Publications by authors named "Shirley Chang"

30 Publications

  • Page 1 of 1

Insight Into Disorder, Stress and Strain of Radiation Damaged Pyrochlores: A Possible Mechanism for the Appearance of Defect Fluorite.

Front Chem 2021 8;9:706736. Epub 2021 Nov 8.

Australian Nuclear Science and Technology Organisation, Lucas Heights, NSW, Australia.

We have examined the irradiation response of a titanate and zirconate pyrochlore-both of which are well studied in the literature individually-in an attempt to define the appearance of defect fluorite in zirconate pyrochlores. To our knowledge this study is unique in that it attempts to discover the mechanism of formation by a comparison of the different systems exposed to the same conditions and then examined a range of techniques that cover a wide length scale. The conditions of approximately 1 displacement per atom He ions were used to simulate long term waste storage conditions as outlined by previous results from Ewing in a large enough sample volume to allow for neutron diffraction, as not attempted previously. The titanate sample, used as a baseline comparison since it readily becomes amorphous under these conditions behaved as expected. In contrast, the zirconate sample accumulates tensile stress in the absence of detectable strain. We propose this is analogous to the lanthanide zirconate pyrochlores examined by Simeone et al. where they reported the appearance of defect fluorite diffraction patterns due to a reduction in grain size. Radiation damage and stress results in the grains breaking into even smaller crystallites, thus creating even smaller coherent diffraction domains. An (ErNd)(ZrTi)O pyrochlore was synthesized to examine which mechanism might dominate, amorphization or stress/strain build up. Although strain was detected in the pristine sample Synchrotron X-ray diffraction it was not of sufficient quality to perform a full analysis on.
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http://dx.doi.org/10.3389/fchem.2021.706736DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8630592PMC
November 2021

Evaluating for a correlation between osteopathic examination and ultrasonography on thoracic spine asymmetry.

J Osteopath Med 2021 Oct 13;122(1):31-43. Epub 2021 Oct 13.

Department of Anatomy, Midwesetern University, Arizona College of Osteopathic Medicine, Glendale, AZ, USA.

Context: The thoracic spine is a common area of focus in osteopathic manipulative medicine (OMM) for a variety of conditions. Thoracic spine somatic dysfunction diagnosis is achieved by palpating for asymmetry at the tips of the transverse processes (TPs). Previous studies reveal that instead of following the rule of threes, the TPs of a given thoracic vertebra generally align with the spinous process (SP) of the vertebra above. Ultrasonography has been widely utilized as a diagnostic tool to monitor musculoskeletal conditions; it does not utilize ionizing radiation, and it has comparable results to gold-standard modalities. In the case of thoracic somatic dysfunction, ultrasound (US) can be utilized to determine the location of each vertebral TP and its relationship with the SP. Previous studies have investigated the correlation between OMM and ultrasonography of the cervical, lumbar, and sacral regions. However, there has been no study yet that has compared osteopathic structural examination with ultrasonographic examination of the thoracic vertebral region.

Objectives: To examine the relationship between osteopathic palpation and ultrasonographic measurements of the thoracic spine by creating a study design that utilizes interexaminer agreement and correlation.

Methods: The ClinicalTrials.gov study identifier is NCT04823637. Subjects were student volunteers recruited from the Midwestern University (MWU)-Glendale campus. A nontoxic, nonpermanent marker was utilized to mark bony landmarks on the skin. Two neuromusculoskeletal board-certified physicians (OMM1, OMM2) separately performed structural exams by palpating T2-T5 TPs to determine vertebral rotation. Two sonographers (US1, US2) separately scanned and measured the distance from the tip of the SP to the adjacent TPs of the vertebral segment below. Demographic variables were summarized with mean and standard deviation. Interexaminer agreement was assessed with percent agreement, Cohen's Kappa, and Fleiss' Kappa. Correlation was measured by Spearman's rank correlation coefficient. Recruitment and protocols were approved by the MWU Institutional Review Board (IRB).

Results: US had fair interexaminer agreement for the overall most prominent segmental rotation of the T3-T5 thoracic spine, with Cohen's Kappa at 0.27 (0.09, 0.45), and a total agreement percentage at 51.5%. Osteopathic palpation revealed low interexaminer agreement for the overall most prominent vertebral rotation, with Cohen's Kappa at 0.05 (0.0, 0.27), and 31.8%. Segment-specific vertebral analysis revealed slight agreement between US examiners, with a correlation coefficient of 0.23, whereas all other pairwise comparisons showed low agreement and correlation. At T4, US had slight interexaminer agreement with 0.24 correlation coefficient, and osteopathic palpation showed low interexaminer (OMM1 vs. OMM2) agreement (0.17 correlation coefficient). At T5, there was moderate agreement between the two sonographers with 0.44 (0.27, 0.60) and 63.6%, with a correlation coefficient of 0.57, and slight agreement between OMM1 and OMM2 with 0.12 (0.0, 0.28) and 42.4%, with 0.23 correlation coefficient.

Conclusions: This preliminary study of an asymptomatic population revealed that there is a low-to-moderate interexaminer reliability between sonographers, low-to-slight interexaminer reliability between osteopathic physicians, and low interexaminer reliability between OMM palpatory examination and ultrasonographic evaluation of the thoracic spine.
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http://dx.doi.org/10.1515/jom-2021-0020DOI Listing
October 2021

Beyond Single Nucleotide Polymorphisms: Composite and Haplotype Associations to Tacrolimus Pharmacokinetics in Black and White Renal Transplant Recipients.

Front Genet 2020 11;11:889. Epub 2020 Aug 11.

Immunosuppressive Pharmacology Research Program, Translational Pharmacology Research Core, NYS Center of Excellence in Bioinformatics and Life Sciences, Buffalo, NY, United States.

Interpatient variability in tacrolimus pharmacokinetics is attributed to metabolism by cytochrome P-450 3A5 (CYP3A5) isoenzymes and membrane transport by P-glycoprotein. Interpatient pharmacokinetic variability has been associated with genotypic variants for both or . Tacrolimus pharmacokinetics was investigated in 65 stable Black and Caucasian post-renal transplant patients by assessing the effects of multiple alleles in both and A metabolic composite based upon the polymorphisms: (rs776746), (10264272), ), each independently responsible for loss of protein expression was used to classify patients as extensive, intermediate and poor metabolizers. In addition, the role of on tacrolimus pharmacokinetics was assessed using haplotype analysis encompassing the single nucleotide polymorphisms: > > > . Finally, a combined analysis using both and polymorphisms was developed to assess their inter-related influence on tacrolimus pharmacokinetics. Extensive metabolizers identified as homozygous wild type at all three loci were found in 7 Blacks and required twice the tacrolimus dose (5.6 ± 1.6 mg) compared to Poor metabolizers [2.5 ± 1.1 mg (P < 0.001)]; who were primarily Whites. These extensive metabolizers had 2-fold faster clearance ( < 0.001) with 50% lower AUC ( < 0.001) than Poor metabolizers. No differences in C were found due to therapeutic drug monitoring. The majority of blacks (81%) were classified as either Extensive or Intermediate Metabolizers requiring higher tacrolimus doses to accommodate the more rapid clearance. Blacks who were homozygous for one or more loss of function SNPS were associated with lower tacrolimus doses and slower clearance. These values are comparable to Whites, 82% of who were in the Poor metabolic composite group. The haplotype analysis detected significant associations of the wildtype haplotype to tacrolimus dose ( = 0.03), CL ( = 0.023), CL/LBW ( = 0.022), and AUC ( = 0.078). Finally, analysis combining and genotypes indicated that the presence of the 3435 T allele significantly reduced tacrolimus clearance for all three CPY3A5 metabolic composite groups. Genotypic associations of tacrolimus pharmacokinetics can be improved by using the novel composite haplotypes. Consideration of multiple alleles using metabolic composites and drug transporter ABCB1 haplotypes provides a more comprehensive appraisal of genetic factors contributing to interpatient variability in tacrolimus pharmacokinetics among Whites and Blacks.
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http://dx.doi.org/10.3389/fgene.2020.00889DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7433713PMC
August 2020

