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Age-related macular degeneration (AMD) is the leading cause of low vision and blindness for which there is currently no cure. Increased matrix metalloproteinase-9 (MMP-9) was found in AMD and potently contributes to its pathogenesis. Resident microglia also promote the processes of chronic neuroinflammation, accelerating the progression of AMD. The present study investigates the effects and mechanisms of the natural compound theissenolactone B (LB53), isolated from Theissenia cinerea, on the effects of RPE dysregulation and microglia hyperactivation and its retinal protective ability in a sodium iodate (NaIO

Purpose: Attention-deficit/hyperactivity disorder (ADHD) was reported to be associated with disturbances in the prefrontal circuitry and seems to be associated with dysfunctions of eye motility. This study aimed to explore associations between ADHD and ocular abnormalities, including amblyopia, hypermetropia, astigmatism, and heterotropia, using a large, nationwide population-based dataset in Taiwan.Methods: We retrieved our sample for this cross-sectional study from the Taiwan National Health Insurance Research Database. In total, 116,308 children with ADHD were selected as the study group and 116,308 randomly selected children without ADHD as the comparison group. We used conditional logistic regression analyses to examine the odds ratios (ORs) of amblyopia, hypermetropia, astigmatism, and heterotropia between children with and those without ADHD.Results: We found that children with ADHD had significantly higher prevalences of amblyopia (1.6% vs. 0.9%, p< .001), hypermetropia (2.4% vs. 1.3%, p < .001), astigmatism (0.2% vs. 0.1%, p < .001), and heterotropia (1.1% vs. 0.5%, p < .001) than children without ADHD. The ORs of amblyopia, hypermetropia, astigmatism and heterotropia for children with ADHD were 1.89 (95% confidence interval (CI) = 1.76 ~ 2.05), 1.82 (95% CI = 1.68 ~ 1.92), 1.73 (95% CI = 1.34 ~ 2.16), and 2.01 (95% CI = 1.82 ~ 2.21) compared to children without ADHD.Conclusions: The findings suggest that ADHD is associated with ocular abnormalities, including amblyopia, hypermetropia, astigmatism, and heterotropia.

Background Elevated intraocular pressure (IOP) is a major risk factor for glaucoma that has been found to induce matrix metalloproteinase-9 (MMP-9) activation and result in eventual retinal dysfunction. Proinflammatory cytokines such as monocyte chemoattractant protein-1 (MCP-1) and interleukin-1β (IL-1β) were also found to be involved in disease progression by mediating MMP-9 production. We previously reported that fungal derivative theissenolactone C (LC53) could exert ocular protective effects by suppressing neuroinflammation in experimental uveitis. Purpose The aim of this study was to investigate the retinoprotective effects of natural compound LC53 on the high IOP-induced ischemia/reperfusion (I/R)-injury model of glaucoma and its cellular mechanisms. Methods A high IOP-induced I/R-injury model was manipulated by normal saline injection into the anterior chamber of the rat eye. MCP-1-stimulated monocytes and IL-1β-activated primary astrocytes were used to investigate the cellular mechanisms of LC53. Retinal function was evaluated with the scotopic threshold response (STR) and combined rod–cone response by electroretinography (ERG). As a positive control, rats were treated with memantine. MMP-9 gelatinolysis, mRNA expression and protein expression were analyzed by gelatin zymography, RT-PCR, and Western Blot, respectively. The phosphorylation levels of MAPKs and NF-κB p65 were tested by Western Blot. Additionally, the levels of inflammatory MCP-1 and IL-1β were determined by ELISA. Results The present study revealed that LC53 preserved the retina functional deficiency assessed by scotopic threshold response (STR) and combined rod–cone response of ERG after high IOP-induced I/R injury. These retinal protective effects of LC53 were positively correlated with inhibitory activities in I/R injury-elicited ocular MMP-9 activation and expression. The increased level of MCP-1 was not affected, and the enhanced IL-1β production was partially reduced by LC53 in the retina after I/R injury. According to cellular studies, LC53 significantly and concentration-dependently abrogated MMP-9 activation and expression in MCP-1-stimulated THP-1 monocytes. We found the inhibitory activities of LC53 were through the ERK- and NF-κB-dependent pathways. In addition, LC53 dramatically suppressed IL-1β-induced MMP-9 activation and expression in primary astrocytes. The phosphorylation of 65-kD protein (p65) of NF-κB was substantially blocked by LC53 in IL-1β-stimulated primary astrocytes. Conclusion LC53 exerted a retinal protective effect through NF-κB inhibition and was highly potent against MMP-9 activities after high IOP-induced I/R injury, suggesting that LC53 would be a promising drug lead for glaucoma or related medical conditions attributed to retinal ischemia.

