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1.
Article in English | MEDLINE | ID: mdl-38984990

ABSTRACT

The urgent challenges posed by the energy crisis, alongside the heat dissipation of advanced electronics, have embarked on a rising demand for the development of highly thermally conductive polymer composites. Electrospun composite mats, known for their flexibility, permeability, high concentration and orientational degree of conductive fillers, stand out as one of the prime candidates for addressing this need. This study explores the efficacy of boron nitride (BN) and its potential alternative, silicon nitride (SiN) nanoparticles, in enhancing the thermal performance of the electrospun composite thermoplastic polyurethane (TPU) fibers and mats. The 3D reconstructed models obtained from FIB-SEM imaging provided valuable insights into the morphology of the composite fibers, aiding the interpretation of the measured thermal performance through scanning thermal microscopy for the individual composite fibers and infrared thermography for the composite mats. Notably, we found that TPU-SiN fibers exhibit superior heat conduction compared to TPU-BN fibers, with up to a 6 °C higher surface temperature observed in mats coated on copper pipes. Our results underscore the crucial role of arrangement of nanoparticles and fiber morphology in improving heat conduction in the electrospun composites. Moreover, SiN nanoparticles are introduced as a more suitable filler for heat conduction enhancement of electrospun TPU fibers and mats, suggesting immense potential for smart textiles and thermal management applications.

2.
Small ; 19(52): e2305104, 2023 Dec.
Article in English | MEDLINE | ID: mdl-37553775

ABSTRACT

The pressing issues of the energy crisis and rapid electronics development have sparked a growing interest in the production of highly thermally conductive polymer composites. Due to the challenges related to the poor processability of hybrid materials and filler distribution to achieve high thermal conductivity, electrospinning is employed to create composite nanofibers and yarns using polyimide (PI) and thermally conductive silicon nitride (SiN) nanoparticles. The thermal performance of the individual nanofibers is evaluated using scanning thermal microscopy (SThM), providing significant insights into their heat transfer performance. Next, the nanofibers are applied as coatings on resistance wires to assess the thermal conductivity and insulation properties. Notably, the samples containing 35 wt.% of SiN exhibit a 25% increase in surface temperature. These innovative materials hold great promise as exceptional candidates for smart textiles and thermal management applications, addressing the growing demand for effective heat dissipation and regulation.

3.
J Acad Ophthalmol (2017) ; 11(2): e24-e29, 2019 Jul.
Article in English | MEDLINE | ID: mdl-32656491

ABSTRACT

PURPOSE: To determine the amount of time ophthalmologists using Electronic Health Records (EHRs) spend looking at the patient and its correlation on patient satisfaction. METHODS: This prospective cohort study examined 67 patients seeking care at two different ophthalmology clinics. Videos of entire office visits were recorded and each video was graded for amount of time spent by physicians gazing at the patient, computer, paper medical records, or other areas. Videos were also graded for the amount of time examining the patient, and the physician speaking during each visit. A patient satisfaction survey was administered at the end of each office encounter. Time of physician gaze to the patient was correlated to satisfaction outcome measures. RESULTS: Ophthalmologists spent 28.0% ± 21.2% of the visit looking at the computer. Overall, patient satisfaction levels were very high (4.8 ± 0.5, 5-point Likert scale). Ophthalmologists spent the same amount of time looking at patients who were extremely satisfied (28.8% ± 16.7%) as those who were not extremely satisfied (28.8% ± 15.9%). CONCLUSIONS: Ophthalmologists on EHRs spend over a third of each patient visit looking at the computer. However, patient satisfaction levels are very high. The amount of time that the ophthalmologist gazes at the patient or the computer does not appear to have an effect on patient satisfaction in this particular study. Further research still needs to be performed regarding the effects of EHRs on the patient experience. Physicians should continue to be sensitive to their patients' needs and approach the use of EHRs in patient encounters on an individual basis.