Correlation between structural progression in glaucoma and obstructive sleep apnea.

Eye (Lond) 2019 09 10;33(9):1459-1465. Epub 2019 Apr 10.

Department of Ophthalmology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan.

Background/objectives: To investigate the correlation between obstructive sleep apnea (OSA) severity and the structural and functional progression in patients with glaucoma.

Subjects/methods: This retrospective comparative cohort study included subjects from the polysomnography database in Chang Gung Memorial Hospital between June 1, 2009, and June 1, 2017, by identifying patients who had received diagnoses of primary open-angle glaucoma (POAG), normal-tension glaucoma (NTG), or glaucoma suspect. Patients with follow-up time of <3 years and/or <3 consecutive reliable optical coherence tomography (OCT) or visual field (VF) tests were excluded. Progression of overall peripapillary retinal nerve fiber layer (RNFL) thickness on OCT scans and VF mean deviation (MD) or VF index (VFI) were determined through linear regression trend analysis.

Results: Thirty-two patients were included. There was a trend to higher percentage of progression on RNFL thickness and VF in higher OSAS severity. After stratifying patients to no OSA/mild OSA (group 1) and moderate/severe OSA (group 2), group 2 exhibited a significantly higher percentage of RNFL thickness progression than did group 1 (64.7% vs 26.7%, P = 0.042). Multivariate Cox regression analysis showed that severe OSA had an 8.448-fold higher risk of RNFL thickness progression after age, sex, diabetes mellitus, hypertension, hyperlipidemia, and body mass index adjustment (95% confidence interval, 1.464-48.752, P = 0.017).

Conclusions: Severe OSA is significantly correlated with a higher risk of structural deterioration in patients with glaucoma.
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http://dx.doi.org/10.1038/s41433-019-0430-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7002483PMC
September 2019

Utility of Serial Protocol Biopsies Performed After 1 Year in Predicting Long-Term Kidney Allograft Function According to Histologic Phenotype.

Exp Clin Transplant 2018 08 5;16(4):391-400. Epub 2017 Dec 5.

From Department of Internal Medicine, Division of Nephrology, SUNY at the University at Buffalo, Buffalo, NY, USA.

Objectives: Prognostic implications of early protocol biopsies have been studied; however, the value of late protocol biopsy in predicting graft outcome has not been well defined. Here, we compared the effects of early and late protocol biopsy histologic findings in stable kidney allografts and aimed to understand the significance of "borderline" rejection on allograft function.

Materials And Methods: We studied 261 biopsies from 159 renal transplant recipients who were on a steroid-free, calcineurin inhibitor and mycophenolate mofetil regimen and who received transplants between 2004 and 2012 with mean follow-up of 5 years. Early (between 3 and 9 mo) and subsequent late (between 12 and 24 mo) protocol biopsies were performed. Biopsies were classified as normal, interstitial fibrosis and/or tubular atrophy, subclinical acute rejection with interstitial fibrosis and/or tubular atrophy, and borderline rejection with interstitial fibrosis and/or tubular atrophy. A linear mixed-effects model was used to determine the effects of early and late protocol biopsies on estimated glomerular filtration rate changes, with baseline time for estimated glomerular filtration rate fixed at 12 months.

Results: The adjusted model showed that estimated glomerular filtration rate at 3 months, donor age, delayed graft function, and early protocol biopsies were associated with baseline estimated glomerular filtration rate at 12 months. Estimated glomerular filtration rate changes over time were associated with findings of interstitial fibrosis and/or tubular atrophy at early biopsy and subclinical acute rejection and borderline rejection at late biopsy. At last follow-up, final estimated glomerular filtration rate was significantly associated with interstitial fibrosis and/or tubular atrophy at early biopsy and with subclinical acute rejection at late biopsy.

Conclusions: Although early protocol biopsy predicted baseline estimated glomerular filtration rate, late biopsy was important for predicting changes in function over time. In addition, a diagnosis of "borderline" rejection on protocol biopsies predicted long-term graft function.
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http://dx.doi.org/10.6002/ect.2016.0323DOI Listing
August 2018

Anterior Chamber Angle and Anterior Segment Structure of Eyes in Children With Early Stages of Retinopathy of Prematurity.

Am J Ophthalmol 2017 Jul 24;179:46-54. Epub 2017 Apr 24.

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

Purpose: To compare structural differences in the anterior chamber angle (ACA) and related optic components in children with or without retinopathy of prematurity (ROP).

Design: Prospective cross-sectional study.

Methods: Setting: A referred medical center in Taiwan.

Study Population: The patients included preterm children with a history of ROP who had undergone laser therapy. The controls included age-matched healthy full-term children.

Observation Procedure: The ACA structures were evaluated using gonioscopy.

Main Outcome Measures: The angularity of the anterior chamber and associated anatomic changes.

Results: We examined 54 eyes of 29 preterm children with ROP and 134 eyes of 67 children born at term. The eyes of the ROP children exhibited a narrower ACA, steeper iris curvature, and more anteriorly inserted iris than those of the full-term children (P < .001, P = .002, and P = .08, respectively). The eyes of the ROP children also exhibited steeper corneas, shallower anterior chamber depths, thicker lenses, and higher degrees of refractive errors (all P < .001) than those of the full-term children. The axial lengths did not differ between the 2 groups (P = .15).

Conclusions: The eyes of the ROP children presented a narrower ACA and a more anteriorly curved and inserted iris than those of the full-term children. A steeper cornea, shallower anterior chamber, and greater lens thickness were the main structural changes in the anterior segment components of these patients. Further research is needed to investigate the association between these structural changes and the development of certain ocular diseases, such as glaucoma, in these patients.
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http://dx.doi.org/10.1016/j.ajo.2017.04.010DOI Listing
July 2017

Regional Relationship between Macular Retinal Thickness and Corresponding Central Visual Field Sensitivity in Glaucoma Patients.

J Ophthalmol 2017 21;2017:3720157. Epub 2017 Mar 21.

