Publications by authors named "Sarah Moran"

42 Publications

Evaluation of a uniplanar pupil expansion ring in small-pupil cataract surgery: a feasibility study.

Int Ophthalmol 2021 Oct 16. Epub 2021 Oct 16.

Department of Ophthalmology, Rothschild Foundation, Paris, France.

Purpose: The aim of this study was to evaluate the effectiveness of a disposable uniplanar pupil expansion device in small-pupil cataract surgery.

Methods: This is a feasibility study carried out at the Rothschild Foundation, Paris, France. Patients undergoing routine cataract surgery with a dilated pupil size < 6 mm, and who agreed to participate in the study were included. The trial enrolled 25 patients, of whom 21 proceeded to cataract surgery using the pupil expansion device to be evaluated. The pupil diameter was measured at defined stages during the cataract surgery, which was performed by a single surgeon, in a single center setting. The 1st generation Bhattacharjee pupil expansion ring was used if the preoperative pupil size was < 6 mm. Intraoperative and postoperative adverse events were recorded.

Results: Pupil size immediately after the Bhattacharjee ring implantation was ≥ 6 mm for 15 eyes (71.4%). The mean dilated pupil size before ring insertion was 4.5 ± 0.8 mm (range 2.5-5.8 mm), and the mean pupil size after ring insertion was 6.1 ± 0.3 mm (range 5.9-6.8 mm). Mean pupil size following removal of the ring was 4.2 ± 0.8 mm (range 2.5-5.4 mm). Two adverse events occurred during the surgeries: 1 Bhattacharjee ring broke prior to implantation, and 1 implanted Bhattacharjee ring was unstable and removed before the end of the surgery. No postoperative adverse event was recorded.

Conclusions: The Bhattacharjee ring is an effective pupil expansion device, which facilitates stable pupil expansion during cataract surgery. This study was registered as a clinical trial at clinicaltrials.gov under the number NCT02434588.
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http://dx.doi.org/10.1007/s10792-021-02065-9DOI Listing
October 2021

The Clinical Application of Urine Soluble CD163 in ANCA-Associated Vasculitis.

J Am Soc Nephrol 2021 11 13;32(11):2920-2932. Epub 2021 Sep 13.

Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan.

Background: Up to 70% of patients with ANCA-associated vasculitis (AAV) develop GN, with 26% progressing to ESKD. Diagnostic-grade and noninvasive tools to detect active renal inflammation are needed. Urinary soluble CD163 (usCD163) is a promising biomarker of active renal vasculitis, but a diagnostic-grade assay, assessment of its utility in prospective diagnosis of renal vasculitis flares, and evaluation of its utility in proteinuric states are needed.

Methods: We assessed a diagnostic-grade usCD163 assay in () a real-world cohort of 405 patients with AAV and 121 healthy and 488 non-AAV disease controls; () a prospective multicenter study of 84 patients with potential renal vasculitis flare; () a longitudinal multicenter cohort of 65 patients with podocytopathy; and () a cohort of 29 patients with AAV (with or without proteinuria) and ten controls.

Results: We established a diagnostic reference range, with a cutoff of 250 ng/mmol for active renal vasculitis (area under the curve [AUC], 0.978). Using this cutoff, usCD163 was elevated in renal vasculitis flare (AUC, 0.95) but remained low in flare mimics, such as nonvasculitic AKI. usCD163's specificity declined in patients with AAV who had nephrotic-range proteinuria and in those with primary podocytopathy, with 62% of patients with nephrotic syndrome displaying a "positive" usCD163. In patients with AAV and significant proteinuria, usCD163 normalization to total urine protein rather than creatinine provided the greatest clinical utility for diagnosing active renal vasculitis.

Conclusions: usCD163 is elevated in renal vasculitis flare and remains low in flare mimics. Nonspecific protein leakage in nephrotic syndrome elevates usCD163 in the absence of glomerular macrophage infiltration, resulting in false-positive results; this can be corrected with urine protein normalization.
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http://dx.doi.org/10.1681/ASN.2021030382DOI Listing
November 2021

The Myeloid-Kidney Interface in Health and Disease.

Clin J Am Soc Nephrol 2021 Sep 10. Epub 2021 Sep 10.

Department of Pathology and Molecular Medicine, Queen's University, Kingston, Ontario, Canada.

Kidney homeostasis is highly dependent upon the correct functioning of myeloid cells. These cells form a distributed surveillance network throughout the kidney, where they play an integral role in the response to organ threat. Dysregulation of resident proinflammatory and profibrotic macrophages leads to kidney structural damage and scarring after kidney injury. Fibrosis throughout the kidney parenchyma contributes to the progressive functional decline observed in CKD, independent of the etiology. Circulating myeloid cells bearing intrinsic defects also affect the kidney substructures, such as neutrophils activated by autoantibodies that cause GN in ANCA-associated vasculitis. The kidney can also be affected by disorders of myelopoiesis, including myeloid leukemias (acute and chronic myeloid leukemias) and myelodysplastic syndromes. Clonal hematopoiesis of indeterminate potential is a common, newly recognized premalignant clinical entity characterized by clonal expansion of hyperinflammatory myeloid lineage cells that may have significant kidney sequelae. A number of existing therapies in CKD target myeloid cells and inflammation, including glucocorticoid receptor agonists and mineralocorticoid receptor antagonists. The therapeutic indications for these and other myeloid cell-targeted treatments is poised to expand as our understanding of the myeloid-kidney interface evolves.
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http://dx.doi.org/10.2215/CJN.04120321DOI Listing
September 2021

COMPARATIVE ANALYSIS OF 2 BIOMETERS USING SWEPT-SOURCE OPTICAL COHERENCE TOMOGRAPHY TECHNOLOGY.

J Cataract Refract Surg 2021 May 21. Epub 2021 May 21.

Department of Ophthalmology, Rothschild Foundation, 25, Rue Manin, 75019, Paris, France.

Purpose: To report the repeatability, level of agreement and correlation of 2 swept-source optical coherence tomography (SS-OCT) biometers, the IOLMaster 700® (biometer A, Carl Zeiss, Germany) and the Anterion® (biometer B, Heidelberg Engineering GmbH, Heidelberg, Germany).

Setting: Rothschild Foundation Hospital, Paris, France.

Design: Prospective comparative case series.