5.
Am J Ophthalmol ; 179: 179-189, 2017 Jul.
Article in English | MEDLINE | ID: mdl-28501392

ABSTRACT

PURPOSE: To identify determinants of adverse outcomes in acute retinal necrosis (ARN), presenting characteristics and incidence rates of vision loss and ocular complications in a cohort of polymerase chain reaction (PCR)-positive eyes were analyzed. DESIGN: Retrospective observational cohort study. METHODS: Forty-one eyes of 36 patients with clinically diagnosed ARN, PCR-positive for herpes simplex virus or varicella zoster virus and evaluated between January 2002 and June 2013, were included. Main outcome measures included incidence rates of vision loss and retinal detachment (RD). RESULTS: Presenting visual acuity was generally poor (20/50 to >20/200 in 27%; 20/200 or worse in 56%). The incidence rate of ≤20/200 was 0.66/eye-year (EY), (95% confidence interval [CI], 0.32/EY to 1.22/EY); the rate of light perception or no light perception vision was 0.07/EY (95% CI, 0.02/EY to 0.16/EY). During follow-up, 59% of eyes developed at least 1 RD (rate = 0.40/EY, 95% CI, 0.19/EY to 0.58/EY). Eyes with retinitis involving ≥25% of the retina at presentation detached at nearly 12 times the rate, as compared to those with <25% retinal involvement (0.70/EY vs 0.06/EY; P = .001). Development of an RD was the greatest determinant of adverse visual outcomes, with 4% of eyes, that had experienced at least 1 RD, achieving a best-corrected visual acuity of ≥20/40 compared to 53% of eyes that never detached (P = .0003). CONCLUSIONS: Poor outcomes in ARN were common in this cohort. RD confers the greatest risk of incident vision loss, and once 25% or more of the retina is involved the risk of RD and visual loss increases significantly.


Subject(s)
DNA, Viral/analysis , Eye Infections, Viral/complications , Herpes Simplex/genetics , Herpes Zoster Ophthalmicus/complications , Herpesvirus 3, Human/genetics , Retinal Necrosis Syndrome, Acute/diagnosis , Visual Acuity , Adolescent , Adult , Aged , Aged, 80 and over , Child , Eye Infections, Viral/diagnosis , Eye Infections, Viral/virology , Female , Follow-Up Studies , Herpes Zoster Ophthalmicus/diagnosis , Herpes Zoster Ophthalmicus/virology , Humans , Male , Middle Aged , Polymerase Chain Reaction/methods , Retinal Necrosis Syndrome, Acute/etiology , Retrospective Studies , Young Adult
6.
Ocul Immunol Inflamm ; 25(4): 503-512, 2017 Aug.
Article in English | MEDLINE | ID: mdl-27003850

ABSTRACT

PURPOSE: To describe the incidence of ocular hypertension (OHT) and secondary glaucoma (SG) in JIA-associated uveitis, identify risk factors for development of these complications, and describe their effect on visual outcomes. METHODS: A retrospective cohort of 108 patients (196 eyes) with JIA-associated uveitis seen over 30 years at an academic practice. RESULTS: Of examined eyes, 40% had OHT or SG at presentation. These eyes had a nearly three-fold higher incidence of legal blindness during follow-up, compared with eyes without OHT or SG. An additional 41 eyes developed OHT or SG during follow-up. Presenting with anterior uveitis, active inflammation, and using systemic corticosteroids were risk factors for developing OHT, while use of immunosuppressive medication at presentation reduced this risk. Risk factors for developing SG included anterior uveitis and use of systemic corticosteroids. CONCLUSIONS: OHT and SG were common in patients with JIA-associated uveitis. Use of immunosuppressive drugs may decrease the risk of developing OHT.


Subject(s)
Arthritis, Juvenile/complications , Glaucoma/etiology , Ocular Hypertension/etiology , Uveitis/complications , Adolescent , Arthritis, Juvenile/physiopathology , Child , Child, Preschool , Female , Follow-Up Studies , Glaucoma/epidemiology , Glaucoma/physiopathology , Glucocorticoids/therapeutic use , Humans , Immunosuppressive Agents/therapeutic use , Incidence , Infant , Intraocular Pressure/physiology , Male , Ocular Hypertension/epidemiology , Ocular Hypertension/physiopathology , Retrospective Studies , Risk Factors , Tonometry, Ocular , Uveitis/physiopathology , Visual Acuity/physiology
7.
Am J Ophthalmol ; 175: 183-193, 2017 Mar.
Article in English | MEDLINE | ID: mdl-27984025