Department of Ophthalmology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, No. 5, Fuhsing Street, Kweishan, Taoyuan 333, Taiwan.

. To investigate the relationship between macular retinal thickness (MRT) and central visual field sensitivity (VFS) in patients with glaucoma. . This retrospective study enrolled patients diagnosed with open-angle glaucoma. All study patients underwent Humphrey 10-2 visual field (VF) test and Spectralis spectral-domain optical coherence tomography (SD-OCT) exam for MRT measurement. . Sixty-eight eyes of 68 patients were examined. The correlation coefficients between VFS and MRT were 0.331 ( = 0.006) and 0.491 ( = 0.000) in the superior and inferior hemispheres, respectively. The average MRT in the eyes with abnormal 10-2 VF hemifields was significantly thinner than that in the eyes without abnormal hemifields in both hemispheres ( = 0.005 and 0.000 in the superior and inferior hemisphere, resp.). The average MRT values with an optimal sensitivity-specificity balance for discriminating the abnormal VF hemifield from the normal hemifield were 273.5 m and 255.5 m in the superior and inferior hemisphere, respectively. The area under the receiver operating characteristic curve was 0.701 in the superior hemisphere and 0.784 in the inferior hemisphere (both < 0.05). . MRT measured through SD-OCT was significantly correlated with central VFS. Lower MRT values might be a warning sign for central VF defects in glaucoma patients.
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http://dx.doi.org/10.1155/2017/3720157DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5379126PMC
March 2017

A method to preserve limbus during penetrating keratoplasty for a case of presumed PHACES syndrome with sclerocornea: A case report.

Medicine (Baltimore) 2016 Oct;95(41):e4938

Limbal Stem Cell Laboratory, Department of Ophthalmology Center for Tissue Engineering, Chang Gung Memorial Hospital, Linkou Department of Medicine Department of Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan, R.O.C.

Background: Sclerocornea, a congenital corneal pathology characterized by bilateral scleralization of the cornea, which can be found in few cases with posterior fossa malformationshemangiomas-arterial anomalies-cardiac defects-eye abnormalities-sternal cleft and supraumbilical raphe (PHACES) syndrome. Presence of vascularization in peripheral cornea and smaller diameter of recipient cornea correlate to poor outcome of penetrating keratoplasty (PKP) in sclerocornea. Here we report a method to preserve limbus during PKP for small, irregular, and scleralized cornea.

Methods: A 12-year-old boy with multiple congenital anomalies diagnosed as PHACES syndrome suffered from bilateral total sclerocornea and poor visual acuity. Due to the fact that the left eye cornea was small (6.5 mm × 10 mm), lamellar dissection and posterior recession of inferior limbus was first performed and followed by a 6 mm trephination and PKP with a 6.5 mm graft for left eye. At the same time, lens aspiration and release of peripheral anterior synechia were performed.

Results: After 6 years of follow-up, the cornea remained clear, and there has been no sign of inflammation and conjunctivalization. The patient maintained useful vision of 20/400 in left eye.

Conclusion: The stabilization of corneal surface is possible after PKP for sclerocornea if the limbus can be preserved during the operation, and epithelium can remain corneal in phenotype preventing pannas growth.
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http://dx.doi.org/10.1097/MD.0000000000004938DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5072933PMC
October 2016

The relationship of bleb morphology and the outcome of needle revision with 5-fluorouracil in failing filtering bleb.

Medicine (Baltimore) 2016 Sep;95(36):e4546

Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou College of Medicine, Chang Gung University, Taoyuan Biostatistical Center for Clinical Research, Chang Gung Memorial Hospital, Linkou, Taiwan.

To investigate the risk factors for failure of needling revision with 5-fluorouracil (5-FU) and to identify the correlation of outcomes of needling revision and the morphological features of dysfunctional filtration blebs using Moorfields bleb grading system.This retrospective, nonrandomized, comparative case-control study included 41 consecutive patients (41 eyes) who underwent 5-FU needling revision for failed or failing filtration blebs between July 2012 and August 2014 in Chang Gung Memorial Hospital, a referral center in Taiwan. The main outcome measures were the bleb survival and the correlation factors of bleb morphology before revision. The secondary outcome measure was the identification of any study factor associated with bleb failure.Forty-one eyes of 41 patients were included in this study. The most frequent glaucoma diagnoses were 10 cases (24%) of neovascular glaucoma and 8 cases (19%) of chronic open-angle glaucoma. Survival of bleb at 6, 12, and 24 months was 42%, 39%, and 23%. Fourteen cases (34%) maintained overall success at the last follow-up, with an average follow-up of 22.7 ± 9.4 months (range: 12-48 months). The central bleb area and height were significantly different between the successful needling group and the failed needling group (P = 0.03 and 0.04, respectively). Further trend test confirmed that smaller central bleb extension and flatter height were associated with a higher chance of failure (P = 0.02 and 0.02, respectively). Time from initial trabeculectomy to needling of less than 4 months and higher intraocular pressure (IOP) in the first postoperative week also led to significantly higher risk for failure (P = 0.01 and 0.03, respectively).A small central area and the flat height of dysfunctional blebs were more likely to fail after the needle revision. Cautious case selections, taking account of the time from the initial filtering surgery and postoperative IOP, may improve the surgical outcome.
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http://dx.doi.org/10.1097/MD.0000000000004546DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5023867PMC
September 2016

Anterior chamber depth and angle-closure glaucoma after central retinal vein occlusion.

BMC Ophthalmol 2016 May 31;16:68. Epub 2016 May 31.

Department of Ophthalmology, Chang Gung Memorial Hospital, 5 Fu-Hsin Rd., Kweishan, 333, Taoyuan, Taiwan.

Background: The purpose of this study was to report the anterior chamber (AC) depth and the attack of angle-closure glaucoma (ACG) in eyes with the recent onset of central retinal vein occlusion (CRVO).

Methods: This retrospective case series included 24 patients with recent onset of CRVO (within one month of attack) from July 2001 to December 2002. The mean follow-up period of the patients was 46 months (range: 3 to 92 months). AC depth was measured using an ultrasound biomicroscopy. Clinical data, including systemic disorders, intraocular pressure, and visual outcomes were recorded. The main outcome measures were AC depth in the diseased eye and the fellow eye of the same patient and the attack of ACG after CRVO.

Results: The mean AC depth in the diseased eyes was significantly shallower than in the unaffected fellow eyes (2.43 ± 0.45 mm vs. 2.55 ± 0.46 mm; p < 0.001). Four patients (17 %) developed ACG after the onset of CRVO within one month of the CRVO attack. In these four patients, the mean AC depth in the diseased eyes was 1.91 ± 0.21 mm, which was much shallower than the eyes without ACG attack (2.53 ± 0.40 mm).

Conclusions: AC depth is significantly shallower following the onset of CRVO. ACG can occur in patients after the onset of CRVO.
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http://dx.doi.org/10.1186/s12886-016-0256-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4886398PMC
May 2016

Association of Extrarenal Adverse Effects of Posttransplant Immunosuppression With Sex and ABCB1 Haplotypes.