Methods: Consecutive patients who attended for cataract assessment had SS-OCT biometry performed with the reference and the biometer B. Axial length (AL), mean keratometry (mean K), central corneal thickness (CCT), anterior chamber depth (ACD), lens thickness (LT), and corneal diameter measurements (WTW) were measured. The intraoperator repeatability was calculated using ANOVA and repeatability limits. . Correlations were assessed and the level of agreement between the biometers was represented with the Bland-Altman method.

Results: The study comprised 63 patients (125 eyes). There was a statistically significant difference between the 2 biometers in all measurements (P < .05). All repeatability measurements were very high as were the level of correlation and level of agreement between the biometer A and the biometer B for all parameters.

Conclusion: The biometer B provided good agreement and repeatability compared with the biometer A, however all parameters are not interchangeable in particular the WTW measurement and high keratometric values.
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http://dx.doi.org/10.1097/j.jcrs.0000000000000704DOI Listing
May 2021

Quantitative comparison of corneal surface areas in keratoconus and normal eyes.

Sci Rep 2021 03 25;11(1):6840. Epub 2021 Mar 25.

Rothschild Foundation Hospital, Paris, France.

Keratoconus is a highly prevalent corneal disorder characterized by progressive corneal thinning, steepening and irregular astigmatism. To date, pathophysiology of keratoconus development and progression remains debated. In this study, we retrospectively analysed topographic elevation maps from 3227 eyes of 3227 patients (969 keratoconus and 2258 normal eyes) to calculate anterior and posterior corneal surface area. We compared results from normal eyes and keratoconus eyes using the Mann-Whitney U test. The Kruskal-Wallis test was used to compare keratoconus stages according to the Amsler-Krumeich classification. Keratoconus eyes were shown to have statistically significantly larger corneal surface areas, measured at the central 4.0 mm and 8.0 mm, and total corneal diameter. However, no significant increase in corneal surface area was seen with increasing severity of keratoconus. We suggest that these results indicate redistribution, rather than increase, of the corneal surface area with keratoconus severity.
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http://dx.doi.org/10.1038/s41598-021-86185-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7994394PMC
March 2021

Association of venous thromboembolic events with skin, pulmonary and kidney involvement in ANCA-associated vasculitis: a multinational study.

Rheumatology (Oxford) 2021 Oct;60(10):4654-4661

Department of Medicine, University of Cambridge, Cambridge, UK.

Objective: To investigate the occurrence of venous thromboembolic events (VTE) in a large cohort of patients with antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) across the European Union, Turkey, Russia, UK and North America.

Methods: Patients with a definite diagnosis of AAV who were followed for at least 3 months and had sufficient documentation were included. Data on VTE, including either deep vein thrombosis or pulmonary embolism, were collected retrospectively from tertiary vasculitis centres. Univariate and multivariate regression models were used to estimate odds ratios (ORs) and 95% CIs.

Results: Over a median follow-up of 63 (interquartile range: 29, 101) months, VTE occurred in 278 (9.7%) of 2869 AAV patients with a similar frequency across different countries (from 6.3% to 13.7%), and AAV subtype [granulomatosis with polyangiitis: 9.8% (95% CI: 8.3, 11.6%); microscopic polyangiitis: 9.6% (95% CI: 7.9, 11.4%); and eosinophilic granulomatosis with polyangiitis: 9.8% (95% CI: 7.0, 13.3%)]. Most VTE (65.6%) were reported in the first-year post-diagnosis. Multiple factor logistic regression analysis adjusted for sex and age showed that skin (OR 1.71, 95% CI: 1.01, 2.92), pulmonary (OR 1.78, 95% CI: 1.04, 3.14) and kidney [eGFR 15-60 ml/min/1.73 m2, OR 2.86 (95% CI: 1.27, 6.47); eGFR <15 ml/min/1.73 m2, OR 6.71 (95% CI: 2.94, 15.33)] involvement were independent variables associated with a higher occurrence of VTE.

Conclusion: Two-thirds of VTE occurred during the initial phase of active disease. We confirmed previous findings from smaller studies that a decrease in kidney function, skin involvement and pulmonary disease are independently associated with VTE.
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http://dx.doi.org/10.1093/rheumatology/keab071DOI Listing
October 2021

Management of Patients With Glomerulonephritis During the COVID-19 Pandemic: Recommendations From the Canadian Society of Nephrology COVID-19 Rapid Response Team.

Can J Kidney Health Dis 2020 26;7:2054358120968955. Epub 2020 Nov 26.

Division of Nephrology, Queen's University, Kingston, ON, Canada.

Purpose Of Program: This article will provide guidance on how to best manage patients with glomerulonephritis (GN) during the COVID-19 pandemic.

Sources Of Information: We reviewed relevant published literature, program-specific documents, and guidance documents from international societies. An informal survey of Canadian nephrologists was conducted to identify practice patterns and expert opinions. We hosted a national webinar with invited input and feedback after webinar.

Methods: The Canadian Society of Nephrology (CSN) Board of Directors invited physicians with expertise in GN to contribute. Specific COVID-19-related themes in GN were identified, and consensus-based recommendations were made by this group of nephrologists. The recommendations received further peer input and review by Canadian nephrologists via a CSN-sponsored webinar. This was attended by 150 kidney health care professionals. The final consensus recommendations also incorporated review by Editors of the .

Key Findings: We identified 9 areas of GN management that may be affected by the COVID-19 pandemic: (1) clinic visit scheduling, (2) clinic visit type, (3) provision of multidisciplinary care, (4) blood and urine testing, (5) home-based monitoring essentials, (6) immunosuppression, (7) other medications, (8) patient education and support, and (9) employment.

Limitations: These recommendations are expert opinion, and are subject to the biases associated with this level of evidence. To expedite the publication of this work, a parallel review process was created that may not be as robust as standard arm's length peer review processes.

Implications: These recommendations are intended to provide optimal care during the COVID-19 pandemic. Our recommendations may change based on the evolving evidence.
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http://dx.doi.org/10.1177/2054358120968955DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7705766PMC
November 2020

Anatomical and Visual Outcomes after LASIK Performed in Myopic Eyes with the WaveLight® Refractive Suite (Alcon® Laboratories Inc., USA).

J Ophthalmol 2020 3;2020:7296412. Epub 2020 Oct 3.

Department of Anterior Segment and Refractive Surgery, Rothschild Foundation, Paris, France.