ABSTRACT

PURPOSE: To reassess the prevalence and incidence of post-cataract surgery optic neuropathy (PCSON) in the modern era. DESIGN: Retrospective cohort study. METHODS: Setting: Single-center tertiary care practice. STUDY POPULATION: All patients with a diagnosis of nonarteritic anterior ischemic optic neuropathy (NAION) seen in the Wilmer Eye Network system between January 1, 2010 and December 31, 2014 were included. Inclusion was based on the following: (1) a history of an acute unilateral decrease in vision, (2) a visual field defect consistent with NAION, (3) a relative afferent pupillary defect, (4) observed optic disc swelling, and (5) no other etiology being found. MAIN OUTCOME MEASURES: The prevalence and incidence of PCSON and the temporal association between surgery and onset of PCSON. The secondary outcome was the risk of PCSON in the fellow eye of patients with prior unilateral spontaneous NAION. RESULTS: One hundred eighty-eight patients had developed NAION during the study period. Of these, 18 (9.6%) had undergone cataract surgery (CS) during the year prior to developing NAION. There was no significant temporal pattern associated with the distribution of NAION cases (P = .28). The incidence of PCSON in patients who had noncomplex CS was 10.9 cases per 100 000 (95% CI, 1.3, 39.4). CONCLUSIONS: Our data indicate that both the prevalence and incidence of NAION after modern CS are comparable to those of the general population and that there is no significant temporal relationship between modern CS and the subsequent development of NAION in the operated eye. Thus, although this study has inherent biases owing to its retrospective nature, concern regarding an increased risk of PCSON in the fellow eye in patients who have experienced it or spontaneous NAION in 1 eye may be unwarranted.


Subject(s)
Cataract Extraction/adverse effects , Optic Neuropathy, Ischemic/epidemiology , Postoperative Complications , Adult , Aged , Aged, 80 and over , Female , Follow-Up Studies , Humans , Incidence , Male , Maryland/epidemiology , Middle Aged , Optic Neuropathy, Ischemic/etiology , Prevalence , Retrospective Studies , Time Factors , Young Adult
8.
Am J Ophthalmol ; 169: 113-124, 2016 09.
Article in English | MEDLINE | ID: mdl-27345732

ABSTRACT

OBJECTIVE: To describe risk factors for hypotony in patients with juvenile idiopathic arthritis (JIA)-associated uveitis. DESIGN: Retrospective cohort study. METHODS: All patients with JIA-associated uveitis (N = 108; affected eyes = 196) evaluated and followed at the Wilmer Eye Institute from July 1984 through June 2014 were included in this study. Prevalence and incidence of hypotony (intraocular pressure [IOP] <5 mm Hg) and low IOP (5 mm Hg ≤ IOP < 8 mm Hg) and risk factors for developing hypotony were analyzed. RESULTS: At presentation, 9.3% of patients (7.1% of affected eyes) had hypotony. During a median follow-up of 5.3 years, the rate of developing hypotony and low IOP were 0.04 per eye-year (/EY; 95% confidence interval [CI]: 0.02/EY, 0.05/EY) and 0.06/EY (95% CI: 0.04/EY, 0.08/EY), respectively. Risk factors for development of hypotony during follow-up appeared to be associated with more severe uveitic disease, such as the presence of panuveitis (adjusted hazard ratio [aHR], 43.1; P = .004), anterior chamber cells or flare ≥ 3+ (aHR, 25.6, P < .001), posterior synechiae (aHR, 5.9, P = .02), and the use of oral corticosteroid (aHR 28.9; P = .003) at the presenting examination. Receiving immunosuppressive drug therapy at the time of presentation was associated with a lower risk of development of hypotony (aHR, 0.02; P = .002). CONCLUSIONS: Hypotony affects a small but significant proportion of patients with JIA-associated uveitis and is associated with signs of active and severe uveitis. Immunosuppression was associated with significantly lower risk of hypotony, suggesting that aggressive control of the inflammation may reduce risk of hypotony in JIA-associated uveitis.


