Publications by authors named "Ling Yeung"

99 Publications

Foveal Microvascular Integrity Association With Anti-VEGF Treatment Response for Diabetic Macular Edema.

Invest Ophthalmol Vis Sci 2021 Jul;62(9):41

Department of Ophthalmology, Chang Gung Memorial Hospital, Keelung, Taiwan.

Purpose: To investigate the association between foveal microvascular integrity and anti-vascular endothelial growth factor (VEGF) treatment response for diabetic macular edema (DME).

Methods: This retrospective study enrolled 58 eyes (from 45 patients) with DME. Treatment strategy was three to five monthly anti-VEGF injections followed by a PRN protocol. Treatment with an intravitreal corticosteroid would be considered for persistent DME after five consecutive anti-VEGF injections. Eyes achieving a treatment-free interval ≥ four months within two years were classified into the good clinical course group (group 1). Eyes with frequent recurrent edema (treatment-free interval < four months) or requiring an intravitreal corticosteroid within two years were classified into the suboptimal clinical course group (group 2). Foveal microvascular integrity was evaluated by two continuous variables, that is, vessel density (%) within a width of 300 µm around the foveal avascular zone (FD-300) on optical coherence tomography angiography (OCTA) and perifoveal leakage (area %) on fluorescein angiography (FA).

Results: There were 37 eyes in group 1 and 21 eyes in group 2. FD-300 (odds ratio 0.733, 95% CI 0.620-0.867, P < 0.001) and perifoveal leakage (odds ratio 1.064, 95% CI 1.007-1.124, P = 0.027) were significantly associated with suboptimal clinical course. Area under curve (AUC) was 0.820 for FD-300 and 0.723 for perifoveal leakage in predicting clinical course. FD-300 was negatively correlated with perifoveal leakage (coefficient = -0.325, P = 0.014).

Conclusions: Compromised foveal microvascular integrity, represented by lower FD-300 and more severe perifoveal fluorescein leakage, was associated with suboptimal clinical course in anti-VEGF treatment for DME. A negative correlation between FD-300 and perifoveal leakage existed.
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http://dx.doi.org/10.1167/iovs.62.9.41DOI Listing
July 2021

Management of neovascular age-related macular degeneration: Taiwan expert consensus.

J Formos Med Assoc 2021 Jul 14. Epub 2021 Jul 14.

Department of Ophthalmology, Changhua Christian Hospital, Changhua, Taiwan; College of Medicine, Chung-Shan Medical University, Taichung, Taiwan; Department of Optometry, College of Nursing and Health Science, Da-Yeh University, Changhua, Taiwan. Electronic address:

Neovascular age-related macular degeneration (nAMD) is a leading cause of irreversible vision loss. The present consensus provides suggestions on diagnosis, evaluation, treatment, and follow-up strategies for nAMD from a panel of 11 practicing ophthalmologists. The experts suggest that the baseline visit for nAMD management should include a comprehensive ophthalmologic examination via a multimodal approach consisting of visual and anatomical evaluation. Patients diagnosed with nAMD should be subjected to treatment with the goal of maintaining visual function while diminishing anatomical disease activity and minimizing treatment burden. Currently, anti-VEGF therapy is the main treatment strategy for nAMD, and evaluation involving comprehensive ophthalmologic examination within 1 month of completion of the loading phase comprising three monthly injections is recommended to guide subsequent management. Either a treat-and-extend or pro re nata regimen can be considered for the maintenance phase of anti-VEGF therapy, and the regimen should be chosen and adjusted according to disease activity, reimbursement criteria, financial burden, and patient preferences. In the event of inactive nAMD or poor treatment outcomes, after thorough evaluation and patient education, anti-VEGF therapy may be stopped. The consensus provides practical nAMD management guidelines for ophthalmologists and fellow healthcare professionals.
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http://dx.doi.org/10.1016/j.jfma.2021.06.012DOI Listing
July 2021

Prospective evaluation of the comorbidity of obstructive sleep apnea in patients with glaucoma.

J Clin Sleep Med 2021 Jun 23. Epub 2021 Jun 23.

Department of Ophthalmology, Chang Gung Memorial Hospital, Keelung, Taiwan.

Study Objectives: This study aimed to prospectively identify the correlation between obstructive sleep apnea (OSA) severity, ocular microcirculation changes, and visual function changes in patients with glaucoma.

Methods: We prospectively enrolled patients with glaucoma who were willing to undergo overnight polysomnography (PSG). The enrolled patients were further divided into normal tension glaucoma (NTG),high-tension glaucoma (HTG), and control. Visual field (VF) progression was analyzed using sequential standard automated perimetry. Peripapillary and macular vessel density (VD) were assessed through optical coherence tomography angiography (OCT-Angiography). The associations between PSG parameters, OCT-Angiography parameters, and VF progression were analyzed.

Results: A total of 22 patients with NTG, 30 patients with HTG, and 24 control patients were enrolled. Through regression analysis, glaucoma was found to be an independent predictor of moderate-to-severe OSA ( = .035); furthermore, moderate-to-severe OSA was significantly associated with VF progression ( =.008 in the HTG subgroup, and = .008 in the overall glaucoma). Additionally, OSA severity was negatively correlated with the ganglion cell complex thinning rate in the NTG subgroup.

Conclusions: Presence of glaucoma increased the risk of moderate-to-severe OSA compare with the control group. OSA severity was related to VF deterioration in patients with glaucoma and further associated with structural progression in the NTG subgroup. Careful monitoring of the comorbid OSA status of patients with glaucoma is essential to prevent disease progression.
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http://dx.doi.org/10.5664/jcsm.9488DOI Listing
June 2021

Macular Ischemia Quantification Using Deep-Learning Denoised Optical Coherence Tomography Angiography in Branch Retinal Vein Occlusion.

Transl Vis Sci Technol 2021 06;10(7):23

Department of Ophthalmology, Chang Gung Memorial Hospital, Keelung, Taiwan.

Purpose: To examine whether deep-learning denoised optical coherence tomography angiography (OCTA) images could enhance automated macular ischemia quantification in branch retinal vein occlusion (BRVO).

Methods: This retrospective, single-center, cross-sectional study enrolled 74 patients with BRVO and 46 age-matched healthy subjects. The severity of macular ischemia was graded as mild, moderate, or severe. Denoised OCTA images were produced using a neural network model. Quantitative parameters derived from denoised images, including vessel density and nonperfusion area, were compared with those derived from the OCTA machine. The main outcome measures were correlations between quantitative parameters, and areas under receiver operating characteristic curves (AUCs) in classifying the severity of the macular ischemia.

