rabbits received intravenous verteporfin at doses of 0.43 or 0.86 mg/kg, and two rabbits did not receive verteporfin (controls). A second phase of the study involved eight rabbits using a retinoblastoma xenograft to determine the effect of indirect PDT on subretinal tumors.

Results: For phase 1, a total of 20 laser treatments were performed in the right eyes of six rabbits. Laser power levels ranged between 40 and 150 mW/cm and treatment duration ranged between 1 and 3 min. In the four rabbits that received verteporfin, focal retinal scars were noted at 40 mW/cm and higher power levels. In the two control rabbits that did not receive verteporfin, thermal burns were confirmed at 75 mW/cm and higher power levels. Histopathology showed focal retino-choroidal scars at the site of PDT treatment, without evidence of generalized ocular damage. Using the retinoblastoma xenograft, the indirect PDT system was shown to cause areas of tumor necrosis on histopathology.

Conclusions: The results of this pre-clinical study suggest verteporfin may be activated in the rabbit retina with the indirect delivery system and the 690 nm laser unit (i.e., Indirect PDT). Using verteporfin, treatment effects were observed at 40-50 mW/cm in the rabbit retina, while photocoagulation was achieved at 75 mW/cm and higher power levels. Fundoscopic and histopathologic examination of treated areas showed circumscribed areas of retinal damage and a lack of generalized ocular toxicity, suggesting that this modality may represent a safe and localized method for treating intraocular retinoblastoma.
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http://dx.doi.org/10.1007/s00417-017-3805-8DOI Listing
December 2017

Three presentations of CNS disease in patients with intraocular retinoblastoma at a tertiary medical center in the United States.

Ophthalmic Genet 2018 Jan-Feb;39(1):115-119. Epub 2017 Sep 26.

a Vision Center , Children's Hospital Los Angeles , Los Angeles , CA , USA.

Background: Patients with intraocular retinoblastoma who present with central nervous (CNS) disease at diagnosis is very rare in developed countries.

Methods: Herein, we report a review of patients with intraocular retinoblastoma diagnosed with concurrent CNS disease in the United States between January 2011 and June 2013.

Results: Three patients were identified in this review. The first case is a 2-year old male who presented with unilateral Group E retinoblastoma, optic nerve infiltration to the orbital apex, and a suprasellar mass. The second case is a 5-month old female with bilateral retinoblastoma, who had no optic nerve invasion, but demonstrated a temporal lobe lesion that was biopsy-proven to be metastatic retinoblastoma. The third case is a 10-month old girl with bilateral retinoblastoma who presented with a sellar mass and no evidence of optic nerve invasion in the enucleated Group E eye.

Conclusions: Although rare in developed countries, patients with intraocular retinoblastoma can present with a spectrum of CNS findings at the time of diagnosis. Magnetic resonance imaging of the brain and orbits is a critical component of the staging evaluation.
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http://dx.doi.org/10.1080/13816810.2017.1368089DOI Listing
March 2018

Retcam fluorescein angiography findings in eyes with advanced retinoblastoma.

Br J Ophthalmol 2014 Dec 22;98(12):1666-71. Epub 2014 Jul 22.

Department of Ophthalmology, Vision Center, Children's Hospital Los Angeles (location of study), Los Angeles, California, USA.

Purpose: To characterise the fluorescein angiogram (FA) findings of eyes with advanced retinoblastoma evaluated with the Retcam contact fundus camera.

Methods: A retrospective case series was performed on all new retinoblastoma patients evaluated with Retcam FA between 2000 and 2012. Inclusion criteria included (1) patients with advanced retinoblastoma (group D or E), (2) eyes studied with early, mid-phase and late-phase Retcam FA photographs and (3) no prior treatment.

Results: A total of 100 eyes fulfilling the inclusion criteria were identified. For the 47 group D eyes, FA findings included iris neovascularisation (10/47), large retinal vessel dilatation (46/47), small retinal vessel changes (35/47) and retinal venous leakage (20/47). Among the 53 group E eyes, FA findings included iris neovascularisation (45/53), large retinal vessel dilatation (43/53), small retinal vessel changes (37/53) and vascular abnormalities at multiple levels (11/53).

Conclusions: Advanced intraocular retinoblastoma is associated with multiple retinal vascular abnormalities on Retcam FA. These findings may be helpful in defining the extent of disease and distinguishing this tumour from other paediatric ocular conditions. Key clinical findings were subclinical iris neovascularisation, a variety of small vessel changes, intrinsic tumour vessels and retinal venous leakage. Retcam FA was not found to be clinically useful after 3 min.
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http://dx.doi.org/10.1136/bjophthalmol-2014-305180DOI Listing
December 2014

Immunomodulation by imiquimod in patients with high-risk primary melanoma.

J Invest Dermatol 2012 Jan 18;132(1):163-9. Epub 2011 Aug 18.

Division of Dermatology, Los Angeles Biomedical Research Institute, Harbor-UCLA Medical Center, Torrance, California 90502, USA.