Subject(s)
Arthritis, Juvenile/complications , Ocular Hypotension/epidemiology , Uveitis, Anterior/complications , Adolescent , Adult , Arthritis, Juvenile/diagnosis , Arthritis, Juvenile/drug therapy , Child , Child, Preschool , Cohort Studies , Female , Follow-Up Studies , Glucocorticoids/therapeutic use , Humans , Immunosuppressive Agents/therapeutic use , Incidence , Infant , Intraocular Pressure/physiology , Male , Ocular Hypotension/physiopathology , Prevalence , Retrospective Studies , Risk Factors , Tonometry, Ocular , Uveitis, Anterior/diagnosis , Uveitis, Anterior/drug therapy , Visual Acuity/physiology
9.
Clin Dermatol ; 34(2): 205-13, 2016.
Article in English | MEDLINE | ID: mdl-26903186

ABSTRACT

Autoimmune blistering diseases are a heterogeneous group of disorders that mostly affect the skin and mucous membranes. Occasionally, other organ systems may be involved, depending on the unique pathophysiology of each disease. Cicatricial pemphigoid, pemphigus vulgaris, and paraneoplastic pemphigus are distinct entities, but all have the potential to have cutaneous and ocular involvement. Awareness and early recognition of ocular involvement in these diseases is important given the increased risk for vision loss and blindness with delay in management. Several skin diseases may be associated with involvement of the external eye. The most common autoimmune diseases are cicatricial pemphigoid, pemphigus vulgaris, and paraneoplastic pemphigus.


Subject(s)
Paraneoplastic Syndromes/complications , Pemphigoid, Benign Mucous Membrane/complications , Pemphigus/complications , Animals , Humans , Mouth Diseases/etiology , Paraneoplastic Syndromes/immunology , Paraneoplastic Syndromes/therapy , Pemphigoid, Benign Mucous Membrane/drug therapy , Pemphigoid, Benign Mucous Membrane/epidemiology , Pemphigoid, Benign Mucous Membrane/immunology , Pemphigus/drug therapy , Pemphigus/epidemiology , Pemphigus/immunology
10.
Ocul Immunol Inflamm ; 23(6): 444-53, 2015.
Article in English | MEDLINE | ID: mdl-26517764

ABSTRACT

PURPOSE: To describe the practice patterns and perceptions of uveitis specialists regarding the use of the intravitreal dexamethasone (DEX) implant for the treatment of noninfectious uveitis. METHODS: We invited uveitis specialists to participate in an anonymous online survey. RESULTS: Among the 45 respondents, 76.5% identified uveitic macular edema as the most common clinical finding for which they use the DEX implant. The most common contraindications to DEX implantation were aphakia and glaucoma requiring >2 medications. Nearly two-thirds (64.3%) felt that the advent of the DEX implant did not change the frequency with which they used the fluocinolone acetonide (FA) implant, and about one-third (32.3%) preferred to use at least one DEX implant, before committing a patient to an FA implant. CONCLUSIONS: Uveitis physicians use the DEX implant for a wide range of clinical findings and uveitic diagnoses. There was no clear consensus on preferences regarding the use of DEX versus FA implants.


Subject(s)
Clinical Competence , Dexamethasone/administration & dosage , Glucocorticoids/administration & dosage , Ophthalmology , Physicians/standards , Specialization , Surveys and Questionnaires , Uveitis/drug therapy , Drug Implants , Humans , Treatment Outcome , Workforce
11.
Graefes Arch Clin Exp Ophthalmol ; 253(12): 2137-42, 2015 Dec.
Article in English | MEDLINE | ID: mdl-25744333

ABSTRACT

PURPOSE: To evaluate changes in macular sensitivity, as measured with microperimetry, among patients with maculopathy and stable visual acuity (VA). METHODS: Macular sensitivity was assessed using the Spectral OCT/SLO™ microperimetry (OCT/SLO, Optos Plc., Dunfermline, UK) in 25 eyes (16 patients) with maculopathy and stable VA (<5 letters change in ETDRS score) at two consecutive clinic visits. To take the limits of the test-retest repeatability of the OCT/SLO into account, coefficient of repeatability (CoR) was employed to estimate the probability of the sensitivity changes being secondary to measurement noise. RESULTS: The point sensitivity changes were statistically significant (Wilcoxon signed-rank test, P < 0.001). Seventy-seven points (11 %) out of a total of 700 sensitivity points had a genuine sensitivity change, with a mean increase of 8.6 ± 2.6 dB in 35 points and a mean decrease of 7.9 ± 2.2 dB in 42 points. CONCLUSIONS: Point-to-point change in macular sensitivity can be used as a biomarker of changes in disease activity in patients with maculopathy, and can be more accurate than either mean sensitivity or BCVA in detection of changes in macular function. The measurement variability should be considered when observing the local sensitivity changes.