Purpose: To evaluate changes in corneal anatomy and quality of vision following LASIK refractive surgery for mild to high myopia using the WaveLight® Refractive Suite (Alcon® Laboratories Inc., USA). . Rothschild Foundation, Paris, France.

Design: Prospective interventional case series.

Methods: We examined 60 myopic eyes (average SE -4.5 D, from -9.3 to -0.75 D) of 30 patients from 21.3 to 38.7 years old. Pachymetry, keratometry, factor, corneal aberrations, visual acuity (VA), contrast sensitivity, dry eye assessment, and quality of vision were measured preoperatively, one day (D1), and 1, 3, and 6 months postoperatively.

Results: 6 months postoperatively, keratometry became flatter, and the factor became more oblate (from -0.18 ± 0.08 to +0.19 ± 0.06). Pachymetry decreased by 117.9 ± 62.2 m at D1 and increased by 37.87 ± 32.6 m between D1 and M6. Refraction was emmetropic at D1 and remained stable thereafter. Six months after surgery, VA was slightly but nonsignificantly improved (<0.05 log MAR), whereas contrast sensitivity remained unchanged. Quality of vision was not affected by surgery and was more related to dry eye symptoms than to corneal HOAs (  = 0.49; < 0.001 vs.  = 0.03; < 0.001).

Conclusions: LASIK surgery for moderate to high myopia, performed with the WaveLight® Refractive Suite, showed good postoperative outcomes, with demonstrated safety, predictability, efficiency, and stability. This is probably due to well-controlled spherical aberration and the use of large optical zones. Besides, we can assume that the patients' quality of vision depends more on the postoperative dry eye disease generated by the laser than on the induced HOAs.
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http://dx.doi.org/10.1155/2020/7296412DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7556114PMC
October 2020

Heads-up Descemet Membrane Endothelial Keratoplasty Surgery: Feasibility, Surgical Duration, Complication Rates, and Comparison With a Conventional Microscope.

Cornea 2021 Apr;40(4):415-419

Department of Ophthalmology, Rothschild Foundation, Paris, France.

Purpose: To assess the feasibility of Descemet membrane endothelial keratoplasty (DMEK) surgery using the glasses-assisted 3-dimensional (3D) display system NGENUITY (Alcon Laboratories, Fort Worth, TX) and to compare with standard DMEK surgery by using a conventional operating microscope.

Methods: Twelve consecutive cases of DMEK surgery were performed using the glasses-assisted 3D display system NGENUITY (Alcon) and matched with similar cases performed by using the OPMI-Lumera 700 surgical microscope (Carl Zeiss Meditec, Jena, Germany) in this prospective cross-sectional study realized at the Rothschild Foundation, Paris, France. DMEK graft preparation time, graft unfolding time, time to perform the descemetorhexis (DM), and overall surgical time were recorded. Best corrected visual acuity, endothelial cell density of the donor tissue measured by specular microscopy, and the recipient's central corneal thickness were recorded preoperatively and again at 1 and 3 months postoperatively.

Results: In the 3D group, time to perform the graft preparation, DM, and global surgical time were significantly higher in the 3D group than in the conventional groups (17 minutes 36 seconds ± 3 minutes 13 seconds and 14 minutes 50 seconds ± 1 minutes 28 seconds, P = 0.04; 6 minutes 18 seconds ± 2 minutes 30 seconds vs. 3 minutes 50 seconds ± 2 minutes 8 seconds, P = 0.03; and 31 minutes 30 seconds ± 6 minutes 10 seconds vs. 24 minutes 10 seconds ± 3 minutes 26 seconds, respectively, P = 0.05). The time to unfold the graft was higher, although not significantly so, in the 3D group compared with the conventional group (5 minutes 15 seconds ± 2 minutes 40 seconds vs. 4 minutes 40 seconds ± 2 minutes 25 seconds, P = 0.89). Mean central corneal thickness decreased about 168 ± 82 μm at 3 months after surgery in the 3D group and about 228 ± 123 μm in the conventional group without significant difference (P = 0.60). Best corrected visual acuity in the 3D group was 0.33 ± 0.32 LogMAR at 3 months after surgery with no significant differences found when compared with conventional surgery. The percent endothelial cell loss from preoperative at 3 months was 35% in the 3D group and 26% in the conventional group, respectively, with no significant difference (P > 0.05).

Conclusions: Performing DMEK surgery using a 3D display system is feasible; however, it is more challenging and the total surgical time is longer. This method would certainly be useful for instructional courses.
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http://dx.doi.org/10.1097/ICO.0000000000002419DOI Listing
April 2021

Management of Advanced Chronic Kidney Disease During the COVID-19 Pandemic: Suggestions From the Canadian Society of Nephrology COVID-19 Rapid Response Team.

Can J Kidney Health Dis 2020 19;7:2054358120939354. Epub 2020 Jul 19.

Queen's University, Kingston, ON, Canada.

Purpose Of Program: To provide guidance on the management of patients with advanced chronic kidney disease (CKD) not requiring kidney replacement therapy during the COVID-19 pandemic.

Sources Of Information: Program-specific documents, pre-existing, and related to COVID-19; documents from national and international kidney agencies; national and international webinars, including webinars that we hosted for input and feedback; with additional information from formal and informal review of published academic literature.

Methods: Challenges in the care of patients with advanced CKD during the COVID-19 pandemic were highlighted within the Canadian Senior Renal Leaders Forum discussion group. The Canadian Society of Nephrology (CSN) developed the COVID-19 rapid response team (RRT) to address these challenges. They identified a lead with expertise in advanced CKD who identified further nephrologists and administrators to form the workgroup. A nation-wide survey of advanced CKD clinics was conducted. The initial guidance document was drafted and members of the workgroup reviewed and discussed all suggestions in detail via email and a virtual meeting. Disagreements were resolved by consensus. The document was reviewed by the CSN COVID-19 RRT, an ethicist and an infection control expert. The suggestions were presented at a CSN-sponsored interactive webinar, attended by 150 kidney health care professionals, for further peer input. The document was also sent for further feedback to experts who had participated in the initial survey. Final revisions were made based on feedback received until April 28, 2020. (CJKHD) editors reviewed the parallel process peer review and edited the manuscript for clarity.