Results: The vessel density and nonperfusion area from denoised images were correlated strongly with the corresponding parameters from machine-derived images in control eyes and BRVO eyes with mild or moderate macular ischemia (all P < 0.001). However, no such correlation was found in eyes with severe macular ischemia. The vessel density and nonperfusion area from denoised images had significantly larger area under receiver operating characteristic curve than those derived from the original images in classifying moderate versus severe macular ischemia (0.927 vs 0.802 [P = 0.042] and 0.946 vs 0.797, [P = 0.022], respectively). There were no significant differences in the areas under receiver operating characteristic curve between the denoised images and the machine-derived parameters in classifying control versus BRVO, and mild versus moderate macular ischemia.

Conclusions: A neural network model is useful for removing speckle noise on OCTA images and facilitating the automated grading of macular ischemia in eyes with BRVO.

Translational Relevance: Deep-learning denoised optical coherence tomography angiography images could enhance automated macular ischemia quantification.
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http://dx.doi.org/10.1167/tvst.10.7.23DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8212432PMC
June 2021

A Multimodal Imaging-Based Deep Learning Model for Detecting Treatment-Requiring Retinal Vascular Diseases: Model Development and Validation Study.

JMIR Med Inform 2021 May 31;9(5):e28868. Epub 2021 May 31.

College of Medicine, Chang Gung University, Taoyuan, Taiwan.

Background: Retinal vascular diseases, including diabetic macular edema (DME), neovascular age-related macular degeneration (nAMD), myopic choroidal neovascularization (mCNV), and branch and central retinal vein occlusion (BRVO/CRVO), are considered vision-threatening eye diseases. However, accurate diagnosis depends on multimodal imaging and the expertise of retinal ophthalmologists.

Objective: The aim of this study was to develop a deep learning model to detect treatment-requiring retinal vascular diseases using multimodal imaging.

Methods: This retrospective study enrolled participants with multimodal ophthalmic imaging data from 3 hospitals in Taiwan from 2013 to 2019. Eye-related images were used, including those obtained through retinal fundus photography, optical coherence tomography (OCT), and fluorescein angiography with or without indocyanine green angiography (FA/ICGA). A deep learning model was constructed for detecting DME, nAMD, mCNV, BRVO, and CRVO and identifying treatment-requiring diseases. Model performance was evaluated and is presented as the area under the curve (AUC) for each receiver operating characteristic curve.

Results: A total of 2992 eyes of 2185 patients were studied, with 239, 1209, 1008, 211, 189, and 136 eyes in the control, DME, nAMD, mCNV, BRVO, and CRVO groups, respectively. Among them, 1898 eyes required treatment. The eyes were divided into training, validation, and testing groups in a 5:1:1 ratio. In total, 5117 retinal fundus photos, 9316 OCT images, and 20,922 FA/ICGA images were used. The AUCs for detecting mCNV, DME, nAMD, BRVO, and CRVO were 0.996, 0.995, 0.990, 0.959, and 0.988, respectively. The AUC for detecting treatment-requiring diseases was 0.969. From the heat maps, we observed that the model could identify retinal vascular diseases.

Conclusions: Our study developed a deep learning model to detect retinal diseases using multimodal ophthalmic imaging. Furthermore, the model demonstrated good performance in detecting treatment-requiring retinal diseases.
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http://dx.doi.org/10.2196/28868DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8204240PMC
May 2021

Relationship between Obstructive Sleep Apnea and Central Serous Chorioretinopathy: A Health Insurance Database Study.

Ophthalmic Epidemiol 2021 May 20:1-8. Epub 2021 May 20.

Department of Ophthalmology, Chang Gung Memorial Hospital, Keelung, Taiwan.

: To evaluate the association between obstructive sleep apnea (OSA) and central serous chorioretinopathy (CSCR).: A retrospective, cohort, longitudinal study was conducted using the national health insurance database in Taiwan between 1996 and 2013. Patients diagnosed with OSA were enrolled after exclusion, and a control group with similar age, gender, and major systemic co-morbidities were included in a 1:1 ratio by propensity score matching. The primary outcome is the occurrence of CSCR, and patients with CSCR were categorized via severity for further analysis. The percentage of incident CSCR in the OSA group and control groups and the adjusted hazard ratios (aHR) of CSCR were determined by Cox proportional hazard regression.: There were 13,084 patients enrolled in both the OSA group and control groups, respectively. The total event of CSCR was 50 (0.4%) in the OSA group and 25 (0.2%) in the control group ( < .001). Moreover, the OSA group has an increased aHR of 1.9 ( = .012) for developing CSCR. In the subgroup analysis, patients with OSA aged from 30 to 39 and 50 to 59 demonstrated higher risk of developing CSCR compared to the control group, and the presence of OSA would lead to a higher incidence of mild CSCR (all < .05).: OSA patients aged from 30 to 39 and 50 to 59 have a higher risk of developing CSCR, while the severity of CSCR will not be worsen by OSA.
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http://dx.doi.org/10.1080/09286586.2021.1925306DOI Listing
May 2021

Endophthalmitis: Clinical Settings, Antibiotic Susceptibility, and Management Outcomes.

Microorganisms 2021 Apr 24;9(5). Epub 2021 Apr 24.

Department of Ophthalmology, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan.

is known to cause severe acute endophthalmitis and often leads to poor visual outcomes in most ophthalmic infections. This retrospective study is to report the clinical settings, antimicrobial susceptibility patterns, and visual outcome of endophthalmitis at a tertiary referral institution in Taoyuan, Taiwan. endophthalmitis was diagnosed in 37 eyes of 37 patients. Post-cataract surgery was the most common cause ( = 27, 73%), followed by bleb-associated ( = 3, 8%), endogenous ( = 2, 5%), corneal ulcer-related ( = 2, 5%), post-vitrectomy ( = 1, 3%), post-pterygium excision ( = 1, 3%), and trauma ( = 1, 3%). Visual acuities upon presentation ranged from counting fingers to no light perception. Pars plana vitrectomy with intravitreal antibiotics were performed in 23 eyes (76%) as primary or secondary treatment. All isolates (37/37, 100%) were sensitive to vancomycin, penicillin, ampicillin, and teicoplanin. Six of 22 eyes (27%) were resistant to high-level gentamicin (minimum inhibitory concentration > 500 mg/L). Final visual acuities were better than 20/400 in 11 eyes (30%), 5/200 to hand motions in 4 eyes (11%), and light perception to no light perception in 22 eyes (59%). Three eyes were treated with evisceration. Compared with non-cataract subgroups, the post-cataract subgroup showed a significant difference of better visual prognosis ( = 0.016).
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http://dx.doi.org/10.3390/microorganisms9050918DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8146393PMC
April 2021

Higher HbA1c may reduce axial length elongation in myopic children: a comparison cohort study.