Medicine (Baltimore) 2015 Sep;94(37):e1315

From the Nephrology Division; Medicine, School of Medicine and Biomedical Sciences (RCV, SC, NL, AG, NN, KMT); Erie County Medical Center, Buffalo, New York (RCV, AG, KMT); Immunosuppressive Pharmacology Research Program, Translational Pharmacology Research Core, NYS Center of Excellence in Bioinformatics and Life Sciences (CJM, SEM, LMC, KMT); Pharmacy, School of Pharmacy and Pharmaceutical Sciences (CJM, SEM, KMT); Biostatistics, School of Public Health and Health Professions, University at Buffalo, Buffalo, New York (JDC, GEW); and Department of Pharmaceutical Sciences, College of Pharmacy, University of New England, Portland, Maine (DB).

Extrarenal adverse effects (AEs) associated with calcineurin inhibitor (CNI) and mycophenolic acid (MPA) occur frequently but are unpredictable posttransplant complications. AEs may result from intracellular CNI accumulation and low activity of P-glycoprotein, encoded by the ABCB1 gene. Since ABCB1 single nucleotide polymorphisms (SNPs) and sex influence P-glycoprotein, we investigated haplotypes and extrarenal AEs. A prospective, cross-sectional study evaluated 149 patients receiving tacrolimus and enteric coated mycophenolate sodium or cyclosporine and mycophenolate mofetil. Immunosuppressive AE assessment determined individual and composite gastrointestinal, neurologic, aesthetic, and cumulative AEs. Lipids were quantitated after 12-hour fast. ABCB1 SNPs: c.1236C>T (rs1128503), c.2677G>T/A (rs2032582), and c.3435C>T (rs1045642) were determined with haplotype associations computed using the THESIAS program, and evaluated by immunosuppression, sex and race using multivariate general linear models. Tacrolimus patients exhibited more frequent and higher gastrointestinal AE scores compared with cyclosporine with association to CTT (P = 0.018) and sex (P = 0.01). Aesthetic AE score was 3 times greater for cyclosporine with TTC haplotype (P = 0.005). Females had higher gastrointestinal (P = 0.022), aesthetic (P < 0.001), neurologic (P = 0.022), and cumulative AE ratios (P < 0.001). Total cholesterol (TCHOL), low-density lipoproteins (LDL), and triglycerides were higher with cyclosporine. The TTC haplotype had higher TCHOL (P < 0.001) and LDL (P = 0.005). Higher triglyceride (P = 0.034) and lower high-density lipoproteins (P = 0.057) were associated with TTT with sex-adjusted analysis. ABCB1 haplotypes and sex were associated with extrarenal AEs. Using haplotypes, certain female patients manifested more AEs regardless of CNI. Haplotype testing may identify patients with greater susceptibility to AEs and facilitate CNI individualization.
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http://dx.doi.org/10.1097/MD.0000000000001315DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4635790PMC
September 2015

Acute angle-closure glaucoma in retinopathy of prematurity following pupil dilation.

BMC Ophthalmol 2015 Aug 8;15:96. Epub 2015 Aug 8.

Department of Ophthalmology, Chang Gung Memorial Hospital, 5 Fu-Hsin Rd., Kweishan 333, Taoyuan, Linkou, Taiwan.

Background: Pupil dilation is a known risk factor for acute angle-closure glaucoma. Regular retinal evaluation is necessary for retinopathy of prematurity (ROP) cases. An acute attack of angle-closure glaucoma following pupil dilation in regressed ROP has never been reported.

Case Presentation: A five-year-old girl presented to the hospital for a routine retina check-up. The patient was born prematurely with a gestation age of 27 weeks and a body weight of 980 grams. She had a history of stage 4A ROP in the right eye and received scleral buckling. After pupil dilation with 1 % tropicamide and 10 % phenylephrine for retinal examination, acute elevation of intraocular pressure (IOP) was observed in the right eye. Her IOP remained over 50 mmHg in the right eye even under treatment with oral acetazolamide and maximal tolerated doses of topical anti-glaucoma medications. Ultrasound biomicroscopy (UBM) showed that the angle in the right eye was closed 360 degrees circumferentially. In order to lower IOP, trabeculectomy with mitomycin C (0.2 mg/cc) was performed under general anesthesia. Postoperatively, the cornea became clear, the filtering bleb functioned well, and IOP returned to normal values. In the two-year follow-up, IOP was kept around 15 mmHg without anti-glaucoma medications. Although mild lens opacity was noted, her postoperative VA remained 20/200 in the right eye.

Conclusion: Regular retinal evaluation will be necessary for the increasing number of ROP cases to be seen in the future. Ophthalmologists should bear in mind that pupil dilation for a retina check-up could result in acute angle-closure glaucoma in ROP patients.
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http://dx.doi.org/10.1186/s12886-015-0099-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4528847PMC
August 2015

Influence of sex and race on mycophenolic acid pharmacokinetics in stable African American and Caucasian renal transplant recipients.

Clin Pharmacokinet 2015 Apr;54(4):423-34

Department of Pharmacy Practice, School of Pharmacy and Pharmaceutical Sciences, Immunosuppressive Pharmacology Research Program, Translational Pharmacology Research Core, NYS Center of Excellence in Bioinformatics and Life Sciences, University at Buffalo, 701 Ellicott Street, Buffalo, NY, 14203, USA,

Background And Objectives: No evaluation of sex and race influences on mycophenolic acid (MPA) pharmacokinetics and adverse effects (AEs) during enteric-coated mycophenolate sodium (ECMPS) and tacrolimus immunosuppression are available. The primary objective of this study was to investigate the influence of sex and race on MPA and MPA glucuronide (MPAG) pharmacokinetics in stable renal transplant recipients receiving ECMPS and tacrolimus

Methods: The pharmacokinetics of MPA and MPAG and their associated gastrointestinal AEs were investigated in 67 stable renal transplant recipients: 22 African American males (AAMs), 13 African American females (AAFs), 16 Caucasian males (CMs), and 16 Caucasian females (CFs) receiving ECMPS and tacrolimus. A validated gastrointestinal AE rating included diarrhea, dyspepsia, vomiting, and acid-suppressive therapy was completed. Apparent clearance, clearance normalized to body mass index (BMI), area under the concentration-time curve from time zero to 12 h (AUC12) and dose-normalized AUC12 (AUC*) were determined using a statistical model that incorporated gastrointestinal AE and clinical covariates.

Results: Males had more rapid apparent MPA clearance (CMs 13.8 ± 6.27 L/h vs. AAMs 10.2 ± 3.73 L/h) than females (CFs 8.70 ± 3.33 L/h and AAFs 9.71 ± 3.94 L/h; p = 0.014) with a race-sex interaction (p = 0.043). Sex differences were observed in MPA clearance/BMI (p = 0.033) and AUC* (p = 0.033). MPA AUC12 was greater than 60 mg·h/L in 57 % of renal transplant recipients (RTR) with 71 % of patients demonstrating gastrointestinal AEs and a higher score noted in females. In all patients, females exhibited 1.40-fold increased gastrointestinal AE scores compared with males (p = 0.024). Race (p = 0.044) and sex (p = 0.005) differences were evident with greater MPAG AUC12 in AAFs and CFs.