Key Findings: We identified 11 broad areas of advanced CKD care management that may be affected by the COVID-19 pandemic: (1) clinic visit scheduling, (2) clinic visit type, (3) provision of multidisciplinary care, (4) bloodwork, (5) patient education/support, (6) home-based monitoring essentials, (7) new referrals to multidisciplinary care clinic, (8) kidney replacement therapy, (9) medications, (10) personal protective equipment, and (11) COVID-19 risk in CKD. We make specific suggestions for each of these areas.

Limitations: The suggestions in this paper are expert opinion, and subject to the biases associated with this level of evidence. To expedite the publication of this work, a parallel review process was created that may not be as robust as standard arms' length peer-review processes.

Implications: These suggestions are intended to provide guidance for advanced CKD directors, clinicians, and administrators on how to provide the best care possible during a time of altered priorities and reduced resources.
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http://dx.doi.org/10.1177/2054358120939354DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7372621PMC
July 2020

Bleb reconstruction using donor scleral patch graft for late bleb leak and hypotony.

Eur J Ophthalmol 2021 May 26;31(3):1039-1046. Epub 2020 May 26.

Department of Ophthalmology, 58010Royal Victoria Eye and Ear Hospital, Dublin, Ireland.

Purpose: Bleb dysfunction may occur as a late complication following glaucoma filtration surgery. Over-filtering, thinning and cystic blebs can lead to hypotony, leak and corneal dellen. We report our surgical management and outcomes of this specific entity using donor scleral patch grafts.

Methods: This is a 10-year non-comparative, retrospective interventional case series. Bleb reconstruction involved excision of encysted conjunctiva and sclera to identify the original fistula. A functioning donor scleral patch graft was sited over this with fixed and releasable sutures and the conjunctiva advanced. Intraocular pressure, visual acuity and post-operative issues were assessed.

Results: A total of 18 eyes of 17 patients with mean age 65 years (standard deviation 13.5) were included. Trabeculectomy was the primary procedure in 72% ( = 13) and deep sclerectomy in 28% ( = 5). Bleb leak accounted for 61% ( = 11), hypotony 33% ( = 6) and corneal dellen 6% ( = 1). Mean pre-operative intraocular pressure was 7 mm Hg (standard deviation 4.6) which increased to 18.5 mm Hg (standard deviation 12) at day 1 ( < 0.001), 11.8 mm Hg (standard deviation 4.6) at 3 months ( < 0.05), 12.1 mm Hg (standard deviation 4.2) at 1 year ( < 0.01) which was maintained at 12.1 mm Hg (standard deviation 5.3) at last follow-up ( < 0.001). Post-operative interventions included bleb needling, re-suturing, suture removal, further glaucoma management, bleb leak and cataract surgery. Visual acuity also improved post-operatively and was maintained.

Conclusion: Reconstruction of the filtering bleb architecture with donor sclera results in improved intraocular pressure while maintaining visual acuity. Post-operative care is required to support the restored bleb function. Our findings support the use of scleral patch graft as an effective and safe method for the long-term management of hypotony and bleb leak as a late complication of glaucoma filtration surgery.
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http://dx.doi.org/10.1177/1120672120924343DOI Listing
May 2021

Evaluation of vision-related quality of life in keratoconus patients, and associated impact of keratoconus severity indicators.

Graefes Arch Clin Exp Ophthalmol 2020 Jul 15;258(7):1459-1468. Epub 2020 Apr 15.

Department of Ophthalmology, School of medicine of Paris Descartes, Hôpital Cochin-Hôtel-Dieu, Sorbonne Paris Cité University, Paris, France.

Purpose: To evaluate vision-related quality of life in keratoconus patients and associated impact of keratoconus severity indicators using the National Eye Institute Visual Function Questionnaire (NEI-VFQ-25).

Methods: This was a prospective cross-sectional study carried out from November 1, 2014, to April 30, 2015, in the corneal service of the Hôtel-Dieu hospital, Paris, France. A hundred and one keratoconus patients were consecutively enrolled. Participants completed a French-validated version of the National Eye Institute Visual Function Questionnaire (NEI-VFQ-25). Manifest refraction, maximum keratometry value, and corneal thinnest point were recorded. Associations between clinical and demographic factors, previous medical or surgical treatment, and NEI-VFQ-25 scale scores were evaluated.

Results: Vision-related quality of life was no better in patients managed with rigid gas permeable contact lens, collagen cross-linking, or intracorneal ring segment implantation, compared with untreated patients. In advanced keratoconus (stages II, III, and IV of Amsler-Krumeich classification), rigid gas permeable contact lens wearers had better general vision but more ocular pain. Distance-corrected visual acuity worse than 20/40, mean refractive cylinder > 2.5 diopters, and corneal thinnest point < 460 μm in the better eye were associated with a lower vision-related quality of life. In multivariate analysis, only the uncorrected and distance-corrected visual acuity of the better eye remained significantly correlated with vision-related quality of life.

Conclusions: Low distance-corrected visual acuity in the better eye was the strongest predictor of low vision-related quality of life.
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http://dx.doi.org/10.1007/s00417-020-04680-1DOI Listing
July 2020

A Case-Control Study of Keratoconus Risk Factors.

Cornea 2020 Jun;39(6):697-701

Department of Anterior Segment & Refractive Surgery, Rothschild Foundation, Paris, France; and.

Purpose: To evaluate risk factors associated with keratoconus in a case-control setting.

Methods: This single center, prospective, case-control study was carried out from May 2014 to November 2017 at the Rothschild Foundation (Paris, France). Two hundred two patients with keratoconus and 355 control patients were investigated and followed by a single ophthalmologist. Data regarding multiple variables were gathered, including eye rubbing, pattern of eye rubbing, dominant hand, allergies, history of dry eye, screen time, sleep position, and night-time work.

Results: After multivariable analysis, the following variables showed significant results: eye rubbing with knuckles [odds ratio (OR) = 8.29; 95% confidence interval (CI): 3.92-18.26, P < 0.001] or fingertips (OR = 5.34; 95% CI: 2.44-12.21, P < 0.001), a history of dry eye (OR = 4.16; 95% CI: 2.3-7.7; P < 0.001), male sex (OR = 4.16; 95% CI: 1.47-11.89; P < 0.001), screen time (OR = 1.02; 95% CI: 1.01-1.04; P < 0.001), prone sleep position (OR = 11.63; 95% CI: 3.88-38.16), and side sleep position (OR = 10.17, 95% CI 3.84-33.73).

