Paediatric glaucoma in Hong Kong: a multicentre retrospective analysis of epidemiology, presentation, clinical interventions, and outcomes.

PURPOSE: To document the epidemiology, presentation, clinical interventions, and outcomes of paediatric glaucoma in Hong Kong. METHODS: This multicentre territory-wide retrospective study was performed by reviewing charts of patients with paediatric glaucoma in six clusters of the Hong Kong Hospital Authority and The Chinese University of Hong Kong from 2006 to 2015. RESULTS: This study included 150 eyes of 98 patients with paediatric glaucoma (presenting age: 5.2±5.7 years). Of them, 35 eyes (23.3%) had primary congenital glaucoma, 22 eyes (14.7%) had juvenile open-angle glaucoma, and 93 eyes (62.0%) had secondary glaucoma. The most prevalent types of secondary glaucoma were lens-related after cataract extraction (18.0%), Axenfeld-Rieger anomaly (5.3%), uveitis (5.3%), Sturge-Weber syndrome (4.7%), and traumatic (3.3%). The most common clinical presentations were parental concerns (20.7%) including cloudy cornea (12.7%) and tearing/photophobia (8.0%), followed by poor visual acuity (18.0%), high intraocular pressure (13.3%), and strabismus (6.0%). The follow-up duration was 8.46±6.51 years. Furthermore, 63.2% of eyes with primary glaucoma and 45.2% of eyes with secondary glaucoma were treated surgically. The final visual acuity was 0.90±0.98 LogMAR; intraocular pressure was 18.4±6.6 mm Hg; and number of glaucoma medications was 2.22±1.61. CONCLUSION: Primary congenital glaucoma was most prevalent, followed by juvenile open-angle glaucoma and aphakic glaucoma. Most eyes with primary glaucoma required surgical treatment. Parental concerns were important clinical presentations. Basic assessments by healthcare providers to identify glaucoma signs (eg, poor visual acuity, high intraocular pressure, and strabismus) warranted prompt referral to an ophthalmologist.

Anti-CD20 monoclonal antibody-dependent phagocytosis of chronic lymphocytic leukaemia cells by autologous macrophages.

Unconjugated monoclonal antibodies (mAbs) are an important component of effective combination therapies for chronic lymphocytic leukaemia (CLL). Antibody-dependent phagocytosis (ADP) is a major mediator of mAb cytotoxicity, but there is limited knowledge of the determinants of ADP efficacy. We used macrophages derived in vitro from autologous circulating monocytes to test the effects of mAb structure and concentration, target : effector cell ratio, duration of co-incubation and CLL cell CD20 expression on ADP. Next-generation anti-CD20 mAbs (ofatumumab, ublituximab, obinutuzumab, ocaratuzumab) were significantly more effective at inducing ADP compared to rituximab, but none were as effective as the anti-CD52 mAb alemtuzumab. Ofatumumab (10 µg/ml) used as a representative next-generation anti-CD20 mAb achieved an ADP plateau at 3 h co-incubation with a target : effector ratio of 10 : 1 (mean = 2.1 CLL cells/macrophage, range = 1.5-3.5). At 0.156 µg/ml (the lowest concentration tested) ofatumumab ADP was significantly higher than alemtuzumab. However, ofatumumab-induced ADP did not increase significantly at higher mAb concentrations. We show that anti-CD20 mAb ADP efficacy is determined by the mAb characteristics, target : effector ratio and incubation time. We suggest that preclinical evaluation of anti-CD20 mAbs to understand the determinants of ADP could be useful in designing future combination therapies for CLL.

Enhanced luminescence and white light emission from Eu(3+) -co-doped K3 Ca2 (SO4 )3 Cl:Dy(3+) phosphor with near visible ultraviolet excitation for white LEDs.