PurposeTo investigate the relationship between previously diagnosed open-angle glaucoma (OAG) and neovascular age-related macular degeneration (AMD) using a routine insurance dataset.MethodsThis study retrieved data from the Taiwan Longitudinal Health Insurance Database 2005. We found 3282 patients with neovascular AMD as cases and 13 128 sex- and age-matched subjects without neovascular AMD as controls. Conditional logistic regressions were performed to evaluate the association of neovascular AMD with previously diagnosed OAG among the sampled patients.ResultsOf the 16 410 sampled patients, 2.55% had previously diagnosed OAG, 5.06 and 1.92% for the cases and controls, respectively. The logistic regression analysis showed that the odds ratio (OR) of previously diagnosed OAG for cases was 2.45 (OR: 2.45; 95% confidence interval: 1.99-3.01) compared with the controls after adjusting for potential confounders. In addition, the adjusted ORs for previously diagnosed OAG were similar for patients with AMD in both genders (with an adjusted OR of 2.49 for males and 2.39 for females). Furthermore, it shows that OAG was significantly associated with neovascular AMD regardless of sex even after adjusting for monthly income, geographic region, urbanisation level, and comorbidities (with adjusted ORs of 2.49 for males and 2.39 for females).ConclusionsThis study demonstrated that patients with neovascular AMD had a higher odds of previously diagnosed OAG compared with those patients without neovascular AMD regardless of sex.

Blue light-induced phototoxicity plays an important role in retinal degeneration and might cause damage as a consequence of smartphone dependency. Here, we investigated the effects of periodic exposure to blue light-emitting diode in a cell model and a rat retinal damage model. Retinal pigment epithelium (RPE) cells were subjected to blue light in vitro and the effects of blue light on activation of key apoptotic pathways were examined by measuring the levels of Bcl-2, Bax, Fas ligand (FasL), Fas-associated protein with death domain (FADD), and caspase-3 protein. Blue light treatment of RPE cells increased Bax, cleaved caspase-3, FasL, and FADD expression, inhibited Bcl-2 and Bcl-xL accumulation, and inhibited Bcl-2/Bax association. A rat model of retinal damage was developed with or without continuous or periodic exposure to blue light for 28 days. In this rat model of retinal damage, periodic blue light exposure caused fundus damage, decreased total retinal thickness, caused atrophy of photoreceptors, and injured neuron transduction in the retina.

To determine the toxic effects of long-term topical usage of fluorometholone (FLM) on ganglion cells using a direct in vivo retinopathological Brown Norway (BN) rat model. The BN rat retinal model was investigated with a minimum of 3 rats and a maximum of 4 rats per group. Rats received vehicle and 0.02% FLM suspension via topical administration 3 times a day for 28 days. The fundus images and retinal vessels were detected on days 1, 14, and 28 using Micron III retinal imaging microscope and fundus fluorescein angiography (FFA). For retinal structures, spectral-domain optical coherence tomography (SD-OCT) images were taken after FFA on days 1, 14, and 28 using an SD-OCT Imaging System. For retinal function, electrical signal transduction of photoreceptors and bipolar cells was determined by electroretinographic (ERG) recording on days 1 and 28 and IOP detection. At the end of the experiment on day 28, immunohistochemistry and TUNEL assay were performed to investigate apoptosis in ganglion cells. Total retina and nerve fiber layer (NFL) to the inner plexiform layer (IPL) were significantly thinner following 28 days of FLM treatment. Hematoxylin and eosin stain showed that there were NFL and ganglion cell layer deformations in the FLM group. With FLM treatment, TUNEL assay showed approximately a 4.68-fold increase in apoptotic cells. Moreover, FLM decreased ERG b-wave amplitude by about 56%. Using ophthalmofundoscopy devices, after 28 days of topical administration, FLM decreased NFL-IPL and total retina thickness. This suggests that long-term FLM induces adverse effects with respect to ganglion cell apoptosis.