Acta Diabetol 2021 Jun 15;58(6):779-786. Epub 2021 Feb 15.

Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University, New York, New York, USA.

Aims: To compare the annual axial length (AL) changes in myopic children with type 1 diabetes mellitus (T1DM) and those without diabetes.

Methods: There are two groups of myopic children in this retrospective cohort study. Group 1 consisted of myopic children with T1DM (44 eyes of 22 patients). Group 2 comprised age-matched myopic children without diabetes (44 eyes of 22 children). These two groups were compared with regard to their baseline clinical characteristics. A generalized estimating equations (GEE) model was also used to determine the most likely factor that contributed to the results.

Results: The average ages of group 1 and group 2 were 14.8 and 14.6 years, respectively. Children in group 1 had significantly slower annual AL changes (0.051 mm/year vs 0.103 mm/year; 50.5% slower, P = 0.011) and shorter baseline AL (23.97 vs 25.19 mm, P < 0.001) than those in group 2. GEE also showed that serum glycated hemoglobin (HbA1c) level (B = -0.023, P = 0.039) was the most important factor in reducing AL elongation in group 1 myopic children.

Conclusions: Long-term higher HbA1c level may reduce AL elongation. A strict blood sugar control strategy in clinical practice is warranted to axial myopia progression in T1DM children.
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http://dx.doi.org/10.1007/s00592-020-01631-4DOI Listing
June 2021

Comparison of visual outcomes between therapy choices and subtypes of polypoidal choroidal vasculopathy (PCV) in Taiwan: a real-world study.

Sci Rep 2021 01 11;11(1):470. Epub 2021 Jan 11.

Department of Ophthalmology, School of Medicine, National Taiwan University Hospital, No. 7, Zhongshan South Road, Zhongzheng District, Taipei City, 100, Taiwan.

Polypoidal choroidal vasculopathy (PCV) is a distinctive type of neovascular age-related macular degeneration prevalent in many Asian countries. However, there is still some controversy in how the subtypes of PCV are classified. This post-hoc study redefined the branching vascular network (BVN) and PCV subtypes through retrospective review of indocyanine green angiography (ICGA) and fluorescein angiography images from two observational studies (RENOWNED/REAL). Of the visual outcomes for each angiographic subtype and treatment pattern investigated, BVN was identified in 56.3% of PCV patients. The proportions and features of the re-defined PCV subtypes were 43.8%, 10.4%, and 45.8% for subtype A (without distinctive features of BVN), B (with BVN but no leakage), and C (with BVN and leakage), respectively. Subtype A had better visual outcomes when compared to subtype C. This possibly resulted from a better baseline visual acuity in subtype A. Moreover, combination therapy [photodynamic therapy plus anti-vascular endothelial growth factor (VEGF)] may lead to better visual improvement than mono-anti-VEGF treatment alone. This study provides the prevalence of PCV subtypes in Taiwan and may serve as a reference for PCV treatment strategies in a real-world setting, especially for the combination therapy and patients without distinctive features of BVN.
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http://dx.doi.org/10.1038/s41598-020-80731-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7801625PMC
January 2021

Correlation of Visual Field With Peripapillary Vessel Density Through Optical Coherence Tomography Angiography in Normal-Tension Glaucoma.

Transl Vis Sci Technol 2020 12 17;9(13):26. Epub 2020 Dec 17.

Department of Ophthalmology, Chang Gung Memorial Hospital, Keelung, Taiwan.

Purpose: To investigate the retinal vessel density (VD) in healthy and normal-tension glaucoma (NTG) eyes through optical coherence tomography angiography (OCTA) and to determine the correlation between VD and the retinal nerve fiber layer (RNFL) thickness and functional visual field (VF) defects for different locations.

Methods: A total of 74 NTG eyes and 24 healthy eyes were included. OCTA VD at 4.5 × 4.5 mm peripapillary region and 3.0 × 3.0 mm macula area, RNFL thickness, and VF pattern deviation results were individually analyzed on the basis of the Garway-Heath sectorization. Correlations between VD and VF/RNFL and VF were compared.

Results: In the NTG group, peripapillary VD, superficial macula VD, RNFL thickness, and ganglion cell complex thickness were significantly lower. In the whole peripapillary area and inferotemporal sector, anatomic correlations between VD and VF pattern deviation values were significantly higher than those between the RNFL thickness and VF values. In the subgroup analysis, VD was anatomically correlated with VF in early-, moderate-, and severe-stage NTG eyes, whereas the RNFL thickness was correlated with VF in moderate- and severe-stage NTG eyes.

Conclusions: We observed VD reduction in the peripapillary retina and superficial macula area in NTG eyes. The microvascular dropout of VD in the peripapillary retina, especially in the inferotemporal sector, provided a more accurate anatomic correlation with functional VF defects than that of the RNFL thickness, especially in early-stage NTG eyes.

Translational Relevance: In patients who cannot comply VF exam, VD is a good tool for disease detection.
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http://dx.doi.org/10.1167/tvst.9.13.26DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7746955PMC
December 2020

Role of growth factors and internal limiting membrane constituents in müller cell migration.

Exp Eye Res 2021 01 6;202:108352. Epub 2020 Nov 6.

Department of Ophthalmology, Chang Gung Memorial Hospital, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan; Department of Ophthalmology, Chang Gung Memorial Hospital, Keelung, Taiwan. Electronic address:

This study investigated the effects of growth factors and internal limiting membrane components on Müller cell migration. We studied the effects of epidermal growth factor (EGF), fibroblast growth factor (FGF), somatomedin (IGF-1), platelet derived growth factor (PDGF), and stromal cell-derived factor-1 alpha (SDF-1α) as well as collagen IV, laminin, and fibronectin on the proliferative and migratory activities of rat Müller cells in vitro. A water soluble tetrazolium-1 assay was used to quantify the viability of Müller cells in respective cultures, and analysis was performed using an enzyme-linked immunosorbent assay reader. All the factors examined had significant proliferative effects on cultured Müller cells (p < .05). A two-well Ibidi silicone culture insert was used to assess Müller cell migration. Müller cells cultured in EGF, FGF, IGF-1, collagen IV, and laminin but not in SDF, PDGF, or fibronectin effectively increased the cell migratory activity (p < .001). In addition, combined EGF and collagen IV, combined FGF and collagen IV, and combined IGF-1 and laminin exhibited more significant (p < .001) effects on Müller cell migration compared with culture a single factor. In summary, this study revealed the combinatorial effects of various growth factors and individual internal limiting membrane constituents. This may assist Müller cell migration together with the macular hole healing process.
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http://dx.doi.org/10.1016/j.exer.2020.108352DOI Listing
January 2021

Nasal or Temporal Internal Limiting Membrane Flap Assisted by Sub-Perfluorocarbon Viscoelastic Injection for Macular Hole Repair.