The luminescent properties of europium (Eu)- and dysprosium (Dy)-co-doped K3 Ca2 (SO4 )3 Cl halosulfate phosphors were analyzed. This paper reports the photoluminescence (PL) properties of K3 Ca2 (SO4 )3 Cl microphosphor doped with Eu and Dy and synthesized using a cost-effective wet chemical method. The phosphors were characterized by X-ray diffraction and scanning electron microscopy. The CIE coordinates were calculated to display the color of the phosphor. PL emission of the prepared samples show peaks at 484 nm (blue), 575 nm (yellow), 594 nm (orange) and 617 nm (red). The emission color of the Eu,Dy-co-doped K3 Ca2 (SO4 )3 Cl halophosphor depends on the doping concentration and excitation wavelength. The addition of Eu in K3 Ca2 (SO4 )3 Cl:Dy greatly enhances the intensity of the blue and yellow peaks, which corresponds to the (4) F9/2 → (6) H15/2 and (4) F9/2 → (6) H13/2 transitions of Dy(3+) ions (under 351 nm excitation). The Eu(3+) /Dy(3+) co-doping also produces white light emission for 1 mol% of Eu(3+) , 1 mol% of Dy(3+) in the K3 Ca2 (SO4 )3 Cl lattice under 396 nm excitation, for which the calculated chromaticity coordinates are (0.35, 0.31). Thus, K3 Ca2 (SO4 )3 Cl co-doped with Eu/Dy is a suitable candidate for NUV based white light-emitting phosphors technology.

Topiramate and asymptomatic ocular angle narrowing: a prospective pilot study.

PURPOSE: To investigate whether subclinical ciliochoroidal effusion and resulting asymptomatic angle narrowing occurs in patients taking topiramate, by ultrasound biomicroscopy (UBM). METHODS: Chinese patients aged 18-75 years for whom topiramate was indicated were recruited. Examinations including UBM were performed before and 4 weeks after commencement of topiramate. RESULTS: In this pilot of 20 eyes of 20 patients, there were no statistically significant changes in the angle parameters noted on gonioscopy or UBM, including anterior chamber depth, angle-opening distance at 500 mum, trabecular ciliary process distance, trabecular-iris angle, and scleral thickness. CONCLUSION: Short-term use of topiramate does not induce asymptomatic angle narrowing.

Surgically induced astigmatism in phacoemulsification, pars plana vitrectomy, and combined phacoemulsification and vitrectomy: a comparative study.

PURPOSE: To study the surgically induced astigmatism (SIA) in combined phacoemulsification and vitrectomy, and compare with that when either procedure is performed alone. METHODS: This is a prospective comparative interventional trial comprising of 60 eyes of 60 consecutive patients with cataract and/or vitreo-retinal pathology. They were divided equally into three groups based on the type of procedure: Group A, phacoemulsification alone group, using a 3.0-3.2 mm wide unsutured sclero-corneal tunnel incision at 1.0 mm post-limbus at 10 o'clock; Group B, par plana vitrectomy alone group, using three sclerotomies at 3.5 mm post-limbus at 2, 8, and 10 o'clock (right eye) or at 2, 4, and 10 o'clock (left eye) positions; and Group C, combined phacoemulsification and pars plana vitrectomy group. Main outcome measures were the amplitude (K-induced) and the axis of SIA calculated by rectangular coordinate method using the Holladay-Cravy-Koch formula. RESULTS: The mean K-induced amplitudes were 0.19+/-0.14 D, 0.17+/-0.11 D, and 0.23+/-0.19 D for groups A, B, and C, respectively. The range of K-induced amplitudes for the entire cohort was 0.00-0.77 D. No overall statistically significant differences in the pre- and postoperative topographic astigmatism amplitudes and the K-induced between groups A, B, and C were found (all P>0.05). Minor shifts, of doubtful clinical significance, in the axes of SIA were present. CONCLUSIONS: Combined phacoemulsification and pars plana vitrectomy does not induce significant astigmatic change per se, and its amount is similar to that when either procedure is performed alone.

Liver disease and diabetes mellitus.

The liver plays an important role in the pathogenesis of NIDDM. More importantly to the clinician is the myriad of situations in which the care of the patient with diabetes is affected by or causes an effect to the liver. Patients with underlying diabetes can present with abnormal liver chemistries, which can represent findings as benign as hepatic steatosis or as severe as cirrhosis of the liver. The medications used to treat diabetes can be potent hepatotoxins. Several primary liver diseases are associated with increased risk of the development of diabetes. Epidemiologically, there seems to be a correlation between diabetes mellitus, the most common endocrinologic disease, and hepatitis C, the leading cause of chronic liver disease in the United States. In the management of end-stage liver disease, both cirrhosis and orthotopic liver transplantation promote glucose intolerance and diabetes in a number of patients through various mechanisms including insulin resistance and impaired insulin secretion. These relationships highlight both the importance of the liver as an endocrine organ and the multisystem aspects of the patient with diabetes mellitus.