Conclusions: This study shows a strong correlation between eye rubbing and keratoconus, particularly when rubbing is performed with the knuckles. Additional associations were identified which may merit future investigation as risk factors, including sleep position, night-time work, and screen time.
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http://dx.doi.org/10.1097/ICO.0000000000002283DOI Listing
June 2020

Outcomes of Gel Stent Implantation for Glaucoma in Patients With Previous Corneal Graft Surgery: A Case Series.

Cornea 2020 Apr;39(4):417-421

Rothschild Foundation, Paris, France.

Purpose: To report a series of 5 cases with successful placement of a minimally invasive glaucoma surgery (MIGS) device for glaucoma refractory to medical management in patients with previous corneal grafts.

Methods: This is a retrospective analysis of all cases with a Xen45 Gel Stent (Allergan plc, Dublin, Ireland) for ocular hypertension and glaucoma refractory to medical treatment after corneal graft surgery between 2016 and 2019 at the Rothschild Foundation, Paris. We did the imaging studies and studied the intraocular pressure (IOP) and the endothelial cell count preimplantation and postimplantation with a MIGS device.

Results: Five cases were included in this study, demonstrating a well-tolerated, highly effective, and sustained method for controlling the IOP, which was refractory to previous treatment. An average IOP reduction of 70.5% was noted with a needling rate of 20%, and no adverse events were noted except 1 IOP spike day 7 post-op with no long-term effects.

Conclusions: Glaucoma after graft surgery is a well-known and devastating complication, and as numbers of graft surgery performed increases, so will the incidence of glaucoma. MIGS devices such as the Xen45 Gel Stent (Allergan plc) should become a part of our accepted armory to treat raised IOP refractory to medical treatment without delay.
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http://dx.doi.org/10.1097/ICO.0000000000002253DOI Listing
April 2020

Average lens density quantification with swept-source optical coherence tomography: optimized, automated cataract grading technique.

J Cataract Refract Surg 2019 12;45(12):1746-1752

Department of Ophthalmology, Rothschild Foundation, Paris, France. Electronic address:

Purpose: To assess a revised version of an objective cataract grading method based on the lens densitometry on swept-source optical coherence tomography (SS-OCT) scans.

Setting: Rothschild Foundation, Paris, France.

Design: Prospective case series.

Methods: All patients seeking a cataract evaluation and consenting to study participation were included. Exclusion criteria were a history of ocular surgery, cornea or retina disorders, and ocular dryness. The average lens densitometry (ALD) was measured on SS-OCT scans (IOLMaster 700) using an algorithm developed with MATLAB software. The ocular scatter index (OSI), measured using a double-pass aberrometer (Optical Quality Analysis System); Pentacam nucleus staging (PNS) score; and mean PNS were also measured and compared with the ALD measurements.

Results: Two hundred eighty-five eyes (195 with cataract; 90 controls) of 155 patients aged 20 to 93 years (mean 56.5 years ± 21 [SD]) were included. The ALD measurements were repeatable (P = .99, analysis of variance). The repeatability limit was 2.50 pixel units. The ALD correlated with the OSI (r = 0.41, P < .01) and PNS score (r = 0.65, P < .01). An ALD greater than 73.8 pixel units was the cutoff threshold for cataract, with 96.2% sensitivity and 91.3% specificity. Discriminant analysis produced a model combining visual acuity and the mean ALD with an area under the receiver operating characteristic curve of 0.975 (P < .001), where the mean ALD had the highest coefficient.

Conclusions: Using the automated algorithm based on SS-OCT ALD measurements was a repeatable, reliable objective cataract grading method. When the ALD is greater than 73.8 pixel units, it is reasonable to discuss cataract surgery in symptomatic patients.
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http://dx.doi.org/10.1016/j.jcrs.2019.07.033DOI Listing
December 2019

Comparison of Laser Platform Estimation and Objective Measurement of Maximum Ablation Depth Using Scheimpflug Pachymetry in Myopic Femtosecond Laser In Situ Keratomileusis.

Cornea 2020 Mar;39(3):316-320

Department of Anterior Segment & Refractive Surgery, Rothschild Foundation, Paris, France.

Purpose: To compare the preoperative estimation of maximum ablation depth provided by the laser platform with objective measurement using Scheimpflug pachymetry in myopic femtosecond laser-assisted in situ keratomileusis (FS-LASIK).

Methods: This is a prospective study carried out at the Rothschild Foundation, Paris, France. In 89 consecutive myopic eyes (45 patients) treated with FS-LASIK, the maximum ablation depth was calculated by measuring the difference between preoperative and 3-month postoperative measurements in central corneal thickness using Scheimpflug pachymetry (Pentacam HR; Oculus Optikgeräte, Wetzlar, Germany). These values were compared with the preoperative estimation of the maximum ablation depth provided by the laser platform, without nomogram adjustment.

Results: We found a strong linear correlation between laser platform estimation of maximum ablation depth and Scheimpflug pachymetry (P < 0.00001). The mean ablation depth measured using Scheimpflug pachymetry was greater than that predicted by the laser platform, with a mean overall difference of 2.15 μm (P < 0.05). Subgroup analysis revealed a difference in ablation depth measurements of 7.1 μm in the high myopia subgroup, which was the only subgroup where the difference remained statistically significant.

Conclusions: In myopic FS-LASIK, laser platform estimation of maximum ablation depth correlates well with measurement of maximum ablation depth using Scheimpflug pachymetry and therefore can be used safely.
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http://dx.doi.org/10.1097/ICO.0000000000002143DOI Listing
March 2020

Recent advances in risk prediction, therapeutics and pathogenesis of IgA nephropathy.

Minerva Med 2019 Oct 27;110(5):439-449. Epub 2019 May 27.