Am J Ophthalmol 2021 03 18;223:296-305. Epub 2020 Sep 18.

Department of Ophthalmology, Linkou Chang Gung Memorial Hospital, Taoyuan City, Taiwan; College of Medicine, Chang Gung University, Taoyuan City, Taiwan; Department of Ophthalmology, Chang Gung Memorial Hospital, Keelung, Taiwan. Electronic address:

Purpose: To compare the outcomes between using a nasal and a temporal inverted internal limiting membrane (ILM) flap both assisted by a novel technique in repairing a full-thickness macular hole (FTMH).

Design: Retrospective interventional case series.

Methods: Thirty-nine eyes from 39 patients with a FTMH <600 μm were included from a single institution. All patients underwent vitrectomy using a semicircular single-layered ILM inverted flap assisted by a sub-perfluorocarbon liquid injection of ophthalmic viscoelastic device (OVD) technique. Best-corrected visual acuity (BCVA) and spectral domain optical coherence tomography were used to compare outcomes between nasal (n = 19) and temporal (n = 20) groups.

Results: At 6 months postoperatively, all FTMHs closed and BCVA were significantly improved. Overall, 36 eyes (92%) achieved U-shaped closure, and ellipsoid zone restoration was noted in 24 eyes (62%). An ILM flap was present in 29 eyes (74%) and 86% remained single-layered. There were significantly more deep inner retinal dimples in the temporal group (35%) compared with 5% in the nasal group (P = .04), but these were unrelated to BCVA. Significant retinal thinning in the temporal outer sub-field was noted in the temporal group and was negatively correlated with BCVA (rho [ρ]: - .53; P = .03). No significant postoperative retinal displacement was noted in either group.

Conclusions: The technique of using sub-perfluorocarbon liquid injection of OVD secured single-layered flaps intraoperatively and postoperatively. Both the nasal and temporal inverted ILM flaps repaired FTMH and improved visual acuity. However, both temporal macular thinning and deep inner retinal dimples were significantly greater in the temporal group.
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http://dx.doi.org/10.1016/j.ajo.2020.09.023DOI Listing
March 2021

Impact of blood pressure control on retinal microvasculature in patients with chronic kidney disease.

Sci Rep 2020 08 31;10(1):14275. Epub 2020 Aug 31.

Department of Ophthalmology, Keelung Chang Gung Memorial Hospital, No. 222 Mai-Chin Road, Keelung, 204, Taiwan.

Chronic kidney disease (CKD) is an emerging disease worldwide. We investigated the relationship between blood pressure (BP) control and parafoveal retinal microvascular changes in patients with CKD. This case-control study enrolled 256 patients with CKD (stage 3-5) and 70 age-matched healthy controls. Optical coherence tomography angiography showed lower superficial vascular plexus (SVP) vessel density, lower deep vascular plexus (DVP) vessel density, and larger SVP flow void area in the CKD group. The BP parameters at enrollment and during the year before enrollment were collected in patients with CKD. Partial correlation was used to determine the relationship between BP parameters and microvascular parameters after controlling for age, sex, diabetes mellitus, axial length, and intraocular pressure. The maximum systolic blood pressure (SBP) (p = 0.003) and within-patient standard deviation (SD) of SBP (p = 0.006) in 1 year were negatively correlated with SVP vessel density. The average SBP (p = 0.040), maximum SBP (p = 0.001), within-patient SD of SBP (p < 0.001) and proportion of high BP measurement (p = 0.011) in 1 year were positively correlated with the SVP flow void area. We concluded that long-term SBP was correlated with SVP microvascular injury in patients with CKD. Superficial retinal microvascular changes may be a potential biomarker for prior long-term BP control in these patients.
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http://dx.doi.org/10.1038/s41598-020-71251-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7459351PMC
August 2020

Optic disc hemorrhage in nonglaucomatous eyes: A cross-sectional study with average 8-year follow-up.

PLoS One 2020 17;15(8):e0237796. Epub 2020 Aug 17.

Department of Ophthalmology, Chang Gung Memorial Hospital, Keelung, Taiwan.

Purpose: To characterize changes in the retinal nerve fiber layer (RNFL) and peripapillary vessel density (VD) at the site of disc hemorrhage (DH) in nonglaucomatous eyes.

Materials And Methods: This retrospective cross-sectional study included nonglaucomatous eyes diagnosed with unilateral DH. The change of DH was recorded using disc photography. Both anatomical data and functional visual field (VF) data were collected using optical coherence tomography angiography and Humphrey VF examination.

Results: Sixteen patients were included with average follow-up duration of 95 months. Almost half of DH episodes was initially presented at the inferotemporal area of the optic disc. Pigment formation at the previous DH site after resolution was noted in 12.5% of eyes. Sectoral radial peripapillary VD at the DH site was significantly lower in DH eyes than in the control group; however, the sectoral RNFL thickness at the DH site was not significantly decreased. Progression of the VF defect corresponding to the DH site was found in 81.3% of eyes despite regular use of antiglaucoma agents. The mean change in the VF mean deviation was -0.64 dB/year in DH eyes.

Conclusion: During long follow-up periods, decreased peripapillary VD at the DH site and progression of the VF defect corresponding to the DH site were detected in nonglaucomatous eyes. Retinal pigmentation with an RNFL defect is a clue for DH, although RNFL showed no significant change. Antiglaucoma treatment may not prevent the deterioration of visual function.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0237796PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7430739PMC
October 2020

Spatial variation of floatable plastic debris and microplastics in the Pearl River Estuary, South China.

Mar Pollut Bull 2020 Sep 15;158:111383. Epub 2020 Jul 15.

Greenpeace East Asia, Hong Kong, China.

