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OBJECTIVE: To evaluate longitudinal endothelial cell characteristics of children with posterior polymorphous corneal dystrophy (PPCD). METHODS: In this prospective case-control study, children with PPCD were followed with slit-lamp photography and non-contact specular microscopy. Patient’s eyes were subdivided according to the clinical subtypes of PPCD (vesicular, band, diffuse, and unaffected) and the number of lesions present on the posterior corneal surface. Findings were then compared with age-matched controls. RESULTS: Thirty eyes of 15 patients with PPCD with a mean age 10.5 ± 3.1 years were analysed. Mean follow-up was 3.0 ± 1.0 years. PPCD morphology was vesicular in 40%, diffuse in 37%, band type in 10% and 13% had no detectable lesions despite contralateral involvement. Fourteen eyes (47%) had ≥5 endothelial lesions. Patients with PPCD had significantly lower endothelial cell densities (ECD) at recruitment (1918.9 ± 666.3 vs. 3340.1 ± 286.5 cells/mm(2), p

Corneal cross-linking (CXL) is typically performed under topical anesthesia, which may be unsuitable in children and individuals with severe anxiety, poor cooperation, or neurodevelopmental issues. We describe a technique of CXL under general anesthesia that uses sevoflurane and propofol with laryngeal airway or nasal oxygen cannulas, and forceps or microsponges to stabilize the eye position intraoperatively. We also developed a simple and time-saving technique of bilateral simultaneous CXL, whereby the second eye can undergo CXL concurrently with the first in a staggered fashion. Using this technique, we have been able to eliminate up to 25% of surgical time required in standard bilateral procedures. Postoperatively, multimodal analgesia was administered to ensure patient comfort and prevent excessive eye rubbing. In total, 21 eyes of 13 subjects ≤18 years of age were treated. During a median follow-up of 14.5 months (range, 4-43), the only complication observed was sterile corneal infiltrate in 1 eye that resolved with a short course of corticosteroids.

ObjectiveTo examine the relationship between Mediterranean diet and risk of later-onset Crohn’s disease (CD) or ulcerative colitis (UC).DesignWe conducted a prospective cohort study of 83 147 participants (age range: 45–79 years) enrolled in the Cohort of Swedish Men and Swedish Mammography Cohort. A validated food frequency questionnaire was used to calculate an adherence score to a modified Mediterranean diet (mMED) at baseline in 1997. Incident diagnoses of CD and UC were ascertained from the Swedish Patient Register. We used Cox proportional hazards modelling to calculate HRs and 95% CI.ResultsThrough December of 2017, we confirmed 164 incident cases of CD and 395 incident cases of UC with an average follow-up of 17 years. Higher mMED score was associated with a lower risk of CD (Ptrend=0.03) but not UC (Ptrend=0.61). Compared with participants in the lowest category of mMED score (0–2), there was a statistically significant lower risk of CD (HR=0.42, 95% CI 0.22 to 0.80) but not UC (HR=1.08, 95% CI 0.74 to 1.58). These associations were not modified by age, sex, education level, body mass index or smoking (all Pinteraction >0.30). The prevalence of poor adherence to a Mediterranean diet (mMED score=0–2) was 27% in our cohorts, conferring a population attributable risk of 12% for later-onset CD.ConclusionIn two prospective studies, greater adherence to a Mediterranean diet was associated with a significantly lower risk of later-onset CD.

Introduction: Allogeneic hematopoietic stem cell transplantation (HSCT) is an established treatment of myeloid and lymphoid malignancies, solid tumors and a number of metabolic conditions in childr...