The Toronto Glomerulonephritis Registry and Division of Nephrology, University Health Network, Toronto, ON, Canada -

Immunoglobulin A nephropathy (IgAN) is the world's commonest primary glomerular disease with variable clinical presentation and progression rates that are dependent on clinical-pathologic phenotype and duration of follow-up. Overall 4-40% of patients progress to end-stage kidney disease (ESKD) by 10 years. Treatment decisions remain a challenge due to these variations. The ultimate goal of management is to prevent progression to ESKD and of vital importance is the potential reversible early detection of active glomerular inflammation prior to scarring. IgAN is globally, is the most common biopsy proven glomerulonephritis and a leading cause of ESKD. The Oxford pathological classification was devised by a collaborative pathology and nephrology network to provide an evidence-based scoring system with reproducible independent pathology features of predictive value. Clinical variables that alter prognosis include male sex, increasing age, increased body weight, smoking, Pacific Asian ethnicity, hypertension, proteinuria, and complement deficiency. Excellent conservative therapy is the cornerstone of therapy with tight blood control, renin-angiotensin system inhibition, and statin therapy. The role of immunosuppressive therapy including corticosteroids in IgAN remains open with ongoing clinical trials of low dose oral corticosteroids and enteric coated budesonide. Complement activation contributes to the pathogenic process of IgAN with evidence from genetic, serological, histological and in-vitro studies. This knowledge has translated to clinical trials of investigational agents directly targeting the alternative pathway.
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http://dx.doi.org/10.23736/S0026-4806.19.06165-2DOI Listing
October 2019

Recurrent Exposure of XEN Gel Stent Implant and Conjunctival Erosion.

J Glaucoma 2019 03;28(3):e37-e40

Department of Anterior Segment and Refractive Surgery, Fondation Rothschild, Paris, France.

Purpose: The purpose of this study was to report a case of recurrent conjunctival erosion and XEN Gel Stent exposure after implantation in a primary open-angle glaucoma patient. Minimally invasive glaucoma surgery (MIGS) is a new approach in glaucoma surgery, and there is a lack of published data with regard to the management of postoperative ocular surface complications.

Methods: This is a case report of a patient with a persistent corneal erosion after XEN Gel Stent implantation. A standalone MIGS surgery was planned for both eyes in this case of refractory glaucoma. Despite a first surgical revision, the patient was suffering from a chronic leaking bleb, an exposed XEN Gel Stent, and severe hypotonia in the left eye.

Results: A free conjunctival autografting technique covered with a complementary amniotic membrane graft was performed under local anesthesia. One month following bleb revision, the intraocular pressure was 13 mm Hg on medical treatment, and slit-lamp examination showed a well-formed moderate bleb with no leakage.

Conclusions: This is the first described case of the use of a free conjunctival autograft to treat a persistently leaking bleb after XEN Gel Stent implantation. This case highlights the potential complication of conjunctival erosion due to XEN Gel Stent implantation. It emphasizes the management of complicated filtration blebs after MIGS surgery.
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http://dx.doi.org/10.1097/IJG.0000000000001146DOI Listing
March 2019

Urinary soluble CD163 and monocyte chemoattractant protein-1 in the identification of subtle renal flare in anti-neutrophil cytoplasmic antibody-associated vasculitis.

Nephrol Dial Transplant 2020 02;35(2):283-291

Trinity Health Kidney Centre, Trinity College Dublin, Dublin, Ireland.

Background: Prior work has shown that urinary soluble CD163 (usCD163) displays excellent biomarker characteristics for detection of active renal vasculitis using samples that included new diagnoses with highly active renal disease. This study focused on the use of usCD163 in the detection of the more clinically relevant state of mild renal flare and compared results of usCD163 testing directly to testing of urinary monocyte chemoattractant protein-1 (uMCP-1).

Methods: Patients with anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV, n = 88) were identified within a serially sampled, longitudinal and multicentre cohort. Creatinine-normalized usCD163 and uMCP-1 levels were measured by enzyme-linked immunosorbent assay and, both alone and in combination, were compared between times of active renal AAV and during remission and/or active non-renal AAV.

Results: Samples from 320 study visits included times of active renal vasculitis (n = 39), remission (n = 233) and active extrarenal vasculitis (n = 48). Median creatinine levels were 0.9 mg/dL [interquartile range (IQR) 0.8-1.2] in remission and 1.4 mg/dL (IQR 1.0-1.8) during renal flare. usCD163 levels were higher in patients with active renal vasculitis compared with patients in remission and those with active extrarenal vasculitis, with median values of 162 ng/mmol (IQR 79-337), 44 (17-104) and 38 (7-76), respectively (P < 0.001). uMCP-1 levels were also higher in patients with active renal vasculitis compared with patients in remission and those with active extrarenal vasculitis, with median values of 10.6 pg/mmol (IQR 4.6-23.5), 4.1 (2.5-8.4) and 4.1 (1.9-6.8), respectively (P < 0.001). The proposed diagnostic cut-points for usCD163 and uMCP-1 were 72.9 ng/mmol and 10.0 pg/mmol, respectively. usCD163 and uMCP-1 levels were marginally correlated (r2 = 0.11, P < 0.001). Combining novel and existing biomarkers using recursive tree partitioning indicated that elevated usCD163 plus either elevated uMCP-1 or new/worse proteinuria improved the positive likelihood ratio (PLR) of active renal vasculitis to 19.2.

Conclusion: A combination of usCD163 and uMCP-1 measurements appears to be useful in identifying the diagnosis of subtle renal vasculitis flare.
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http://dx.doi.org/10.1093/ndt/gfy300DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8205505PMC
February 2020

A novel glucocorticoid-free maintenance regimen for anti-neutrophil cytoplasm antibody-associated vasculitis.

Rheumatology (Oxford) 2019 02;58(2):260-268

University College London Centre for Nephrology, Royal Free Hospital, London, UK.

Objectives: Glucocorticoids (GCs) are a mainstay of treatment for patients with ANCA-associated vasculitis (AAV) but are associated with significant adverse effects. Effective remission induction in severe AAV using extremely limited GC exposure has not been attempted. We tested an early rapid GC withdrawal induction regimen for patients with severe AAV.

Methods: Patients with active MPO- or PR3-ANCA vasculitis or ANCA-negative pauci-immune glomerulonephritis were included. Induction treatment consisted of two doses of rituximab, 3 months of low-dose CYC and a short course of oral GC (for between 1 and 2 weeks). Clinical, biochemical and immunological outcomes as well as adverse events were recorded.