The estuaries of populated catchments have been documented as hotspots of plastic pollution. In this study, microplastics (0.355-5.0 mm) and large plastic debris (>5.0 mm) of surface water collected from the Inner Lingding Bay of the Pearl River Estuary (PRE) were quantified and categorized according to their size, shape, colour and composition. Both microplastics and large plastic debris were detected at all sampling sites with mean abundances of 2.376 ± 0.700 n/m and 0.110 ± 0.039 n/m, respectively. Microplastics constitute 95.4% of the total abundance by number. The average microplastic concentration in the inner PRE was almost 3.5 times higher than that in the central PRE, indicating a positive correlation between plastic concentration and proximity to the river mouth. This result reveals the important role of rivers in transporting plastic debris from land to the oceans.
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http://dx.doi.org/10.1016/j.marpolbul.2020.111383DOI Listing
September 2020

Outcomes in patients with lacrimal gland carcinoma treated with definitive radiotherapy or eye-sparing surgery followed by adjuvant radiotherapy.

Radiat Oncol 2020 Jun 22;15(1):156. Epub 2020 Jun 22.

Department of Electro-Optical Engineering, National Taipei University of Technology, 1, Sec. 3, Chung-Hsiao E. Rd, Taipei, 10608, Taiwan, ROC.

Background: The optimal treatment for lacrimal gland cancer remains unclear. Eye-preserving surgery, as opposed to exenteration, followed by adjuvant radiotherapy (RT), has recently been reported to deliver satisfactory outcomes, but evidence is sparse. The aim of the present study was to evaluate outcomes in patients with lacrimal gland cancer treated at two tertiary medical centers.

Methods: We retrospectively examined data from patients with lacrimal gland cancer who had received eye-preserving surgical treatment followed by adjuvant RT with or without chemotherapy, or (if the tumor was inoperable) needle biopsy with definitive RT with or without chemotherapy. Baseline clinical and pathological characteristics were considered. Outcomes of interest included post-treatment complications, overall survival (OS), locoregional progression-free survival (LPFS), and distant metastasis-free survival (DMFS).

Results: Eighteen patients were included. Two-year OS, LPFS, and DMFS rates were 69.0, 76.7, and 71.4%, respectively. Patients with early-stage (T1-T2) lacrimal gland cancer had significantly better outcomes than those with advanced-stage disease (T3-T4). Two-year OS, LPFS, and DMFS rates were each 100% in patients with disease stages T1-T2, and 37.5, 50, and 37.5%, respectively, in those with disease stages T3-T4 (P < 0.05). Orbital complications were well tolerated.

Conclusions: Eye-sparing surgery with adjuvant RT can achieve satisfactory results in patients with T1-T2 lacrimal gland carcinoma. Disease stage T3 and above was associated with poor outcomes even with post-operative RT, likely due to distant metastasis. Adding neoadjuvant chemotherapy or adjuvant chemotherapy to current treatment strategies might be a suitable choice for this group of patients.
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http://dx.doi.org/10.1186/s13014-020-01601-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7310012PMC
June 2020

Management of diabetic macular edema: experts' consensus in Taiwan.

Jpn J Ophthalmol 2020 May 28;64(3):235-242. Epub 2020 Apr 28.

Department of Ophthalmology, School of Medicine, National Yang-Ming University, Taipei, Taiwan.

Diabetic macular edema (DME) is the most common cause of vision loss among patients with diabetes mellitus (DM), rendering it an important growing challenge in ophthalmology. In the past decades, the management strategies for DME had a few paradigm shifts, and the advent of an expanding number of anti-vascular endothelial growth factor (VEGF) agents also calls for an in-depth examination of the currently available evidence. This article was composed with the intention to provide recommendations for practicing clinicians to improve the management and, through it the outcomes of DME. Drawing from current guideline recommendations, clinical trial findings and local clinical experiences, these consensus recommendations for the management of DME were formed by an expert panel through iterations of discussion and voting. First, the treatment goal of DME is to achieve best visual outcome with edema improvement while minimizing treatment burden. Second, anti-VEGF therapy should be considered as the first-line treatment for patients with center-involving DME causing vision loss. Baseline visual acuity (VA) and central subfield thickness (CST) should be taken into consideration when choosing anti-VEGF agents. Third, early intensive anti-VEGF therapy (at least 3 monthly doses) is important for better patients' VA and anatomical improvement. In non-responders who have already been treated with 3-5 injections of anti-VEGF agents, it is reasonable to switch to other modalities, such as steroids. Finally, for the follow-up phase, fixed or individualized dosing should be considered based on VA and OCT.
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http://dx.doi.org/10.1007/s10384-020-00741-4DOI Listing
May 2020

Dipeptidyl peptidase-4 inhibitors and the risks of autoimmune diseases in type 2 diabetes mellitus patients in Taiwan: a nationwide population-based cohort study.

Acta Diabetol 2020 Oct 21;57(10):1181-1192. Epub 2020 Apr 21.

College of Medicine, Chang Gung University, Taoyuan, Taiwan.

Aims: Dipeptidyl peptidase-4, a transmembrane glycoprotein expressed in various cell types, serves as a co-stimulator molecule to influence immune response. This study aimed to investigate associations between DPP-4 inhibitors and risk of autoimmune disorders in patients with type 2 diabetes mellitus in Taiwan.

Methods: This retrospective cohort study used the nationwide data from the diabetes subsection of Taiwan National Health Insurance Research Database between January 1, 2009, and December 31, 2013. Cox proportional hazards models were developed to compare the risk of autoimmune disorders and the subgroup analyses between the DPP-4i and DPP-4i-naïve groups.

Results: A total of 774,198 type 2 diabetic patients were identified. The adjusted HR of the incidence for composite autoimmune disorders in DPP-4i group was 0.56 (95% CI 0.53-0.60; P < 0.001). The subgroup analysis demonstrated that the younger patients (aged 20-40 years: HR 0.47, 95% CI 0.35-0.61; aged 41-60 years: HR 0.50, 95% CI 0.46-0.55; aged 61-80 years: HR 0.63, 95% CI 0.58-0.68, P = 0.0004) and the lesser duration of diabetes diagnosed (0-5 years: HR 0.48, 95% CI 0.44-0.52; 6-10 years: HR 0.48, 95% CI 0.43-0.53; ≧ 10 years: HR 0.86, 95% CI 0.78-0.96, P < 0.0001), the more significant the inverse association of DPP-4 inhibitors with the incidence of composite autoimmune diseases.

Conclusions: DPP-4 inhibitors are associated with lower risk of autoimmune disorders in type 2 diabetes mellitus patients in Taiwan, especially for the younger patients and the lesser duration of diabetes diagnosed. The significant difference was found between the four types of DPP-4 inhibitors and the risk of autoimmune diseases. This study provides clinicians with useful information regarding the use of DPP-4 inhibitors for treating diabetic patients.
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http://dx.doi.org/10.1007/s00592-020-01533-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7173685PMC
October 2020

Baseline clinical features predict visual outcome in young patients with central retinal vein occlusion.