Conclusion: Sex and race differences were evident, with females having slower MPA clearance, higher MPAG AUC12, and more severe gastrointestinal AEs. These findings suggest sex and race should be considered during MPA immunosuppression.
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http://dx.doi.org/10.1007/s40262-014-0213-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4435744PMC
April 2015

Neovascular glaucoma after central retinal vein occlusion in pre-existing glaucoma.

BMC Ophthalmol 2014 Oct 5;14:119. Epub 2014 Oct 5.

Department of Ophthalmology, Chang Gung Memorial Hospital, 222 Mai-Chin Rd, Keelung 204, Taiwan.

Background: To determine the outcome of central retinal vein occlusion (CRVO) in pre-existing glaucoma and the predisposing factors of developing neovascular glaucoma (NVG).

Methods: We retrospectively assessed a pre-existing glaucoma CRVO group and a non-glaucoma CRVO group to elucidate the demographics, clinical course and ocular parameters of these two cohorts. Among the pre-existing glaucoma cases, the predisposing factors for the development of NVG were monitored, including the retinal capillary non-perfusion status, intraocular pressure (IOP) and best-corrected visual acuity (BCVA) at presentation.

Results: Of 642 CRVO patients reviewed in this 10-year cohort study, 60 (9.3%) had pre-existing glaucoma at a mean follow-up of 30.8 months, including 28 (4.4%) primary open angle glaucoma (POAG), 27 (4.2%) primary angle closure glaucoma (PACG), and 5 (0.8%) normal tension glaucoma (NTG) cases. Although the presence of glaucoma in the CRVO eyes was not significantly associated with the risk of developing NVG, the incidence of developing NVG in pre-existing glaucoma eyes was significantly higher in the group with IOP greater than 20 mmHg at CRVO presentation (P = 0.02, Chi-square test) as well as in the ischemic CRVO group compared to the non-ischemic patients (P = 0.005, Fisher's exact test). Overall, 20% of pre-existing glaucoma patients needed glaucoma surgery after a CRVO event, including 11.7% of patients who developed iris neovascularisation (INV) and 8.3% of patients who developed a high IOP without INV.

Conclusions: Both the retinal non-perfusion status and uncontrolled IOP contribute to NVG in patients with pre-existing glaucoma after CRVO. Following CRVO, glaucoma surgery is necessary for pre-existing glaucoma cases with intractable elevated IOP with or without INV.
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http://dx.doi.org/10.1186/1471-2415-14-119DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4193090PMC
October 2014

Epithelial phenotype in total sclerocornea.

Mol Vis 2014 11;20:468-79. Epub 2014 Apr 11.

Department of Biology, University of California, Berkeley, CA.

Purpose: To understand whether the epithelial phenotype in total sclerocornea is corneal or conjunctival in origin.

Methods: Four cases of total sclerocornea (male:female = 1:3; mean age = 5.4 ± 4.3; 1-11 years old) who received penetrating keratoplasty (PKP) at our hospital between 2008 and 2011 were included. Corneal buttons obtained during PKP were used for transmission electron microscopy (TEM) as well as immunoconfocal microscopy for cytokeratins 3, 12, and 13, goblet cell mucin MUC5AC, connexin 43, stem cell markers p63 and ABCG2, laminin-5, and fibronectin.

Results: After a mean follow-up period of 38.8 ± 14.0 (12-54) months, the grafts remained clear in half of the patients. TEM examination revealed a markedly attenuated Bowman's layer in the scleralized corneas, with irregular and variably thinned collagen lamellar layers, and disorganization and random distribution of collagen fibrils, which were much larger in diameter compared with a normal cornea. Immunoconfocal microscopy showed that keratin 3 was expressed in all four patients, while p63, ABCG2, and MUC5AC were all absent. Cornea-specific keratin 12 was universally expressed in Patients 1 to 3, while mucosa (including conjunctiva)-specific keratin 13 was negative in these patients. Interestingly, keratin 12 and 13 were expressed in Patient 4 in a mutually exclusive manner. Linear expression of laminin-5 in the basement membrane zone and similar expression of fibronectin were observed.

Conclusions: The epithelia in total sclerocornea are essentially corneal in phenotype, but in the event of massive corneal angiogenesis, invasion by the conjunctival epithelium is possible.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3984041PMC
September 2014

Late-onset secondary pigmentary glaucoma following foldable intraocular lenses implantation in the ciliary sulcus: a long-term follow-up study.

BMC Ophthalmol 2013 Jun 7;13:22. Epub 2013 Jun 7.

Background: To review the long-term outcomes of eyes with secondary pigmentary glaucoma associated with the implantation of foldable intraocular lenses (IOL) in the ciliary sulcus.

Methods: The study retrospectively reviewed a series of cases who developed secondary pigmentary glaucoma after cataract operations. Data were collected from cases that were referred between 2002 and 2011.

Results: Ten eyes of 10 patients who developed secondary pigmentary glaucoma after foldable IOLs implantation in the sulcus were included in this study.

Conclusion: Secondary pigmentary glaucoma accompanying the implantation of a foldable IOL in the ciliary sulcus may present as acute IOP elevation during the early postoperative period or, more commonly, late onset of IOP elevation accompanied by advanced glaucomatous optic nerve damage. Despite treatment, the visual prognosis for these patients can be poor. Placing a foldable IOL in the ciliary sulcus could pose a threat to the vision of the patients and long-term follow-up of IOP in these patients is necessary.
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http://dx.doi.org/10.1186/1471-2415-13-22DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3693900PMC
June 2013

Bortezomib induces apoptosis and growth suppression in human medulloblastoma cells, associated with inhibition of AKT and NF-ĸB signaling, and synergizes with an ERK inhibitor.

Cancer Biol Ther 2012 Apr 1;13(6):349-57. Epub 2012 Apr 1.

Beckman Research Institute, City of Hope Comprehensive Cancer Center, Duarte, CA, USA.

Medulloblastoma is the most common brain tumor in children. Here, we report that bortezomib, a proteasome inhibitor, induced apoptosis and inhibited cell proliferation in two established cell lines and a primary culture of human medulloblastomas. Bortezomib increased the release of cytochrome c to cytosol and activated caspase-9 and caspase-3, resulting in cleavage of PARP. Caspase inhibitor (Z-VAD-FMK) could rescue medulloblastoma cells from the cytotoxicity of bortezomib. Phosphorylation of AKT and its upstream regulator mTOR were reduced by bortezomib treatment in medulloblastoma cells. Bortezomib increased the expression of Bad and Bak, pro-apoptotic proteins, and p21Cip1 and p27Kip1, negative regulators of cell cycle progression, which are associated with the growth suppression and induction of apoptosis in these tumor cells. Bortezomib also increased the accumulation of phosphorylated IĸBα, and decreased nuclear translocation of NF-ĸB. Thus, NF-ĸB signaling and activation of its downstream targets are suppressed. Moreover, ERK inhibitors or downregulating ERK with ERK siRNA synergized with bortezomib on anticancer effects in medulloblastoma cells. Bortezomib also inhibited the growth of human medulloblastoma cells in a mouse xenograft model. These findings suggest that proteasome inhibitors are potentially promising drugs for treatment of pediatric medulloblastomas.
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http://dx.doi.org/10.4161/cbt.19239DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3341212PMC
April 2012

The validity of clinical feature profiles for cytomegaloviral anterior segment infection.