PURPOSE To investigate differences in the utilization of healthcare services between subjects with open-angle glaucoma (OAG) and comparison subjects without OAG using Taiwan's National Health Insurance population-based database. PATIENTS AND METHODS The study comprised 2204 subjects with OAG and 2204 sex-matched and age-matched subjects without OAG. We individually followed each subject for a 1-year period to evaluate their healthcare resource utilization. Outcome variables of the healthcare resource utilization were as follows: numbers of outpatient visits and inpatient days and the mean costs of outpatient and inpatient treatment. In addition, we divided healthcare resource utilization into ophthalmologic and nonophthalmologic services. RESULTS As for the utilization of ophthalmologic services, OAG subjects had significantly more outpatient visits (7.4 vs. 1.3, P

To assess the association between cataract and chronic rhinosinusitis (CRS) using a population-based database.The study sample for this case-control study was retrieved from Taiwan's Longitudinal Health Insurance Database 2000. The study included 3045 patients who had undergone cataract surgery as cases and 9135 subjects without cataract as controls. Conditional logistic regression was performed to calculate odds ratios (ORs) and corresponding 95% confidence intervals (CIs) of having a prior diagnosis of CRS in cases versus controls.In the total study sample, the prevalence of prior CRS was 3.88%; 5.16% among cases and 3.45% among controls (p 0.001). Conditional logistic regression suggested that the unadjusted OR for prior CRS among cases was 1.52 (95% CI 1.25-1.85, p 0.001) compared to controls. After adjusting for monthly income, residential urbanization and geographic region, the OR for prior CRS among cases was 1.58 (95% CI 1.30-1.94, p 0.001) compared to controls. Furthermore, the results consistently suggested that cases had higher adjusted ORs for prior CRS than controls across all age groups (40-59, 60-69, and69 years). It is particularly noteworthy that younger groups demonstrated higher ORs for prior CRS among cases compared to controls. In particular, the adjusted OR for cases aged 40-50 years was 1.71 (95% CI 1.09∼2.66; p 0.05) compared to controls.While the true relationship between CRS and cataract remains to be further investigated, the result of this present study demonstrated CRS may be associated with cataract.

Anatomically, the eyes and paranasal sinuses are neighboring structures and some studies have mentioned eye disease in conjunction with chronic rhinosinusitis (CRS). However, to the best of our knowledge, no prior research has investigated the risk of developing open-angle glaucoma (OAG) among CRS patients. This study aims to provide an estimated risk of developing OAG among patients with CRS by using a population-based data set in Taiwan.This retrospective cohort study used data sourced from the 'Longitudinal Health Insurance Database 2000'. A total of 15,642 CRS patients were included in the study cohort and 46,926 subjects were randomly extracted as a comparison cohort. A cox proportional-hazards regression analysis was performed to calculate the 5-year risk of subsequently developing OAG following a diagnosis of CRS between the study cohort and the comparison cohort.The incidence rate of developing OAG over the 5-year follow-up period was 5.45 (95% CI: 4.95-5.98) per 1000 person-years for the study cohort and 2.80 (95% CI: 2.60-3.03) per 1000 person-years for the comparison cohort. After censoring the cases that died over the 5-year period and adjusting for the factors of monthly income, geographic region, hypertension, diabetes, coronary heart disease, hyperlipidemia, and hypothyroidism the hazard ratio for developing OAG over the 5-year period for subjects with CRS to subjects without CRS was 1.73 (95% CI: 1.53-1.96).We found that those subjects with CRS had a significantly higher risk of developing OAG over the 5-year follow-up period as compared with subjects without CRS.