Graefes Arch Clin Exp Ophthalmol 2020 Jul 12;258(7):1367-1377. Epub 2020 Apr 12.

Department of Ophthalmology, Keelung Chang Gung Memorial Hospital, No. 222, Maijin Road, Keelung City, 204, Taiwan.

Purpose: To evaluate prognostic factors in young patients with central retinal vein occlusion (CRVO).

Methods: Retrospective case series. CRVO patients aged ≤ 50 and follow-up ≥ 6 months were enrolled. The best corrected visual acuity (BCVA) and central retinal thickness (CRT) at baseline, 3 months, 6 months, and last visit were documented. Severity of retinopathy was graded by comparing to standard photos. Prognostic factors associated with visual outcome at 6 months were evaluated by multiple linear regression models.

Results: A total of 73 eyes from 69 patients with mean age 37.6 ± 8.5 were enrolled. Forty-seven (68%) patients were male. The mean follow-up duration was 25.9 ± 23.0 months. LogMAR BCVA improved from 0.979 ± 0.785 at baseline to 0.594 ± 0.748 at the 6 months (p < 0.001) and CRT improved from 475 ± 222 μm to 299 ± 104 μm (p < 0.001). Forty-eight (66%) eyes required anti-vascular endothelial growth factor (anti-VEGF) treatment. The mean number of injections was 2.25 ± 1.41 in the first 6 months and 75% of eyes received ≦ 3 injections during the clinical course. The baseline BCVA (coefficient 0.518, p < 0.001), grade of retinal hemorrhage (coefficient 0.230, p = 0.006), grade of retinal venous engorgement (coefficient 0.238, p = 0.011), grade of optic disc edema (coefficient - 0.226, p = 0.005), and diabetes mellitus (coefficient 0.264, p = 0.047) were the independent factors associated with visual outcome at 6 months.

Conclusions: Baseline clinical features are useful for the prediction of visual outcome at 6 months in young CRVO patients.
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http://dx.doi.org/10.1007/s00417-020-04679-8DOI Listing
July 2020

Treatment of macular hole retinal detachment with macular plug in highly myopic eyes: three-year results.

Acta Ophthalmol 2020 Nov 3;98(7):e839-e847. Epub 2020 Apr 3.

Department of Ophthalmology, Chang Gung Memorial Hospital, Taoyuan, Taiwan.

Purpose: To investigate the long-term surgical outcomes of macular hole retinal detachment (MHRD) following vitrectomy with macular plug in highly myopic eyes.

Methods: Thirty-five cases of highly myopic eyes with MHRD in 35 patients who underwent an initially successful vitrectomy with macular plug and were followed up for at least 3 years were reviewed. The anatomical outcomes were evaluated by fundus examination, fundus photographs and optical coherence tomography (OCT). Myopic features after the surgery were differentiated according to recommendations of the Meta-analysis of Pathologic Myopia (META-PM) Study Group. The best-corrected visual acuities (BCVAs) before and after surgery were analysed as the functional outcome. Main outcome measures time-course changes in BCVA and complications.

Results: The mean patient age was 61.0 ± 11.4 years. The follow-up was 45.2 ± 8.6 months (ranged from 36 to 71 months). The mean axial length was 29.3 ± 1.2 mm. All eyes demonstrated attached retina, but 2 eyes (5.7%) developed reopened macular holes until the last follow-up. Complications of postoperative rhegmatogenous retinal detachment were detected in 2 eyes (5.7%) within 1 year and retina reattached after the secondary vitrectomy. Three cases (8.6%) of prolonged subretinal fluid lasting more than 1 year were detected but finally absorbed completely. Comparing 1-3 years postoperatively, myopic features showed significant progression of myopic maculopathy category (p = 0.035). Functionally, significantly improved BCVA could be maintained postoperatively between 6 months and 3 years. However, vision of 14 eyes (40.0%) worsened within 1-3 years postoperatively, and visual deterioration was associated with progression of myopic maculopathy (p = 0.004) and pre-existing disease of glaucoma (p = 0.006).

Conclusions: A vitrectomy combined with macular plug provided favourable outcomes in the long term, over the ≥3-year follow-up period.
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http://dx.doi.org/10.1111/aos.14418DOI Listing
November 2020

Normal tension glaucoma in obstructive sleep apnea syndrome: A structural and functional study.

Medicine (Baltimore) 2020 Mar;99(13):e19468

College of Medicine, Chang Gung University, Taoyuan.

This study characterized and evaluated normal tension glaucoma (NTG) in obstructive sleep apnea syndrome (OSAS).In this retrospective, cross-sectional study, all participants were examined with polysomnography (PSG). Functional parameters of standard automated perimetry (SAP) were recorded. Structural parameters in optical coherence tomography angiography (OCTA) included peripapillary superficial vessel density (VD RPC), peripapillary whole-layer (VD NH), and superficial and deep macular area VD. Participants were categorized into perimetric and nonperimetric groups by SAP result. Low reliability of SAP and signal strength index <50 in OCTA were excluded.Severity of OSAS was graded by apnea-hypopnea index (AHI) in PSG. Those with moderate/severe OSAS (AHI ≥ 15, n = 39) had longer neck circumference and shorter ocular axial length than mild OSAS (AHI < 15, n = 14). Furthermore, there was significantly higher AHI and larger neck circumference in the NTG perimetric group (n = 27) than in the control group (n = 26; p < 0.001 and p = 0.047, respectively). Superficial and deep-layer peripapillary and macular area VD significantly decreased in the perimetric group. Overall, structural and functional parameters show that VF PSD was negatively correlated with VD NH and VD RPC (p = 0.007, p = 0.015); and VF MD was positively correlated with VD NH (p = 0.029), but not significantly to VD RPC (p = 0.106).OSAS is a risk factor of NTG. With aid of OCTA, whole-layer retinal capillary dropout supports that the vascular dysregulation of OSAS leads to NTG.
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http://dx.doi.org/10.1097/MD.0000000000019468DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7220748PMC
March 2020

Retinal neurovascular changes in chronic kidney disease.

Acta Ophthalmol 2020 Nov 19;98(7):e848-e855. Epub 2020 Mar 19.

College of Medicine, Chang Gung University, Taoyuan, Taiwan.

Purpose: To examine retinal neurovascular changes in patients with chronic kidney disease (CKD).