Graefes Arch Clin Exp Ophthalmol 2011 Jan 21;249(1):103-10. Epub 2010 Sep 21.

Department of Ophthalmology, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Kweishan, Taoyuan, Taiwan.

Background: Anterior segment cytomegalovirus (CMV) infection, which can be presented as anterior uveitis and corneal endotheliitis, has recently been reported in immunocompetent patients. We would like to access the validity of two presumed characteristic clinical profiles: profile 1, non-herpes simplex virus (HSV)/varicella zoster virus (VZV) corticosteroid-recalcitrant inflammatory ocular hypertensive syndrome (IOHS), and profile 2, corneal endotheliitis with specific coin-shaped keratic precipitates (KPs), that could be helpful in identifying CMV anterior segment intraocular infection.

Methods: Patients with either profile 1 or profile 2 or both were enrolled consecutively from the uveitis service in Chang Gung Memorial Hospital, Taoyuan, between January 1, 2006 and May 31, 2010. Diagnostic anterior chamber tapping was performed and followed by real-time quantitative polymerase chain reaction (PCR) to detect herpesviridae DNA including HSV I and II, VZV, CMV, and Epstein-Barr virus.

Results: Thirty-one eyes of 30 patients (21 males and nine females) were enrolled in this study. CMV DNA PCR was positive in 29 eyes of 28 patients (20 males and eight females). Nineteen of 20 eyes (19 patients) in profile 1 had positive CMV PCR. Ten of 11 eyes (11 patients) in profile 2 had positive CMV PCR. The positive predictive value of profile 1 and profile 2 was 94.7% and 90.9%, respectively. The positive predictive value of combining the two profiles was 93.3%.

Conclusions: Non-HSV/ZVZ corticosteroid-recalcitrant IOHS and corneal endotheliitis with specific coin-shaped KPs could be used as the screening tool for CMV anterior segment intraocular infection.
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http://dx.doi.org/10.1007/s00417-010-1510-yDOI Listing
January 2011

Intravitreal loading injection of ganciclovir with or without adjunctive oral valganciclovir for cytomegalovirus anterior uveitis.

Graefes Arch Clin Exp Ophthalmol 2010 Feb 27;248(2):263-9. Epub 2009 Sep 27.

Department of Ophthalmology, Chang Gung Memorial Hospital and Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan.

Background: A pilot study was conducted to evaluate the therapeutic results of intravitreal ganciclovir injection as a loading dose with or without the following oral valganciclovir for the treatment of cytomegalovirus (CMV) anterior uveitis in immunocompetent patients.

Methods: Six consecutive patients in whom active CMV anterior uveitis was detected by polymerase chain reaction assay of the aqueous humor were enrolled between January 2006 and December 2008. These patients received an intravitreal injection of ganciclovir (2 mg/0.05 ml) as a loading dose. Subsequent use of oral valganciclovir (900 mg twice a day) was determined according to the severity of the post-injection aqueous inflammation. Immune status and anterior chamber reaction of individual patients, visual acuity, intraocular pressure (IOP) at study entry, and follow-up intervals were examined.

Results: The mean patient-month follow-up period after intravitreal injection was 14.7 months (range, 12-22 months). Two patients received only the intravitreal ganciclovir injection once and four patients had received the following oral valganciclovir for average 2.3 months (range, 1-4 months). With this treatment strategy, the best-corrected visual acuity of the patients improved or stabilized; the IOP and the inflammation of anterior chamber of the patients were well controlled at all time points and there were no treatment-associated complications by the end of follow-up.

Conclusions: In patients with CMV anterior uveitis, intravitreal ganciclovir injection as a loading dose with or without the following oral valganciclovir can control the inflammation and IOP well.
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http://dx.doi.org/10.1007/s00417-009-1195-2DOI Listing
February 2010

Albuminuria and diabetic nephropathy.

Authors:
Shirley S Chang

Pediatr Endocrinol Rev 2008 Aug;5 Suppl 4:974-9

Department of Pediatrics, State University of New York Downstate Medical Center, The Children's Hospital at Downstate, Brooklyn, New York, USA.

Albuminuria is characterized clinically as an early predictor for progression of diabetic nephropathy (DN). Proteinuria (macroalbuminuria) is the universal finding in progressive renal disease, and is viewed as a measure of the severity and determinant for diabetic renal disease progression. Albuminuria is a marker for early DN, an independent predictor for mortality, and is associated with renal and cardiovascular risks. The definition of albuminuria, its pathogenetic role resulting in progressive renal injury, and review of the current literature of albuminuria with its relationship to DN are discussed. Albuminuria is a predictor of albuminuria progression in DN. Tight glycemic control reduces the risk of progression from normoalbumuria to microalbuminuria, as well as from microalbuminuria to proteinuria. The relationships between albuminuria and blood pressure in renal progression and renal outcomes are examined. Clinical strategies and pharmacological agents used in reducing proteinuria in an effort to slow the progression of DN are summarized.
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August 2008

Having one kidney does not accelerate the rate of development of diabetic nephropathy lesions in type 1 diabetic patients.

Diabetes 2008 Jun 28;57(6):1707-11. Epub 2008 Mar 28.

Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota, USA.

Objective: Reduced nephron number is hypothesized to be a risk factor for chronic kidney disease and hypertension. Whether reduced nephron number accelerates the early stages of diabetic nephropathy is unknown. This study investigated whether the rate of development of diabetic nephropathy lesions was different in type 1 diabetic patients with a single (transplanted) kidney compared with patients with two (native) kidneys.

Research Design And Methods: Three groups of volunteers were studied: 28 type 1 diabetic kidney transplant recipients with 8-20 years of good graft function, 39 two-kidney patients with duration of type 1 diabetes matched to the time since transplant in the one-kidney group, and 30 age-matched normal control subjects. Electron microscopic morphometry was used to estimate glomerular structural parameters on 3.0 +/- 1.4 glomeruli per biopsy.

Results: In the one- versus two-kidney diabetic subject groups, respectively, serum creatinine (means +/- SD 1.3 +/- 0.4 vs. 0.9 +/- 0.2 mg/dl; P < 0.001), systolic blood pressure (133 +/- 13 vs. 122 +/- 11 mmHg; P < 0.001), and albumin excretion rate (median [range] 32.1 microg/min [2-622] vs. 6.8 microg/min [2-1,495]; P = 0.006) were higher. There were no differences in the one- versus two-kidney diabetic subject groups, respectively, in glomerular basement membrane width (median [range] 511 nm [308-745] vs. 473 nm [331-814]), mesangial fractional volume (mean +/- SD 0.30 +/- 0.06 vs. 0.27 +/- 0.07), mesangial matrix fractional volume (0.16 +/- 0.05 vs. 0.16 +/- 0.06), and mesangial matrix fractional volume per total mesangium (0.61 +/- 0.07 vs. 0.64 +/- 0.09). However, these glomerular structural parameters were statistically significantly higher in both diabetic subject groups compared with normal control subjects. Results were similar when patients receiving ACE inhibitors were excluded from the analyses.