To characterize visual outcomes in children screened for retinopathy of prematurity (ROP).Retrospective, interventional case series.Patients who received ROP screening examinations at UCLA Medical Centers and were followed with outpatient eye examinations at Stein Eye Institute and/or Doheny Eye Institute (Los Angeles, California) were included. Data were collected on birth characteristics, worst type of ROP, and ROP treatment. Adverse visual outcomes included myopia, strabismus, amblyopia, macular dragging, and optic atrophy. Snellen visual acuity was reported for children 4 years and older.A total of 175 infants (350 eyes) were included for analysis (mean gestational age = 28.2 weeks and birth weight = 1059 g) from a screening population of 539 infants (1078 eyes, 32.4% follow-up) over a 9-year period. Fifteen eyes received primary anti-vascular endothelial growth factor (anti-VEGF) therapy, whereas 59 eyes received primary laser therapy. Primary anti-VEGF therapy, as compared with primary laser treatment, was associated with a decreased incidence of amblyopia (adjusted odds ratio [aOR] = 0.6-0.86, P.0001) after controlling for gestational age and birth weight. The rates of optic atrophy (P = .79), strabismus (P = .98), and myopia (P = .93) were not different between anti-VEGF and laser treatment groups. Infants receiving anti-VEGF therapy had more posterior disease than laser-treated infants (P = .041). Infants receiving laser therapy were more likely to have severe myopia (aOR = 1.02-1.3, P = .023), amblyopia (aOR = 1.12-1.61, P = .002), and optic atrophy (aOR = 1.01-1.32, P = .045) than infants not treated.These findings add to the advantages of anti-VEGF treatment compared with primary laser treatment, particularly in posterior ROP.

The purpose of this study was to determine longitudinal trends in prevalence and resistance profiles for infectious keratitis at referral centers in Southern California.Cultured infectious keratitis cases from January 1, 2006, through December 31, 2009, and January 1, 2016, through December 31, 2019, at the University of California, Los Angeles, were evaluated. Outcome measures included microbial isolate prevalence and antibiotic/antifungal susceptibility and resistance patterns.One hundred thirty-nine and 315 culture-positive isolates were obtained between 2006-2009 and 2016-2019, respectively. Gram-positive organisms accounted for 65% (2006-2009) and 74% (2016-2019) of bacterial isolates ( P = 0.076). Staphylococcus infections, the most common gram-positive and bacterial isolate in both study epochs, demonstrated increased prevalence from 2006-2009 to 2016-2019 (41% vs. 53%, P = 0.019). Although coagulase-negative Staphylococcus (CoNS) increased from 40% to 58% ( P = 0.0012), the prevalence of methicillin-resistant Staphylococcus aureus was unchanged (28% vs. 28%, P = 0.99). Pseudomonas aeruginosa , the most common gram-negative organism, demonstrated decreased prevalence from 18% to 10% ( P = 0.027). Candida species comprised 3.5% of culture-positive isolates in both epochs. All gram-positive isolates were susceptible to vancomycin, and all Staphylococcus isolates were susceptible to linezolid. Pseudomonas aeruginosa remained susceptible to tested fluoroquinolones (93%) and aminoglycosides (100%) over time.In southern California between 2006 and 2019, there was a shift toward Staphylococcus species, with increased CoNS, decreased methicillin-sensitive Staphylococcus aureus , and decreased prevalence of P. aeruginosa . Empiric therapy of vancomycin and a fluoroquinolone or aminoglycoside provides effective antibacterial coverage for predominant bacterial species when culture sensitivities are pending.

Acacia spp. are exotic tree species that have been widely planted on man-made slopes in Hong Kong since the 1960s. However, as they become mature and senescent, they may become a concern and cause various problems, including soil constraints for plant growth, decreasing provision of intended ecosystem services, declining syndromes, arrested succession, and high risk of failure. In this perspective paper, we present and discuss these problems using practical examples of Acacia-dominated urban forests on man-made roadside slopes in Hong Kong, based on a cross-disciplinary survey and a literature review. To conclude, we suggest that selective cutting, specific silvicultural operations of Acacia plantations, and the management of plantation edge and soils can be exercised, along with the planting of native species, to potentially alleviate these problems associated with mature Acacia plantations, by promoting the establishment of native forests, enhancing biodiversity, expediting succession, and providing better ecosystem services.