Methods: Case-control study. A total of 171 CKD cases and 40 controls were recruited (mean age 62.9 ± 10.3 versus 60.8 ± 9.2, p = 0.257). Retinal neural parameters, including parafoveal retinal thickness (PfRT), macular ganglion cell complex thickness (GCCt), global loss volume (GLV), focal loss volume (FLV) and peripapillary retinal nerve fibre layer thickness (RNFLt), were measured using optical coherence tomography (OCT). Microvascular parameters, including foveal avascular zone size, vessel density over the parafoveal superficial vascular plexus (SVP-VD), parafoveal deep vascular plexus (DVP-VD) and radial peripapillary capillary (RPC-VD), were measured using OCT angiography.

Results: Chronic kidney disease (CKD) patients showed reduced PfRT, GCCt and RNFLt and increased GLV and FLV compared with the controls (all p < 0.005). Among patients with CKD, estimated glomerular filtration rate was an independent factor associated with PfRT (coefficient 0.19, p = 0.015), GCCt (coefficient 0.10, p = 0.006), GLV (coefficient - 0.08, p = 0.001), FLV (coefficient - 0.02, p = 0.006) and RNFLt (coefficient 0.15, p = 0.002). Parafoveal retinal thickness (PfRT), GCCt, GLV, FLV and RNFLt were correlated with SVP-VD (all p < 0.001) but not with DVP-VD (all p > 0.1).

Conclusions: Chronic kidney disease (CKD) patients demonstrated a significant reduction in macular thickness and changes in retinal neural parameters. These changes were associated with the severity of CKD and correlated with the microvascular rarefaction in the parafoveal SVP.
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http://dx.doi.org/10.1111/aos.14395DOI Listing
November 2020

Correlation of corneal pigmented arc with wide epithelial thickness map in orthokeratology-treated children using optical coherence tomography measurements.

Cont Lens Anterior Eye 2020 06 3;43(3):238-243. Epub 2020 Mar 3.

Department of Ophthalmology, Chang Gung Memorial Hospital, Keelung, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan; Program in Molecular Medicine, National Yang Ming University, Taipei, Taiwan. Electronic address:

Purpose: To determine the intensity of corneal pigmented arc in orthokeratology (ortho-k)-treated children and its correlation with wide epithelial thickness map (ETM) obtained through anterior segment optical coherent tomography (AS-OCT).

Methods: This retrospective case series reviews medical records of children who received ortho-k treatment for myopia control. Intensity of ortho-k-associated pigmented arc after wearing ortho-k lens more than 12 months and its correlation with each sector/zone of wide ETM obtained by AS-OCT was explored. Pigmented arcs were further divided into apparent and unapparent groups, and the clinical differences between groups were determined.

Results: This study included 57 eyes of 29 children (mean age, 11.4 years, range 9-15); after initiating ortho-k treatment, the incidence of the corneal pigmented arc was 91.2% with mean lens wear duration of 26.1 months. Intensity of pigmented arc was significantly correlated with lens wear duration, target power, baseline degree of myopia, C zone and sectors I2, I3 and IT3 on wide ETM. Comparison between apparent and unapparent groups showed the same significant results except for C zone. After adjusting for lens wear duration and target power, sector I2 has the highest association with pigmented arc severity.

Conclusion: Children treated with ortho-k are likely to develop ortho-k-associated pigmented arcs. The new wide ETM of AS-OCT can provide important information regarding the intensity of pigmented arc in these children. This can support customized pigmented arc-free ortho-k treatment for children in the future.
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http://dx.doi.org/10.1016/j.clae.2020.02.004DOI Listing
June 2020

Correlation between higher-order aberrations and visual acuity recovery (CoHORT) after spectacles treatment for pediatric refractive amblyopia: A pilot study using iDesign measurement.

PLoS One 2020 14;15(2):e0228922. Epub 2020 Feb 14.

Department of Ophthalmology, Chang Gung Memorial Hospital, Keelung, Taiwan.

Purpose: To determine the correlation between higher-order aberrations (HOAs) and best-corrected visual acuity (BCVA) recovery speed after spectacles treatment using iDesign measurements in refractive amblyopic children.

Methods: This is a prospective case series. Children aged from 3 to 7 years with refractive amblyopia (Landolt C equivalent < 0.8) were recruited. All participants were followed for at least 6 months after full correction of the refraction error by spectacles. The HOAs were measured using iDesign before and after cycloplegia at first visit and at 3-month intervals. Then correlation between BCVA recovery after treatment for 6 months and HOAs was determined.

Results: We analyzed 24 eyes of 12 children (mean age, 4.5 years). Baseline mean BCVA was logarithm of minimal angle of resolution (logMAR) 0.335 (Landolt C equivalent 0.46), which improved to logMAR 0.193 (Landolt C equivalent 0.64) after treatment with full-correction spectacles for 6 months. The amblyopic eye BCVA recovery was negatively correlated with tetrafoil with/without cycloplegia (P = 0.006 and 0.022, respectively) and trefoil with cycloplegia (P = 0.049).

Conclusions: trefoil and tetrafoil measured with iDesign negatively correlates with the BCVA recovery speed of refractive amblyopic eyes after spectacles treatment in this pilot study. The current study results may aid in further investigation for diagnosis and treatment of refractory refractive and idiopathic amblyopia.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0228922PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7021302PMC
May 2020

Correlation between pigmented arc and epithelial thickness (COPE) study in orthokeratology-treated patients using OCT measurements.

Eye (Lond) 2020 02 7;34(2):352-359. Epub 2019 Aug 7.

Department of Ophthalmology, Chang Gung Memorial Hospital, Keelung, Taiwan.

Purpose: To determine the intensity of corneal pigmented arc in orthokeratology (ortho-k)-treated children, and its correlation with key epithelial thickness measurements obtained by anterior segment optical coherence tomography (AS-OCT).

Methods: This study is a retrospective case series. Medical records of children who received ortho-k treatment for myopia control in our hospital were reviewed. Intensity of ortho-k-associated pigmented arc and its correlation with key epithelial thickness parameters in the central 7-mm-diameter zone obtained by AS-OCT was examined. The subjects were further divided into apparent and unapparent pigmented arc groups for severity comparison.

Results: The mean age of children was 11.4 years, and the incidence of corneal pigmented arc was 92.2% after lens wear for a mean duration of 21.2 months. Intensity of pigmented arc was found to be significantly correlated with key epithelial thickness parameters, including maximum and minimum epithelial thickness (Spearman's rank correlation coefficient (rs) = 0.404, P = 0.003; rs = - 0.426, P = 0.002, respectively), the difference between them (Min-Max) (rs = -0.624, P < 0.001) and standard deviation (rs = 0.659, P < 0.001). Significant correlation between intensity of pigmented arc and ortho-k target power (rs = 0.454, P = 0.001) was found. Comparison between the two groups showed significant difference in the same key epithelial thickness parameters.