Results: A total of 49 patients were included, with at least 12 months of follow-up in 46. All patients achieved remission, with decreases observed in creatinine, proteinuria, CRP, ANCA level and BVAS. Three patients requiring dialysis at presentation became dialysis independent. Two patients required the introduction of maintenance GC for treatment of vasculitis. Overall outcomes were comparable to those of two matched cohorts (n = 172) from previous European Vasculitis Society (EUVAS) trials, but with lower total exposure to CYC and GCs (P < 0.001) and reduced rates of severe infections (P = 0.02) compared with the RITUXVAS (rituximab versus cyclophosphamide in AAV) trial. We found no new cases of diabetes in the first year compared with historic rates of 8.2% from the EUVAS trials (P = 0.04).

Conclusion: Early GC withdrawal in severe AAV is as effective for remission induction as the standard of care and is associated with reduced GC-related adverse events.
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http://dx.doi.org/10.1093/rheumatology/key288DOI Listing
February 2019

Urinary and serum soluble CD25 complements urinary soluble CD163 to detect active renal anti-neutrophil cytoplasmic autoantibody-associated vasculitis: a cohort study.

Nephrol Dial Transplant 2019 02;34(2):234-242

Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen, Groningen, The Netherlands.

Background: Early detection of renal involvement in anti-neutrophil cytoplasmic autoantibody (ANCA)-associated vasculitis (AAV) is of major clinical importance to allow prompt initiation of treatment and limit renal damage. Urinary soluble cluster of differentiation 163 (usCD163) has recently been identified as a potential biomarker for active renal vasculitis. However, a significant number of patients with active renal vasculitis test negative using usCD163. We therefore studied whether soluble CD25 (sCD25), a T cell activation marker, could improve the detection of renal flares in AAV.

Methods: sCD25 and sCD163 levels in serum and urine were measured by enzyme-linked immunosorbent assay in 72 patients with active renal AAV, 20 with active extrarenal disease, 62 patients in remission and 18 healthy controls. Urinary and blood CD4+ T and CD4+ T effector memory (TEM) cell counts were measured in 22 patients with active renal vasculitis. Receiver operating characteristics (ROC) curves were generated and recursive partitioning was used to calculate whether usCD25 and serum soluble CD25 (ssCD25) add utility to usCD163.

Results: usCD25, ssCD25 and usCD163 levels were significantly higher during active renal disease and significantly decreased after induction of remission. A combination of usCD25, usCD163 and ssCD25 outperformed all individual markers (sensitivity 84.7%, specificity 95.1%). Patients positive for sCD25 but negative for usCD163 (n = 10) had significantly higher C-reactive protein levels and significantly lower serum creatinine and proteinuria levels compared with the usCD163-positive patients. usCD25 correlated positively with urinary CD4+ T and CD4+ TEM cell numbers, whereas ssCD25 correlated negatively with circulating CD4+ T and CD4+ TEM cells.

Conclusion: Measurement of usCD25 and ssCD25 complements usCD163 in the detection of active renal vasculitis.
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http://dx.doi.org/10.1093/ndt/gfy018DOI Listing
February 2019

Improvement in Context: Exploring Aims, Improvement Priorities, and Environmental Considerations in a National Sample of Programs Using "Small Data".

J Grad Med Educ 2017 Dec;9(6):791-797

Background: In 2013, the Accreditation Council for Graduate Medical Education (ACGME) transitioned into a new accreditation system to reduce burden, focus on outcomes, and promote innovation and improvement. One component is a self-study that includes aims, an environmental assessment, and setting improvement priorities. The ACGME initiated voluntary site visits following the self-study.

Objective: We explored common themes in program aims and assessment of their environment.

Methods: Using grounded theory, inductive and deductive qualitative methods, and truth grounding, we analyzed data from voluntary site visits of 396 core and subspecialty programs between June 2015 and September 2017, with a focus on common themes.

Results: We report common themes for aims and the dimensions of the environmental assessment. Themes for include a collegial, supportive learning environment; responsive leaders; and experiences that prepare residents for unsupervised practice. encompass low learner engagement and "content mismatch" in didactic education, balancing education and service at a time of growing clinical volumes, and improving the utility of assessment systems. Common encompass collaborations that improve education, involving alumni and harnessing technology to enrich education, while include an unsustainable effort for many program leaders, clinical pressures on faculty, and loss of external sites important for education. Linked dimensions of the environmental assessment suggest benefit in a growing focus on learners, and approaches to ensure a humanistic learning environment that allows for growth, self-determination, and inclusion.

Conclusions: The findings highlight actionable themes for the environmental assessment. We discuss implications for programs, institutions, and the ACGME.
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http://dx.doi.org/10.4300/JGME-D-17-00952.1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5734347PMC
December 2017

Thyroid malignancy presenting with visual loss: an unusual case of paraneoplastic retinopathy.

BMJ Case Rep 2016 Oct 19;2016. Epub 2016 Oct 19.

Department of Ophthalmology, Mater Misericordiae University Hospital, Dublin, Ireland.

Paraneoplastic retinopathy is a rare cause of painless vision loss, associated with an underlying (and often occult) systemic malignancy. Ocular examination findings are subtle, and the diagnosis is often made on the basis of electrophysiology findings. This report describes the case of a 48-year-old Caucasian man with paraneoplastic retinopathy presenting as visual disturbance, central scotomata and abnormal electrophysiology. He was subsequently diagnosed with papillary thyroid malignancy.
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http://dx.doi.org/10.1136/bcr-2016-216998DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5073693PMC
October 2016

Kidney transplant outcomes in familial C3 glomerulopathy.

Clin Kidney J 2016 Jun 14;9(3):403-7. Epub 2016 Apr 14.

Department of Nephrology, Beaumont Hospital, Dublin, Ireland; Royal College of Surgeons in Ireland, Dublin, Ireland.

C3 glomerulopathy, a newly designated entity, is characterized by glomerular disease associated with dysregulation of the alternative complement pathway and is a rare cause of end-stage kidney disease. Overall disease characteristics that include clinical presentation, laboratory assessment, histopathology and genetic background have only been unravelled in recent years and have led to the development of anti-complement therapies targeting different levels of the alternative pathway. We describe the long-term outcomes following kidney transplantation in an Irish family with familial C3 glomerulopathy due to a hybrid CFHR3-1 gene.
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http://dx.doi.org/10.1093/ckj/sfw020DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4886915PMC
June 2016

Prolonged Duration of Renal Recovery Following ANCA-Associated Glomerulonephritis.

Am J Nephrol 2016 23;43(2):112-9. Epub 2016 Mar 23.