Imiquimod is a synthetic Toll-like receptor 7 (TLR7) agonist approved for the topical treatment of actinic keratoses, superficial basal cell carcinoma, and genital warts. Imiquimod leads to an 80-100% cure rate of lentigo maligna; however, studies of invasive melanoma are lacking. We conducted a pilot study to characterize the local, regional, and systemic immune responses induced by imiquimod in patients with high-risk melanoma. After treatment of the primary melanoma biopsy site with placebo or imiquimod cream, we measured immune responses in the treated skin, sentinel lymph nodes (SLNs), and peripheral blood. Treatment of primary melanomas with 5% imiquimod cream was associated with an increase in both CD4+ and CD8+ T cells in the skin, and CD4+ T cells in the SLN. Most of the CD8+ T cells in the skin were CD25 negative. We could not detect any increases in CD8+ T cells specifically recognizing HLA-A(*)0201-restricted melanoma epitopes in the peripheral blood. The findings from this small pilot study demonstrate that topical imiquimod treatment results in enhanced local and regional T-cell numbers in both the skin and SLN. Further research into TLR7 immunomodulating pathways as a basis for effective immunotherapy against melanoma in conjunction with surgery is warranted.
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http://dx.doi.org/10.1038/jid.2011.247DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3229834PMC
January 2012

The thymus and the immune system: layered levels of control.

J Thorac Oncol 2010 Oct;5(10 Suppl 4):S273-6

Experimental Transplantation and Immunology Branch, Center for Cancer Research, NCI, Bethesda, Maryland 20892, USA.

Control points of normal thymopoiesis may provide insights into strategies for interrupting cell interactions in thymomas which appear to maintain active T cell production. Thymus production of T cells represents one of two pathways by which peripheral T cell populations are maintained or, if lost, regenerated. The production of T cells by the thymus results from a series of thymus epithelial cell (TEC) - thymocyte interactions from entry of thymocyte precursors into the thymus to release of mature naïve single positive T cells into the periphery. Within this series of interactions, certain control points have been identified, all of which act through TEC to modulate thymopoiesis.
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http://dx.doi.org/10.1097/JTO.0b013e3181f20474DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2951290PMC
October 2010

Unusual eyelid, periocular, and periorbital cutaneous malignancies.

Int Ophthalmol Clin 2009 ;49(4):77-96

Department of Ophthalmology, Stanford University Medical Center, Stanford, CA 94304, USA

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http://dx.doi.org/10.1097/IIO.0b013e3181b7f3f7DOI Listing
July 2010

Rituximab treatment of patients with severe, corticosteroid-resistant thyroid-associated ophthalmopathy.

Ophthalmology 2010 Jan 8;117(1):133-139.e2. Epub 2009 Oct 8.

Division of Rheumatology, Department of Medicine, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA 90095, USA.

Purpose: To study the effectiveness of anti-CD20 (rituximab [RTX]; Rituxan; Genentech, Inc., South San Francisco, CA) therapy in patients with severe, corticosteroid (CS)-resistant thyroid-associated ophthalmopathy (TAO).

Design: Retrospective, interventional case series.

Participants: Six consecutive subjects with severe, progressive TAO unresponsive to CS.

Methods: Electronic medical record review of consecutive patients receiving RTX during the previous 18 months. Responses to therapy were graded using standard clinical assessment and flow cytometric analysis of peripheral lymphocytes.

Main Outcome Measures: Clinical activity score (CAS), proptosis, strabismus, treatment side effects, and quantification of regulatory T cells.

Results: Six patients were studied. Systemic CS failed to alter clinical activity in all patients (mean CAS+/-standard deviation, 5.3+/-1.0 before vs. 5.5+/-0.8 during therapy for 7.5+/-6.4 months; P = 1.0). However, after RTX treatment, CAS improved from 5.5+/-0.8 to 1.3+/-0.5 at 2 months after treatment (P<0.03) and remained quiescent in all patients (CAS, 0.7+/-0.8; P<0.0001) at a mean follow-up of 6.2+/-4.5 months. Vision improved bilaterally in all 4 patients with dysthyroid optic neuropathy (DON). None of the 6 patients experienced disease relapse after RTX infusion, and proptosis remained stable (Hertel measurement, 24+/-3.7 mm before therapy and 23.6+/-3.7 mm after therapy; P = 0.17). The abundance of T regulatory cells, assessed in 1 patient, increased within 1 week of RTX and remained elevated at 18 months of follow-up.

Conclusions: In progressive, CS-resistant TAO, rapid and sustained resolution of orbital inflammation and DON followed treatment with RTX.

Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article.
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http://dx.doi.org/10.1016/j.ophtha.2009.05.029DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2814962PMC
January 2010

Improving child survival through environmental and nutritional interventions: the importance of targeting interventions toward the poor.

JAMA 2007 Oct;298(16):1876-87

Initiative for Global Health, Harvard University, Cambridge, Massachusetts, USA.

Context: The United Nations Millennium Development Goals (MDGs) set targets related to important global poverty, health, and sustainability issues. A critical but underinvestigated question for planning and allocating resources toward the MDGs is how interventions related to one MDG might affect progress toward other goals.