Subject(s)
Contrast Sensitivity/physiology , Retina/physiopathology , Retinal Diseases/physiopathology , Visual Acuity/physiology , Visual Fields/physiology , Adult , Aged , Female , Humans , Male , Middle Aged , Prospective Studies , Tomography, Optical Coherence , Visual Field Tests
12.
Am J Ophthalmol ; 159(2): 334-43.e1, 2015 Feb.
Article in English | MEDLINE | ID: mdl-25447116

ABSTRACT

PURPOSE: To describe the clinical outcomes of ocular syphilis. DESIGN: Retrospective chart review. METHODS: The charts of patients with ocular syphilis (regardless of human immunodeficiency virus [HIV] status) seen in a uveitis referral center between 1984 and 2014 were reviewed. RESULTS: The study included 35 patients (61 eyes). Panuveitis was the most common type of ocular inflammation (28 eyes), independent of HIV status. Thirty-three of 35 patients received systemic antibiotics with 24 patients treated with intravenous (IV) penicillin only. When compared to the HIV-positive patients, HIV-negative patients with ocular syphilis were older (P < .001), were more likely to be female (P = .004), and had poorer visual acuity at presentation (P = .01). During follow-up, the incidence rates of visual impairment were 0.29 per eye-year (EY; 95% confidence interval [CI]: 0.06/EY-0.86/EY) and 0.12/EY (95% CI: 0.01/EY-0.42/EY) among the HIV-negative and the HIV-positive patients, respectively. The incidence of blindness was 0.07/EY (95% CI: 0.009/EY-0.27/EY) and 0.06/EY (95% CI: 0.002/EY-0.35/EY) among the HIV-negative and the HIV-positive patients, respectively. Longer duration of uveitis prior to diagnosis and chorioretinitis in the macula at presentation were associated with ≥ 2 Snellen lines of visual loss (P < .01) and visual acuity loss to 20/50 or worse (P = .03) in HIV-negative patients, respectively. CONCLUSIONS: Syphilis is an uncommon cause of ocular inflammation in both HIV-negative and HIV-positive patients. Visual loss and ocular complications were common among HIV-negative patients even with systemic antibiotic treatment. Delay of diagnosis and chorioretinitis in the macula were associated with visual loss in these patients.


Subject(s)
Eye Infections, Bacterial/diagnosis , Panuveitis/diagnosis , Syphilis/diagnosis , Adult , Aged , Aged, 80 and over , Anti-Bacterial Agents/therapeutic use , Eye Infections, Bacterial/drug therapy , Eye Infections, Bacterial/epidemiology , Female , HIV Seropositivity , Humans , Incidence , Infusions, Intravenous , Male , Middle Aged , Panuveitis/drug therapy , Panuveitis/epidemiology , Penicillin G Benzathine/therapeutic use , Retrospective Studies , Syphilis/drug therapy , Syphilis/epidemiology , Vision Disorders/epidemiology , Visual Acuity , Young Adult
13.
Transl Vis Sci Technol ; 3(5): 3, 2014 Sep.
Article in English | MEDLINE | ID: mdl-25237592

ABSTRACT

PURPOSE: To compare the retinal sensitivity measurements obtained with two microperimeters, the Micro-Perimeter 1 (MP-1) and the Optos optical coherence tomography (OCT)/scanning laser ophthalmoscope (SLO) in subjects with and without maculopathies. METHODS: Forty-five eyes with no known ocular disease and 47 eyes with maculopathies were examined using both microperimeters. A contrast-adjusted scale was applied to resolve the different stimuli and background luminance existing between the two devices. RESULTS: There was a strong ceiling effect with the MP-1 in the healthy group, with 90.1% (1136 of 1260) test points clustered at 20 dB. The mean sensitivity for the corresponding points in the OCT/SLO was 25.8 ± 1.9 dB. A floor effect was also observed with the OCT/SLO in the maculopathy group with 9.7% (128 of 1316) points clustered at 9-dB values. The corresponding mean sensitivity in the MP-1 was 1.7 ± 3.9 dB. A regression equation between the two microperimeters was established in the common 10 to19 dB intervals as: OCT/SLO = 15.6 + 0.564 × MP-1 - 0.009 × MP-12 + k (k is an individual point constant; MP-1 coefficient P < 0.001; MP-12 coefficient P = 0.006). CONCLUSION: The OCT/SLO and the MP-1 provide two different ranges of contrasts for microperimetry examination. Broadening the dynamic range may minimize the constraint of the ceiling and floor effect. There is a significant mathematical relationship in the common interval of the contrast scale. TRANSLATIONAL RELEVANCE: Applying a unified and broadened dynamic range in different types of microperimeters will help to generate consistent clinical reference for measurements.