Purpose Previous studies had reported an increased prevalence of glaucoma in patients with obstructive sleep apnea (OSA). However, the risk of open-angle glaucoma (OAG) among patients with OSA remains unclear. Using a nationwide, population-based dataset in Taiwan, this study aimed to examine the prevalence and risk of OAG among patients with OSA during a 5-year follow-up period after a diagnosis of OSA. Design A retrospective, matched-cohort study. Participants and Controls This study used data sourced from the Longitudinal Health Insurance Database 2000. We included 1012 subjects with OSA in the study cohort and randomly selected 6072 subjects in the comparison group. Methods Each subject in this study was individually traced for a 5-year period to identify those subjects who subsequently received a diagnosis of OAG. Cox proportional hazards regression was performed to calculate the 5-year risk of OAG between the study and comparison cohorts. Main Outcome Measures The incidence and risk of OAG between the study and comparison groups. Results During the 5-year follow-up period, the incidence rate per 1000 person-years was 11.26 (95% confidence interval [CI], 8.61–14.49) and 6.76 (95% CI, 5.80–7.83) for subjects with and without OSA, respectively. After adjusting for monthly income, geographic region, diabetes, hypertension, coronary heart disease, obesity, hyperlipidemia, renal disease, hypothyroidism, and the number of outpatient visits for ophthalmologic care during the follow-up period, stratified Cox proportional hazards regression revealed that the hazard ratio for OAG within the 5-year period for subjects with OSA was 1.67 (95% CI, 1.30–2.17; P Conclusions Our results suggest that OSA is associated with an increased risk of subsequent OAG diagnosis during a 5-year follow-up period. Financial Disclosures(s) The authors have no proprietary or commercial interest in any of the materials discussed in this article.

Purpose This retrospective cohort study examines the association between cataract surgery and neovascular age-related macular degeneration (AMD) during 5-year follow-up using population-based claims data. Methods We analysed data sourced from the Taiwan Longitudinal Health Insurance Database 2005. The study included 3465 patients who had undergone cataract operations and did not have a diagnosis of AMD before or on the surgery date (study group), and 10 395 age- and sex-matched comparison patients selected randomly from the remaining patients without an AMD diagnosis before the index date. We tracked the claims of each patient for a 5-year period to identify patients with a subsequent diagnosis of neovascular AMD. Results The incidence rate of neovascular AMD was 0.88 (95% confidence interval (CI): 0.66–1.14) per 1000 person-years among all sampled patients, 1.60 (95% CI: 1.04–2.36) among the cataract surgery patients and 0.64 (95% CI: 0.43–0.91) among comparison patients (p

Retinitis pigmentosa (RP) is an inherited photoreceptor-degenerative disease, and neuronal degeneration in RP is exacerbated by glial activation. Cassia seed (Jue-ming-zi) is a traditional herbal medicine commonly used to treat ocular diseases in Asia. In this report, we investigated the retina-protective effect of chrysophanol, an active component of Cassia seed, in an N-methyl-N-nitrosourea (MNU)-induced mouse model of RP. We determined that chrysophanol inhibited the functional and morphological features of MNU-induced retinal degeneration using scotopic electroretinography (ERG), optical coherence tomography (OCT), and immunohistochemistry analysis of R/G opsin and rhodopsin. Furthermore, TUNEL assays revealed that chrysophanol attenuated MNU-induced photoreceptor cell apoptosis and inhibited the expression of the apoptosis-associated proteins PARP, Bax, and caspase-3. In addition, chrysophanol ameliorated reactive gliosis, as demonstrated by a decrease in GFAP immunolabeling, and suppressed the activation of matrix metalloproteinase (MMP)-9-mediated gelatinolysis. In vitro studies indicated that chrysophanol inhibited lipopolysaccharide (LPS)-induced iNOS and COX-2 expression in the BV2 mouse microglia cell line and inhibited MMP-9 activation in primary microglia. Our results demonstrate that chrysophanol provided neuroprotective effects and inhibited glial activation, suggesting that chrysophanol might have therapeutic value for the treatment of human RP and other retinopathies.