Conclusions: Reduced nephron number is not associated with accelerated development of diabetic glomerulopathy lesions in type 1 diabetic patients.
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http://dx.doi.org/10.2337/db07-1610DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3645267PMC
June 2008

Glaucoma is associated with peripheral vascular endothelial dysfunction.

Ophthalmology 2008 Jul 20;115(7):1173-1178.e1. Epub 2008 Feb 20.

Department of Ophthalmology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan.

Purpose: To evaluate peripheral vascular endothelial function in patients with normal-tension glaucoma (NTG) and primary open-angle glaucoma (POAG) using noninvasive endothelium-dependent flow-mediated vasodilation (FMD).

Design: Case-control study.

Participants: Thirty patients with NTG, 30 with POAG, and 30 healthy age- and gender-matched controls.

Methods: Participants underwent measurement of FMD and endothelium-independent nitroglycerin-mediated vasodilation (NMD) via high-resolution 2-dimensional ultrasonographic imaging of the brachial artery. All patients also underwent blood sampling for biochemistry, lipid profile, and high sensitivity C-reactive protein analysis.

Main Outcome Measures: The association of FMD with NTG and POAG.

Results: The FMD values differed significantly between the patients with NTG, those with POAG, and controls: NTG, 2.70+/-2.25%; POAG, 5.33+/-2.81%; controls, 7.21+/-2.36%; P<0.001. In comparison with the POAG group and normal controls, the NTG group demonstrated markedly impaired FMD. The POAG group exhibited higher intermediate FMD than the NTG group (P<0.001) but significantly lower FMD than normal controls (P = 0.012). Multivariate analysis indicated that independent predictors for impaired FMD were presence of NTG, presence of POAG, and advanced age. Additionally, FMD values were significantly lower in glaucoma patients than in controls (4.02+/-2.85% vs. 7.21+/-2.36%; P<0.001).

Conclusions: Patients with glaucoma have impaired FMD. Additionally, patients with NTG have lower FMD than those with POAG.
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http://dx.doi.org/10.1016/j.ophtha.2007.10.026DOI Listing
July 2008

Systemic high-sensitivity C-reactive protein levels in normal-tension glaucoma and primary open-angle glaucoma.

J Glaucoma 2007 May;16(3):320-3

Department of Ophthalmology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Tao-Yuan, Taiwan.

Purpose: To determine the systemic high-sensitivity C-reactive protein (hsCRP) level in patients with normal tension glaucoma (NTG) and primary open-angle glaucoma (POAG).

Materials And Methods: With the exclusion of patients with cardiovascular and other systemic diseases, 40 patients with NTG, 40 with POAG, and 40 normal controls were enrolled in this study. Each patient underwent blood sampling for hsCRP, biochemistry, and lipid profile analysis.

Results: Each group had similar demographic parameters including the age, sex, body mass index, heart rate, and blood pressure. There was no statistically significant difference in the hsCRP and biochemistry results between the 3 groups. The lipid profile exhibited a mild elevation in the patients with POAG.

Conclusions: Our data revealed no difference in the hsCRP level between NTG, POAG, and normal controls after exclusion of patients with cardiovascular and other systemic diseases. Systemic vascular inflammation may not be a major cause in the pathogenesis of glaucoma in those without histories of cardiovascular diseases.
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http://dx.doi.org/10.1097/IJG.0b013e3180391a83DOI Listing
May 2007

Contact diode laser transscleral cyclophotocoagulation for refractory glaucoma: comparison of two treatment protocols.

Can J Ophthalmol 2004 Aug;39(5):511-6

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

Background: Diode laser transscleral cyclophotocoagulation has shown promising results in the treatment of refractory glaucoma. Treatment with a lower energy level per pulse and lower total energy is safer but may be less effective. We performed a study to evaluate the clinical effectiveness and safety of contact transscleral cyclophotocoagulation using two different protocols in the treatment of Chinese patients with refractory glaucoma.

Methods: Review of the records of 129 patients with refractory glaucoma who underwent contact transscleral cyclophotocoagulation for the first time performed by two different surgeons. In group 1 (73 eyes) the output was 2.5 W and the exposure time 2 seconds; in group 2 (56 eyes) the corresponding values were 2.0 W and 1.5 seconds. We recorded the number of antiglaucoma medications used, Snellen visual acuity, slit-lamp biomicroscopic findings, intraocular pressure (IOP) and findings on ophthalmoscopy with pupil dilation before and 1 day, 1 week, 1 month, 3 months and 6 months after treatment.

Results: The mean age of the patients was 56.4 years (standard deviation [SD] 18.3 years) in group 1 and 53.5 (SD 18.0) years in group 2. The most frequent diagnoses were neovascular glaucoma secondary to proliferative diabetic retinopathy or central retinal vein occlusion, and glaucoma associated with penetrating keratoplasty. The mean number of laser pulse applications per patient was 27 (SD 5.1) (range 10-36) in group 1 and 55 (SD 6.1) (range 40-60) in group 2. One month after treatment, the mean reduction in IOP was 20.2 mm Hg (SD 14.2 mm Hg) in group 1 and 13.7 mm Hg (SD 15.8 mm Hg) in group 2, a significant difference (p = 0.035). There was no difference between the two groups in the mean reduction in IOP at 6 months (19.1 mm Hg [SD 15.1 mm Hg] vs. 14.2 mm Hg [SD 16.3 mm Hg]). The mean reduction in the number of antiglaucoma medications was 1.2 (SD 1.1) in group 1 and 0.6 (SD 1.0) in group 2 (p = 0.003). The incidence rates of transient hyphema in the anterior chamber (23.3% vs. 7.1%) and of transient exudate in the anterior chamber (8.2% vs. 0.0%) were significantly higher in group 1 than in group 2 (p < 0.005).

Interpretation: To achieve greater IOP reduction with diode laser transscleral cyclophotocoagulation, an increase in energy per pulse may be more effective than an increase in total applications.
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http://dx.doi.org/10.1016/s0008-4182(04)80140-6DOI Listing
August 2004

Secondary pigmentary glaucoma associated with piggyback intraocular lens implantation.

J Cataract Refract Surg 2004 Oct;30(10):2219-22

Chang Gung Memorial Hospital, Linkou, Taiwan.