14.
J Ophthalmol ; 2014: 461078, 2014.
Article in English | MEDLINE | ID: mdl-24701346

ABSTRACT

Uveitis is a common complication of juvenile idiopathic arthritis (JIA) affecting up to 30% of patients with JIA. Although the typical bilateral chronic anterior uveitis associated with the persistent and extended oligoarticular and polyarticular, rheumatoid factor negative variants of JIA occurs predominantly in girls, boys may be more commonly affected in the HLA-B27 positive, enthesitis variant of JIA. While female gender has been associated with the development of the chronic anterior uveitis in children with JIA, the clinical course of JIA-associated uveitis may be worse in boys than in girls. The purpose of this paper is to review the available published literature to determine the role of gender in the clinical presentation and outcomes of patients with JIA-associated uveitis.

15.
Retina ; 34(8): 1666-74, 2014 Aug.
Article in English | MEDLINE | ID: mdl-24743642

ABSTRACT

PURPOSE: To study the clinical features and incidence rate of ocular complications in patients with punctate inner choroidopathy. METHODS: This is a retrospective cohort study conducted in a single-center academic practice setting. Patients diagnosed with punctate inner choroidopathy at the Wilmer Eye Institute, Johns Hopkins University from 1984 to 2012 were identified. Demographics and clinical features including the presence of choroidal neovascularization (CNV) and structural complications were collected. Main outcome measures, including visual impairment and incidence rate of ocular complications, were analyzed. RESULTS: Thirty-one patients (59 eyes) were included in the study. Follow-up data were available for 24 patients (47 eyes) with a mean follow-up time of 3.4 years (range, 2 months to 8.7 years). In the affected eyes with follow-up, the incidence rate of visual impairment to 20/50 or worse was 0.06 per eye-year (EY) (95% confidence interval, 0.022/EY-0.114/EY). The incidence rate of visual loss to 20/200 or worse was 0.006/EY (95% confidence interval, 0.0001/EY-0.034/EY). Thirty-six eyes (77%) had an ultimate visual acuity of 20/40 or better. All of the 13 patients with more than ≥ 3 years of follow-up had a visual acuity of ≥ 20/40 in at least 1 eye at 3 years after presentation. Two thirds of the follow-up patients (67%) on immunomodulatory drug therapy did not have new or recurrent CNV. However, this was not a statistically significant difference. Three eyes with follow-up had recurrence of CNV for an incidence rate of 0.04/EY (95% confidence interval, 0.008/EY-0.12/EY). Two eyes developed new CNV during follow-up for an incidence rate of 0.02/EY (95% confidence interval, 0.002/EY-0.066/EY). CONCLUSION: The visual prognosis in most cases of punctate inner choroidopathy is very good. The incidence rate of new CNV and recurrent CNV was 0.02/EY and 0.04/EY, respectively.


Subject(s)
Choroidal Neovascularization/diagnosis , Choroidal Neovascularization/epidemiology , Choroiditis/complications , Visually Impaired Persons/statistics & numerical data , Administration, Oral , Adult , Angiogenesis Inhibitors/therapeutic use , Choroiditis/diagnosis , Choroiditis/drug therapy , Female , Glucocorticoids/therapeutic use , Humans , Immunosuppressive Agents/therapeutic use , Incidence , Male , Middle Aged , Multifocal Choroiditis , Prevalence , Retrospective Studies , Vascular Endothelial Growth Factor A/antagonists & inhibitors , Vision Disorders/diagnosis , Vision Disorders/epidemiology , Visual Acuity/physiology , Young Adult
16.
Ophthalmology ; 120(6): 1254-61, 2013 Jun.
Article in English | MEDLINE | ID: mdl-23499060