Objectives: To estimate the reduction in child mortality as a result of interventions related to the environmental and nutritional MDGs (improving child nutrition and providing clean water, sanitation, and fuels) and to estimate how the magnitude and distribution of the effects of interventions vary based on the economic status of intervention recipients.

Design, Setting, And Population: Population-level comparative risk assessment modeling the mortality effects of interventions on child nutrition and environmental risk factors, stratified by economic status. Data on economic status, child underweight, water and sanitation, and household fuels were from the nationally representative Demographic and Health Surveys for 42 countries in Latin America and the Caribbean, South Asia, and sub-Saharan Africa. Data on disease-specific child mortality were from the World Health Organization. Data on the hazardous effects of each MDG-related risk factor were from systematic reviews and meta-analyses of epidemiological studies.

Main Outcome Measure: Child mortality, stratified by comparable international quintiles of economic status.

Results: Implementing interventions that improve child nutrition and provide clean water and sanitation and clean household fuels to all children younger than 5 years would result in an estimated annual reduction in child deaths of 49,700 (14%) in Latin America and the Caribbean, 0.80 million (24%) in South Asia, and 1.47 million (31%) in sub-Saharan Africa. These benefits are equivalent to 30% to 48% of the current regional gaps toward the MDG target on reducing child mortality. Fifty percent coverage of the same environmental and nutritional interventions, as envisioned by the MDGs, would reduce child mortality by 26,900, 0.51 million, and 1.02 million in the 3 regions, respectively, if the interventions are implemented among the poor first. These reductions are 30% to 75% larger than those expected if the same 50% coverage first reached the wealthier households, who nonetheless are in need of similar interventions.

Conclusions: Interventions related to nutritional and environmental MDGs can also provide substantial gains toward the MDG of reducing child mortality. To maximize the reduction in childhood mortality, such integrated management of interventions should prioritize the poor.
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http://dx.doi.org/10.1001/jama.298.16.1876DOI Listing
October 2007

[Assessing the effect of the 2001-06 Mexican health reform: an interim report card].

Salud Publica Mex 2007 ;49 Suppl 1:S88-109

Harvard Initiative for Global Health, 104 Mt Auburn Street-3rd floor, Cambridge, MA 02138, USA.

Since 2001, Mexico has been designing, legislating, and implementing a major health-system reform. A key component was the creation of Seguro Popular, which is intended to expand insurance coverage over seven years to uninsured people, nearly half the total population at the start of 2001. The reform included five actions: legislation of entitlement per family affiliated which, with full implementation, will increase public spending on health by 0.8-1.0% of gross domestic product; creation of explicit benefits packages; allocation of monies to decentralised state ministries of health in proportion to number of families affiliated; division of federal resources flowing to states into separate funds for personal and non-personal health services; and creation of a fund to protect families against catastrophic health expenditures. Using the WHO health-systems framework, a wide range of datasets to assess the effect of this reform on different dimensions of the health system was used. Key findings include: affiliation is preferentially reaching the poor and the marginalised communities; federal non-social security expenditure in real per-head terms increased by 38% from 2000 to 2005; equity of public-health expenditure across states improved; Seguro Popular affilates used more inpatient and outpatient services than uninsured people; effective coverage of 11 interventions has improved between 2000 and 2005-06; inequalities in effective coverage across states and wealth deciles has decreased over this period; catastrophic expenditures for Seguro Popular affiliates are lower than for uninsured people even though use of services has increased. We present some lessons for Mexico based on this interim evaluation and explore implications for other countries considering health reforms.
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http://dx.doi.org/10.1590/s0036-36342007000700011DOI Listing
June 2007

Assessing the effect of the 2001-06 Mexican health reform: an interim report card.

Lancet 2006 Nov;368(9550):1920-35

Harvard Initiative for Global Health, Cambridge, MA 02138, USA.

Since 2001, Mexico has been designing, legislating, and implementing a major health-system reform. A key component was the creation of Seguro Popular, which is intended to expand insurance coverage over 7 years to uninsured people, nearly half the total population at the start of 2001. The reform included five actions: legislation of entitlement per family affiliated which, with full implementation, will increase public spending on health by 0.8-1.0% of gross domestic product; creation of explicit benefits packages; allocation of monies to decentralised state ministries of health in proportion to number of families affiliated; division of federal resources flowing to states into separate funds for personal and non-personal health services; and creation of a fund to protect families against catastrophic health expenditures. Using the WHO health-systems framework, we used a wide range of datasets to assess the effect of this reform on different dimensions of the health system. Key findings include: affiliation is preferentially reaching the poor and the marginalised communities; federal non-social security expenditure in real per-head terms increased by 38% from 2000 to 2005; equity of public-health expenditure across states improved; Seguro Popular affiliates used more inpatient and outpatient services than uninsured people; effective coverage of 11 interventions has improved between 2000 and 2005-06; inequalities in effective coverage across states and wealth deciles has decreased over this period; catastrophic expenditures for Seguro Popular affiliates are lower than for uninsured people even though use of services has increased. We present some lessons for Mexico based on this interim evaluation and explore implications for other countries considering health reforms.
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http://dx.doi.org/10.1016/S0140-6736(06)69568-8DOI Listing
November 2006