UCL Centre for Nephrology, Royal Free, London, UK.

Background: As renal biopsies are not routinely repeated to monitor treatment response in anti-neutrophil cytoplasm antibody (ANCA)-associated glomerulonephritis, serum creatinine (SC) and proteinuria assessed by urine protein:creatinine ratio (UPCR) measurements are relied upon to provide a non-invasive estimate of disease activity within the kidney. However, sparse information exists about the time to achieve maximal improvement in these parameters, which has important implications for treatment decisions and disease-scoring systems.

Methods: We analysed patients with ANCA-associated glomerulonephritis and renal impairment from cohorts in the United Kingdom and Ireland, with the primary objective of determining actuarial time to nadir SC and UPCR. Time to disappearance of haematuria was analysed as a secondary objective.

Results: Ninety-four patients fulfilled our selection criteria, with 94 (100%) and 66 (70%) having reached their nadir SC and UPCR respectively during the follow-up period. Nadir SC was achieved after a median of 88 days (95% CI 74-102), UPCR at 346 days (95% CI 205-487). Those of Indo-Asian ethnic origin reached their nadir SC faster (34 days) than other ethnicities (p < 0.01). There were no significant differences in time to nadir SC or UPCR on the basis of gender, clinical diagnosis, ANCA positivity or renal biopsy findings.

Conclusion: In this retrospective study, nadir creatinine and proteinuria occur later than other signs of clinical remission, suggesting that ongoing renal recovery continues for a significant time after diagnosis. It may benefit disease-scoring systems to take into account SC levels beyond the initial assessment.
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http://dx.doi.org/10.1159/000444925DOI Listing
January 2017

Urinary Soluble CD163 in Active Renal Vasculitis.

J Am Soc Nephrol 2016 09 3;27(9):2906-16. Epub 2016 Mar 3.

Trinity Health Kidney Centre,

A specific biomarker that can separate active renal vasculitis from other causes of renal dysfunction is lacking, with a kidney biopsy often being required. Soluble CD163 (sCD163), shed by monocytes and macrophages, has been reported as a potential biomarker in diseases associated with excessive macrophage activation. Thus, we hypothesized that urinary sCD163 shed by crescent macrophages correlates with active glomerular inflammation. We detected sCD163 in rat urine early in the disease course of experimental vasculitis. Moreover, microdissected glomeruli from patients with small vessel vasculitis (SVV) had markedly higher levels of CD163 mRNA than did those from patients with lupus nephritis, diabetic nephropathy, or nephrotic syndrome. Both glomeruli and interstitium of patients with SVV strongly expressed CD163 protein. In 479 individuals, including patients with SVV, disease controls, and healthy controls, serum levels of sCD163 did not differ between the groups. However, in an inception cohort, including 177 patients with SVV, patients with active renal vasculitis had markedly higher urinary sCD163 levels than did patients in remission, disease controls, or healthy controls. Analyses in both internal and external validation cohorts confirmed these results. Setting a derived optimum cutoff for urinary sCD163 of 0.3 ng/mmol creatinine for detection of active renal vasculitis resulted in a sensitivity of 83%, specificity of 96%, and a positive likelihood ratio of 20.8. These data indicate that urinary sCD163 level associates very tightly with active renal vasculitis, and assessing this level may be a noninvasive method for diagnosing renal flare in the setting of a known diagnosis of SVV.
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http://dx.doi.org/10.1681/ASN.2015050511DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5004645PMC
September 2016

The Irish Kidney Gene Project--Prevalence of Family History in Patients with Kidney Disease in Ireland.

Nephron 2015 18;130(4):293-301. Epub 2015 Jul 18.

Department of Nephrology and Transplantation, Beaumont Hospital, Dublin, Ireland.

Background: The prevalence of kidney disease (KD) due to inherited genetic conditions in Ireland is unknown. The aim of this study was to characterise an adult kidney disease population in Ireland and to identify familial clusters of kidney disease within the population.

Methods: This was a multicenter cross-sectional study of patients with kidney disease in the Republic of Ireland, from January 2014 to September 2014, recruiting from dialysis units and out-patient renal departments. A survey was performed by collecting data on etiology of kidney disease and whether a family history of kidney disease exists. Medical records were cross-referenced to confirm the etiology of kidney disease.

Results: A total of 1,840 patients were recruited with a mean age of 55.9 years (range 17-94.5) and a male predominance (n = 1,095; 59.5%). A positive family history was reported by 629 participants (34.2%). Excluding polycystic kidney disease (n = 134, 7.3%), a positive family history was reported by 495 participants (26.9%). Kidney disease due to an unknown etiology was the commonest etiology in the non-polycystic kidney disease group with a positive family history (10.6%, n = 67). Kidney diseases that are not classically associated with familial inheritance including tubulo-interstitial kidney disease, congenital abnormalities of the kidney and urinary tract and glomerulonephritis demonstrated familial clustering.

Conclusion: In an Irish non-polycystic kidney disease population, 26.9% reports a positive family history. The commonest etiology of kidney disease in the positive family history cohort, excluding autosomal dominant polycystic kidney disease, was kidney disease due to unknown etiology. Examining families with kidney disease provides an opportunity to better understand disease pathogenesis and potentially identify genetic predispositions to kidney disease.
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http://dx.doi.org/10.1159/000436983DOI Listing
May 2016

Thyroid-like ophthalmopathy in a euthyroid patient receiving Ipilimumab.

Orbit 2014 Dec 10;33(6):424-7. Epub 2014 Sep 10.

Department of Ophthalmology, Mater Misericordiae University Hospital , Dublin , Ireland.

A 68-year-old lady with metastatic malignant melanoma was treated with Ipilimumab. She presented to Eye Casualty unable to move her eyes. Physical examination confirmed ophthalmoplegia and identified proptosis bilaterally. Radiological imaging showed bilateral enlargement of all the extra-ocular muscles suggestive of thyroid eye disease. Laboratory investigations found this patient to be euthyroid. A diagnosis of thyroid-like orbitopathy secondary to Ipilimumab therapy was made. Thyroid function tests should be performed for all patients prior to their commencement of Ipilimumab. Thyroid-like eye disease may develop in patients treated with Ipilimumab even if they remain euthyroid.
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http://dx.doi.org/10.3109/01676830.2014.949792DOI Listing
December 2014
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