A 51 year-old man developed bilateral pigmentary glaucoma with uncontrolled intraocular pressure (IOP) and signs of pigmentary dispersion syndrome after piggyback intraocular lens (IOL) implantation. Cataract surgery had been performed with in-the-bag implantation of poly(methyl methacrylate) IOLs in both eyes. Increasing myopia was subsequently corrected with implantation of an AcrySofIOL (Alcon Laboratories) in the ciliary sulcus of each eye. After the second implantation, the IOP was unresponsive to antiglaucoma medications, the visual field was damaged, and the visual acuity decreased. Ultrasound biomicroscopy showed that the haptics and the sharp edge of the IOL were chafing the posterior surface of the iris. After the IOL in the sulcus was removed, the IOP was stabilized by medications. This case highlights the importance of the IOL choice for sulcus implantation to avoid the complications of pigmentary dispersion syndrome.
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http://dx.doi.org/10.1016/j.jcrs.2004.03.034DOI Listing
October 2004

Spontaneous, late, in-the-bag intraocular lens subluxation in a patient with a previous acute angle-closure glaucoma attack.

J Cataract Refract Surg 2004 Aug;30(8):1805-7

Department of Ophthalmology, Chang-Gung Memorial Hospital, 5 Fu-Hsing Street, Kwei-Shan, Tao-Yuan 333, Taiwan.

Cataract surgery was performed in a 49-year-old woman 16 months after an acute angle-closure glaucoma attack. Zonular dialysis was observed during surgery, but the intraocular lens (IOL) was implanted in the capsular bag uneventfully. At 4 1/2 months, 1 IOL loop wrapped in the bag herniated into the anterior chamber. The patient had no history of trauma. The IOL loop remained in the anterior chamber for 9 months, until the subluxated IOL spontaneously returned to its original position. Six months later, the IOL again dislocated into the anterior chamber.
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http://dx.doi.org/10.1016/j.jcrs.2003.12.039DOI Listing
August 2004

Comparison of standard white-on-white automated perimetry and short-wavelength automated perimetry in early glaucoma patients.

Chang Gung Med J 2004 Mar;27(3):188-92

Department of Ophthalmology, Chang Gung Memorial Hospital, Taipei.

Background: To evaluate the relationship between short-wavelength automated perimetry (SWAP) and the standard white-on-white automated perimetry (W-W) in detection of early glaucomatous visual field deficits.

Methods: Twenty-four patients suspected of having glaucoma and who had experience with automated visual field tests were evaluated by SWAP and standard W-W perimetry. Results of the mean deviation (MD), pattern standard deviation (PSD), pattern deviation probability plot, test reliability, and test time were compared.

Results: The average MD in the SWAP group was significantly higher than that in the W-W group (SWAP: -6.55 db, W-W: -2.69 db, p<0.001). A significant difference also existed in PSD between the 2 groups (SWAP: 3.49 db, W-W: 2.40 db, p<0.001). The test time was longer in the SWAP group than in the W-W group (SWAP: 15 min, 6 s; W-W: 13 min, 8 s, p<0.001). There was no significant difference between the 2 groups in test reliability or in the number of points that were depressed below the 1% and 5% sensitivity levels on the pattern deviation probability plot.

Conclusions: This study showed that greater MD and PSD were demonstrated with SWAP. The test time was longer for SWAP. However, in order to conclude that SWAP is an early indicator of glaucomatous damage, longer follow-up and further analyses are required.
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March 2004

Central corneal thickness of normal-tension glaucoma and non-glaucoma populations in ethnic Chinese.

Chang Gung Med J 2004 Jan;27(1):50-5

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

Background: The variations in central corneal thickness can influence intraocular pressure measurement. The aim of our study was to determine whether there is a difference in the central corneal thickness between normal-tension glaucoma (NTG) and non-glaucoma populations.

Methods: This prospective study included 33 consecutive patients with NTG and 33 age- and gender-matched healthy subjects as control subjects. The NTG patients were grouped according to the refractive error into group 1 (spherical equivalent +2.5 D approximately -6.0 D) and group 2 (spherical equivalent more than -6.0 D). Central corneal thickness was measured using a ultrasonic pachymeter. The mean central corneal thickness of the NTG and healthy subjects were compared using the student t-test and Nilcoxon Rank Sum test.

Results: The mean (+/- SD) central corneal thickness in the healthy subjects and NTG patients was 554.1 (+/- 36.3) and 547.2 (+/- 31.4) microns, respectively. There were no statistical significant differences between these two groups (p=0.411). The median central corneal thickness in the NTG group 1 and group 2 eyes was 545, and 547.5 microns, respectively. The difference was not statistically significant, either (p=0.799). Ten patients (30%) of NTG had high myopia (group 2), and their median age was 38.5 years old, which was significantly younger than that of the group 1 patients (50 years old, p = 0.0003).

Conclusion: This study indicated that there were no significant differences of central corneal thickness between NTG patients and healthy subjects in our clinic.
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January 2004

Ultrasound biomicroscopy of capsular delamination (true exfoliation) of the crystalline lens.

Chang Gung Med J 2003 Dec;26(12):930-2

Department of Ophthalmology, Chang Gung Memorial Hospital, Taipei.

An 86-year-old woman came to our emergency ward, and the impression was acute-angle-closure glaucoma attack with corneal edema of the left eye. Incidentally, we found a diaphanous membrane in the anterior chamber, and it was confirmed to be capsular delamination (true exfoliation) of the crystalline lens using ultrasound biomicroscopy. Capsular delamination of the lens can easily be missed because it is transparent and very thin. It is more difficult to find this membrane if the cornea is not sufficiently clear. Ultrasound biomicroscopy at 50 MHz produces good resolution of the fine diaphanous capsular split membrane. Ultrasound biomicroscopy is an effective method for investigating these difficult cases.
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December 2003

Needling revision with subconjunctival 5-fluorouracil in failing filtering blebs.

Chang Gung Med J 2002 Feb;25(2):97-103

Department of Ophthalmology, Chang Gung Memorial Hospital, Taipei, Taiwan, ROC.

Background: 5-Fluorouracil, an antimetabolic agent, improves the success rate of trabeculectomies by inhibiting subconjunctival fibrosis. However, complications may be associated with early postoperative use. We investigated the outcome of needling revision with delayed subconjunctival 5-fluorouracil in failing filtering blebs after a trabeculectomy in patients with medically poorly controlled glaucoma.

Methods: We performed needling revision with subconjunctival 5-fluorouracil injection 5.0 +/- 4.0 weeks after trabeculectomy with failing filtering blebs in 25 eyes of 24 patients. The diagnoses of these patients were primary angle-closure glaucoma (4), primary open-angle glaucoma (4), post-cornea-graft glaucoma (8), traumatic glaucoma (5), neovascular glaucoma (3) and pseudophakic glaucoma (1).

Results: Total success was achieved in 21 eyes (84%) including complete success in 10 (40%) and qualified success in 11 (44%) after 3.2 +/- 1.2 needling revisions over an average 8.3 +/- 7.0-month follow-up period from the last needling revision. The mean intraocular pressure was 16.0 +/- 8.4 mmHg in the last visit compared with 26.0 +/- 8.1 mmHg before the procedure. Major complications were transient hypotony (1), transient corneal epithelial defect (13) and hyphema (3).

Conclusions: This study supports the efficacy and safety of the delayed use of 5-fluorouracil with needling revision for managing failing filtering blebs following a trabeculectomy.
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February 2002
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