Conclusions: Children receiving ortho-k treatment tended to develop pigmented arcs. Significant correlation between intensity of pigmented arc and key epithelial thickness parameters was observed. AS-OCT can be a useful tool for predicting intensity of pigmented arc in ortho-k-treated children.
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http://dx.doi.org/10.1038/s41433-019-0542-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7002656PMC
February 2020

Intraocular lens power calculation after radial keratotomy and LASIK - A case report.

Am J Ophthalmol Case Rep 2019 Sep 13;15:100495. Epub 2019 Jun 13.

Department of Ophthalmology, Keelung Chang Gung Memorial Hospital, No.222, Maijin Rd., Keelung City, 204, Taiwan.

Purpose: To report a challenging intraocular lens (IOL) power calculation case who received both radial keratotomy (RK) and laser-assisted in situ keratomileusis (LASIK).

Observations: A 51-year-old man had received refractive surgery with RK and later enhanced by LASIK more than 20 years ago. He developed severe cataract in left eye with best-corrected visual acuity of 20/100. The IOL power calculation was made using several methods available at the American Society of Cataract and Refractive Surgery (ASCRS) online calculator, including IOL calculation formulas for post-LASIK condition (Shammas, Haigis-L, Barrett True K no history, and Potvin-Hill Pentacam) and formulas for post-RK condition (Double K-modified Holladay 1 based on Oculus Pentacam and IOL Master, and Barrett True K). Haigis-L, Shammas and Barrett true K no history were found to be most accurate in predicting IOL power.

Conclusions: Haigis-L, Shammas and Barrett true K no history are reliable formulas for IOL power calculation in patients who received both RK and LASIK.
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http://dx.doi.org/10.1016/j.ajoc.2019.100495DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6584476PMC
September 2019

Perfluoro-n-octane-assisted autologous internal limiting membrane plug for refractory macular hole surgery.

Int Ophthalmol 2019 Dec 28;39(12):2767-2773. Epub 2019 May 28.

Department of Ophthalmology, Chang Gung Memorial Hospital, No. 5, Fu-Hsin Rd., Taoyüan, 33375, Taiwan.

Purpose: To evaluate a surgical technique using a perfluoro-n-octane (PFO)-assisted autologous internal limiting membrane (ILM) plug for refractory macular holes (MHs).

Methods: This study was a retrospective, consecutive, interventional case series. Patients with refractory MHs following PFO-assisted autologous ILM plugs were reviewed between October 1, 2017, and February 28, 2018. The anatomical results of MH preoperatively and postoperatively were evaluated by fundus examination and optical coherence tomography (OCT). The best-corrected visual acuities (BCVAs) before and after surgery were compared as the functional outcome.

Results: Six eyes of six consecutive patients with refractory MH were enrolled in this study. Successful MH closure and BCVA improvement after the surgeries were obtained in all eyes. There were four male and two female patients, and the mean age was 63.7 ± 11.1 years. Intraoperatively, the average number of autologous ILM grafts we harvested was 2.2 ± 0.4. The mean follow-up was 6.0 ± 1.7 months. The averaged BCVA before and after the surgery at the last visit improved from 20/356 to 20/153. The ILM graft tissue was still visible, as shown by OCT, in all 6 of 6 (100%) eyes during the follow-up period.

Conclusions: This surgical technique using PFO-assisted autologous ILM plug may provide an option for the treatment of refractory MH.
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http://dx.doi.org/10.1007/s10792-019-01123-7DOI Listing
December 2019

Epidemiologic study of pterygium in Taiwan.

Jpn J Ophthalmol 2019 Jul 18;63(4):297-303. Epub 2019 May 18.

Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou, Taiwan.

Purpose: To investigate the incidence, prevalence, and factors related to pterygium in Taiwan.

Study Design: An ecological study METHODS: We analyzed a random sample of 1 million individuals in Taiwan drawn from the National Health Insurance Database (NHIRD), established in 2005, for the period 2000 to 2011. Patients with pterygium were identified using ICD-9-CM diagnostic codes. The prevalence and annual age- and gender-adjusted incidence of pterygium were calculated for each county in Taiwan. The risk factors including ultraviolet (UV) exposure, outdoor occupation, educational level, and average socioeconomic status of each county of each index year were identified. Univariate and backward elimination multivariate selection by the mixed-effects model were performed to identify significant risk factors related to the incidence of pterygium in Taiwan.

Results: A total of 22,063 individuals with pterygium (10,125 men and 11,938 women) were identified in this study. The prevalence of pterygium was 2.14% in the overall population and 3.48% in the population aged 40 years or older. The occurrence of pterygium was greater in women. In addition, this study demonstrated that UV exposure and low educational level are correlated with the age- and gender-adjusted incidence of pterygium.

Conclusion: Our study is the first to use the NHIRD to determine the prevalence (2.14%) and annual age- and gender-adjusted incidence of pterygium among the general population of Taiwan. The relationship of pterygium with UV exposure and educational level suggests a complex and multifactorial etiology for this disease.
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http://dx.doi.org/10.1007/s10384-019-00670-xDOI Listing
July 2019

Management of polypoidal choroidal vasculopathy: Experts consensus in Taiwan.

J Formos Med Assoc 2020 Feb 7;119(2):569-576. Epub 2019 May 7.

Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Ophthalmology, School of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan. Electronic address:

Polypoidal choroidal vasculopathy (PCV) is a prevalent retinal disease predominantly occurs in Asians that shares some similarities seen in neovascular age-related macular degeneration. Recent large multicenter clinical trials on intravitreal anti-vascular endothelial growth factor (VEGF) agents and photodynamic therapy (PDT) have shed lights on the management of PCV. The Taiwan National Health Insurance had granted limited anti-VEGF agents and PDT for patients with PCV after the approval of required data submission, especially fundus angiography, optical coherence tomography, and visual acuity. In order to best utilize these limited resources for the patients, an expert meeting was held to provide updated Taiwan consensus recommendations for the management of PCV, including initial therapy selection, assessment of treatment response, re-treatment/rescue treatment, and determination of treatment extension/follow-up schedule. An algorithm for treatment allocation under both initial and re-treatment setting was proposed. Further mechanistic and clinical studies are required to investigate the prognostic factors and optimal treatment protocols that will improve healthcare quality and reduce burden of disease and treatment for patients with PCV.
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http://dx.doi.org/10.1016/j.jfma.2019.04.012DOI Listing
February 2020
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