Purpose Although endophthalmitis secondary to pyogenic liver abscess (PLA) is becoming a globally emerging infectious disease, population-based investigations evaluating the relationship between PLA and endogenous endophthalmitis remain scarce. This study aimed to investigate the incidence and risk of endogenous endophthalmitis in patients with PLA compared with unaffected individuals by using a nationwide, population-based dataset. Design Retrospective, cohort study. Participants and Controls This study used data sourced from Taiwan's National Health Insurance Research Database. In total, 12 727 patients with PLA were included in the study group and 63 635 matched subjects were randomly extracted as a comparison group. Methods Stratified Cox proportional hazards regressions were performed to assess the effect of PLA on the hazard of developing endogenous endophthalmitis. Main Outcome Measures The incidence and risk of endogenous endophthalmitis between the study group and comparison group. Results Of the total sample, 148 subjects (0.10%) were diagnosed with endophthalmitis during the 1-year follow-up period. Endophthalmitis was found in 106 patients (0.84%) with PLA and 42 comparison patients (0.07%). After adjusting for patient monthly income, geographic location, and urbanization level, those suffering from PLA were found to have a greater likelihood of developing endophthalmitis during the 1-year follow-up period than comparison patients (hazard ratio [HR], 12.83; 95% confidence interval, 8.94–18.41). Stratification did not reveal any large differences in the adjusted HRs for endophthalmitis between PLA patients suffering from diabetes and those in whom diabetes was absent. We further analyzed the etiology of cases with endogenous endophthalmitis in this investigation and found Klebsiella pneumonia to be the causative organism among 75.5% of the cases but only 33.4% of the comparison group. Conclusions We found that the incidence and risk of developing endophthalmitis was significantly higher among patients with PLA compared with matched controls irrespective of diabetes status. Financial Disclosure(s) The authors have no proprietary or commercial interest in any of the materials discussed in this article.

Purpose Open-angle glaucoma (OAG) is associated with systemic metabolic and cardiovascular disorders, and both share common risk factors with erectile dysfunction (ED). However, few studies have investigated the association of ED with OAG. This study aimed to estimate the association of ED with prior OAG by using a nationwide, population-based data with a retrospective case-control cohort design in Taiwan. Design Age-matched case-control study. Participants and Controls We identified 4605 patients with ED as the cases and randomly selected 23 025 subjects as the controls (5 controls to 1 case). Methods We used conditional logistic regression analysis to estimate the odds ratio and 95% confidence interval of having previously been diagnosed with OAG according to the presence/absence of ED after adjusting for patient's monthly income, geographical location, hypertension, diabetes, coronary heart disease, hyperlipidemia, obesity, and alcohol abuse. Main Outcome Measures We identified OAG cases not only based on an International Classification of Diseases, Ninth Revision, Clinical Modification code, but also by the prescription of topical antiglaucoma medication. Results In total, prior OAG was found among 137 subjects (0.5 %); 53 individuals (1.1% of the ED patients) from the cases and 84 individuals (0.4% of patients without ED) from the controls. Conditional logistic regression analysis demonstrated that, after adjusting for potential confounders, patients with ED were more likely to have prior OAG than controls (odds ratio, 2.85; 95% confidence interval, 2.10–4.07). Conclusions This study identifies a novel association between ED and prior OAG. Financial Disclosure(s) The authors have no proprietary or commercial interest in any of the materials discussed in this article.