ABSTRACT

PURPOSE: To evaluate the relationship between retinal sensitivity and the photoreceptor inner segment/outer segment (IS/OS) layer status in patients with diabetic macular edema (DME). DESIGN: Cross-sectional study. PARTICIPANTS: Twenty-five adult patients (37 eyes) diagnosed with DME and managed at the Wilmer Eye Institute, Johns Hopkins University (Baltimore, MD). METHODS: We obtained simultaneous fundus microperimetry (MP) and optical coherence tomography (OCT) of patients with DME using a combined MP/OCT system. The device recorded retinal sensitivity and retinal thickness on a 3-dimensional tomography map, and we performed a point-by-point analysis of the IS/OS layer integrity at every MP point. We also reviewed OCT scans to determine the type of DME, cystoid macular edema, or diffuse macular edema (absence of any cysts). In addition, fixation stability and fixation location were analyzed. MAIN OUTCOME MEASURES: Retinal point sensitivity measured by MP. RESULTS: Twenty-five patients (37 eyes: 29 male and 8 female; mean age, 64.16 years) with DME were enrolled. Fixation was centric in 30 eyes (81%), paracentric in 3 eyes (8%), and eccentric in 4 eyes (11%). Twenty-seven eyes had cystoid macular edema, and 10 eyes had diffuse macular edema. Mean central subfield thickness was 325 µm. We analyzed a total of 1036 individual MP points. Mean point sensitivity was 10.51 dB. A total of 793 points (76.5%) had IS/OS layer present, and 243 points (23.5%) had IS/OS layer disrupted. A mixed linear model, constructed to adjust for potential confounders and account for dependence between retinal points, revealed that the absence of the IS/OS junction was significantly associated with a 3.28-dB decrease in retinal point sensitivity (P<0.001). CONCLUSIONS: This novel index study demonstrates that disruption of the IS/OS junction is correlated with a significant decrease in point sensitivity in eyes with DME. Further studies are indicated to confirm and validate this relationship. FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found after the references.


Subject(s)
Diabetic Retinopathy/physiopathology , Macular Edema/physiopathology , Retina/physiopathology , Retinal Photoreceptor Cell Inner Segment/pathology , Retinal Photoreceptor Cell Outer Segment/pathology , Cross-Sectional Studies , Female , Fixation, Ocular/physiology , Fluorescein Angiography , Humans , Imaging, Three-Dimensional , Male , Middle Aged , Tomography, Optical Coherence , Visual Acuity/physiology , Visual Field Tests , Visual Fields/physiology
17.
World J Diabetes ; 4(6): 303-9, 2013 Dec 15.
Article in English | MEDLINE | ID: mdl-24379921

ABSTRACT

Diabetic retinopathy (DR) is the most common cause of visual loss among working age individuals. Diabetic macular edema (DME) is an important complication of DR that affects around one third of the patients with DR. Several treatments have been approved for DME ranging from blood pressure and glycemic control to photocoagulation and more recently the use of vascular endothelial growth factor (VEGF) antagonists. The index review discusses aflibercept (EYLEA(®)-Regeneron Pharmaceuticals, Inc., Tarrytown, New York, NY, and Bayer Healthcare Pharmaceuticals, Berlin, Germany) in the context of other VEGF antagonists currently available for the treatment of DME. A systematic search of literature was conducted on PubMed, Scopus, and Google Scholar with no limitation on language or year of publication. Pre-clinical studies of aflibercept have shown a higher affinity of this molecule for vascular endothelial growth factor A (VEGF-A) along with a longer duration of action as compared to other VEGF antagonists. Recent clinical trials have shown visual outcome results for aflibercept to be similarly favorable as compared to other available agents with the added benefit of fewer required injections and less frequent monitoring. Aflibercept presents a potential exciting new addition to the armamentarium of current VEGF antagonists available for the treatment of DME and other retinal vascular diseases. However, further studies are indicated to confirm the role, safety, and efficacy of aflibercept for DME.