Objective To determine the prevalence of selected comorbidities in patients with open-angle glaucoma (OAG) and whether these comorbidities are more prevalent among individuals with OAG than those without OAG. Design A retrospective, nationwide, case-control study using an administrative database. Participants The study group comprised 76 673 OAG patients. The comparison group comprised 230 019 subjects matched to the study cohort. Methods Data were collected retrospectively from the Taiwan National Health Insurance Research Database. The study cohort comprised all patients with a diagnosis of OAG (International Classification of Diseases, 9th Revision, Clinical Modification codes 365.1–365.11) in 2005 (n = 76 673). The comparison cohort comprised randomly selected patients (3 for every 1 OAG patient; n=230 019) matched with the study group in terms of age, gender, urbanization level, and monthly income. In total, 31 medical comorbidities were selected based mainly on the Elixhauser Comorbidity Index. Separate conditional logistic regression analyses were used to estimate the adjusted odds ratio for each of the medical comorbidities between patients with and without OAG. Main Outcome Measures The prevalences of selected comorbidities. Results More than half (50.5%) of the OAG patients had hypertension, and more than 30% had hyperlipidemia or diabetes (30.5% and 30.2%, respectively). The prevalences of 28 of 31 comorbidities were significantly higher for OAG patients than subjects without glaucoma after adjusting for age, gender, urbanization level, and monthly income. The adjusted odds ratio was more than 1.50 for hypertension, hyperlipidemia, systemic lupus erythematosus, diabetes, hypothyroidism, fluid and electrolyte disorders, depression, and psychosis. Among the studied comorbidities, the prevalence difference of the OAG group minus the control group was 3% or higher for hypertension, hyperlipidemia, stroke, diabetes, liver disease, and peptic ulcer. Conclusions Open-angle glaucoma patients are significantly more likely to have comorbidities, many of which can be life threatening or can affect the quality of life appreciably. Financial Disclosure(s) The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Objective To investigate the risk of open-angle glaucoma (OAG) after a diagnosis of hypothyroidism. Design A retrospective, population-based follow-up study using an administrative database. Participants The study group comprised 257 hypothyroidism patients. The comparison group included 2056 subjects. Methods Data were retrospectively collected from the Taiwan Longitudinal Health Insurance Database. The study cohort comprised patients aged ≥60 who received a first diagnosis of hypothyroidism (International Classification of Diseases, Ninth Revision, Clinical Modification code 244.9) from 1997 to 2001 (n = 257). The comparison cohort consisted of randomly selected patients without hypothyroidism who were aged ≥60 and had no diagnosis of glaucoma before 2001 (8 for every OAG patient; n=2056). Each sampled patient was tracked for 5 years from their index visit. Cox proportional hazard regressions were used to compute the 5-year OAG-free survival rate, after adjusting for possible confounding factors. Main Outcome Measures The risk of developing OAG during the 5-year follow-up period. Results Open-angle glaucoma developed in 7.4% of patients with hypothyroidism and 3.8% of patients in the comparison cohort during the follow-up period. Hypothyroid patients had a significantly lower 5-year OAG-free survival rate than patients in the comparison cohort. After adjusting for patients' age, gender, monthly income, urbanization level, and comorbid medical disorders, hypothyroidism patients were found to have a 1.78-fold (95% confidence interval [CI], 1.04–3.06) greater risk of developing OAG than the comparison cohort. This association remained significant in untreated hypothyroidism patients (adjusted hazard ratio [HR], 2.37; 95% CI, 1.10–5.09) and became statistically nonsignificant in patients treated with levothyroxine (adjusted HR, 1.73; 95% CI, 0.89–3.38). Conclusions Hypothyroid patients had a significantly increased risk of OAG development during the 5-year follow-up period. Levothyroxine seemed to be protective. Financial Disclosure(s) The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Purpose To evaluate age-related changes in astigmatism of both corneal surfaces and the whole cornea. Methods The right eyes of 370 subjects were measured with a rotating Scheimpflug camera (Pentacam). Astigmatisms of the anterior and posterior corneal surfaces were determined. The total corneal astigmatism was derived using power vector summation and vergence tracing. Age-related changes to corneal astigmatism were evaluated using polar value analysis (both in diopter and millimeter). Results For the anterior and total cornea, the proportion of with-the-rule astigmatisms decreased and those of oblique and against-the-rule astigmatisms increased with age. For the posterior cornea, most eyes displayed against-the-rule astigmatisms in all age groups. There was a significant trend toward against-the-rule astigmatism associated with increasing age for both anterior and total corneal astigmatisms (mean changes of -0.18 and -0.16 diopters/5 years, respectively), and toward with the rule in posterior corneal astigmatism (a mean change of 0.022 diopters/5 years). Regarding shape changes, a "flat meridian toward a more vertical orientation" trend with increasing age for both the anterior and posterior corneal surfaces was observed (mean changes of 0.0295 and 0.0224 mm/5 years, respectively). The posterior corneal surface compensated for the astigmatism arising from the anterior corneal surface in 91.4% and 47.7% of eyes in the 21-30 and > or =71 years groups, respectively. Conclusions There were age-related shifts toward against-the-rule and with-the-rule astigmatisms for the anterior and posterior corneal surfaces, respectively. The compensating effects of the posterior corneal surface on anterior corneal astigmatism decreased with advancing age.