18.
Int J Mycobacteriol ; 1(2): 82-6, 2012 Jun.
Article in English | MEDLINE | ID: mdl-26787060

ABSTRACT

BACKGROUND: The risk of death is significantly higher in TB/HIV-infected patients than in those patients with just one disease or the other. This study aims to evaluate the impact of demographic, clinical and laboratory characteristics on the treatment outcome and mortality of TB/HIV co-infected patients in a TB tertiary center in Iran. MATERIALS AND METHODS: The study was conducted at Iran's National Referral Center for Tuberculosis. In total, 111 patients were recruited between 2004 and 2007. Mycobacteriology studies were performed for all patients. Demographic, clinical, and lab data of all patients were analyzed, and predictors of unsuccessful outcomes, as well as mortality, were determined. RESULTS: The mean age for all 111 TB/HIV patients was 38±9years (range 22-70) and 107 patients (96.3%) were male; 104 patients (93.7%) had a history of drug abuse, and 96 patients (86.4%) had a history of imprisonment. The route of transmission of HIV was intravenous drug use in 88 of the patients (79.3%); 23 patients (20.7%) had a history of Category 1 (CAT-1) (5.4%) and CAT-2 treatment. Highly Active Antiretroviral Therapy (HAART) was given to 48 patients (43.2%). There was no significant association found between treatment outcome or mortality with sex, smoking, drug and alcohol abuse, imprisonment, route of transmission, history of CAT-1 and CAT-2, cluster of differentiation 4 (CD4), and adverse effects (p>0.05). Administration of HAART led to a significantly higher rate of good outcome (p<0.001). Lower Albumin levels and body weight were significantly associated with mortality. CONCLUSION: Albumin levels and weight can be predictors of mortality and an unsuccessful outcome. Administration of HAART led to a better outcome.

19.
Ann Thorac Med ; 6(2): 91-5, 2011 Apr.
Article in English | MEDLINE | ID: mdl-21572699

ABSTRACT

BACKGROUND: In preparation for pandemic HINI or H1N1 influenza (H1N1) it is necessary to identify factors associated with mortality of patients with HINI and hospital admissions to intensive care unit (ICU) of patients diagnosed in 2009 with HINI. OBJECTIVES: To describe the clinical and epidemiological features associated with 2009 HIN1 mortality and ICU patient admissions to Masih Daneshvari Teaching Hospital, Iran. METHODS: A retrospective cross-sectional study was conducted among patients with mortality and admissions to ICU with confirmed HINI. Demographic, clinical, laboratory, radiological findings, and epidemiologic data were abstracted from medical records, using a standardized datasheet. RESULTS: From June through December 2009, 20 out of the 46 confirmed hospitalized patients with confirmed H1NI were admitted to the ICU and 7 (15%) died. Among various variables, opium inhalation (P = 0.01), having productive cough, hemoptysis, chest pain, confusion, and loss of consciousness were significantly related to ICU admission (P < 0.05). Pleural effusion (P = 0.006), elevated liver enzymes, as well as CPK and LDH level were significantly relevant to ICU admission (P < 0.05). Delayed antiviral treatment was more common among patients who died and the elderly. DISCUSSION: Patients who were admitted to ICU with confirmed H1N1 included the following risk factors: delayed initiation of antiviral therapy, history of opium inhalation and symptoms including; productive cough, hemoptysis, chest pain, confusion, and loss of consciousness. The mortality rate in the study population was high but compares favorably with other recent published studies.

20.
Tanaffos ; 10(1): 8-11, 2011.
Article in English | MEDLINE | ID: mdl-25191344

ABSTRACT

BACKGROUND: Oseltamivir-resistant cases were reported during the 2009 pandemic influenza outbreak and therefore, widespread emergence of oseltamivir-resistant 2009 H1N1 virus is imaginable. Underlying medical conditions like immunosuppression increase the chance of oseltamivir resistance. MATERIALS AND METHODS: In a retrospective cross-sectional study, respiratory tract specimens of confirmed cases of 2009 H1N1 influenza referred to the Masih Daneshvari Hospital were analyzed for presence of H275Y mutation. RESULTS: From November 2009 through March 2010, oseltamivir-resistant 2009 H1N1 infection was observed and confirmed in 4 patients (including 2 immunocompromised patients) by performing H275Y mutation molecular testing. CONCLUSION: Close monitoring of resistance to neuraminidase inhibitors is essential in tertiary care centers. The H275Y mutation (oseltamivir-resistant genotype) could appear in the absence or presence of selective drug pressure.

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