Objective: To study the relationship between using antiglaucoma medications during pregnancy and the risk of having low-birth-weight (LBW) infants. Methods: The study group comprised 244 pregnant women who had been prescribed topical medication to control glaucoma during pregnancy. The comparison group comprised 1952 pregnant women matched for age, year of delivery, maternal hypertension and gestational diabetes. Multivariate logistic regressions were conducted to calculate the adjusted odds ratio of having LBW infants. Results: The majority of pregnant women (77.5%) were prescribed beta-blockers to control glaucoma. After adjusting for characteristics of the infant (gender, parity and gestational age), mother (age, the highest educational level, marital status, hypertension and gestational diabetes), father (the highest educational level), parental age difference and family monthly income, there was no significant difference in the risk of LBW infants between mothers prescribed beta-blockers and mothers in the comparison cohort (adjusted odds ratio (OR) 1.48, 95% CI 0.86 to 2.56). However, there was a significantly higher risk of LBW infants for mothers prescribed topical antiglaucoma medications other than beta-blockers (adjusted OR 2.15, 95% CI 1.05 to 5.00). Conclusions: Topical beta-blockers can be the first-line drugs when considering medical treatment of glaucoma in a pregnant woman.

Aim: Using a nationwide population-based dataset, this study investigated the relationship between retinal vein occlusion (RVO) and subsequent acute myocardial infarction (AMI). Methods: This study is based on a nationwide database released by the Taiwan National Health Research Institute. The study cohort consisted of all ambulatory care patients who were diagnosed as having RVO during 2000∼2003 (n = 591), while the control cohort comprised 2955 randomly selected patients extracted from the same dataset; five patients for every RVO patient, matched by age and gender. Each patient was individually tracked for 3 years from their index ambulatory care visit. Cox proportional hazard regressions were performed to compute the adjusted 3-year AMI-free survival rates, comparing these two cohorts. Results: RVO patients had a significantly higher rate of AMI (1.86% vs 0.78%) during the 3-year follow-up period than patients in the comparison group (p = 0.032). However, after adjusting for the patients’ gender, age, geographic region and comorbid medical disorders, there was no significant difference between the central retinal vein occlusion, branch retinal vein occlusion patients and the comparison group in terms of the hazard of AMI during the 3-year follow-up period. Conclusion: RVO did not independently increase the risk of AMI.

To report intraocular lens (IOL) power calculation in 2 eyes that were highly undercorrected by previous myopic automated lamellar keratoplasty (ALK).A 35-year-old man underwent bilateral myopic ALK, which caused high residual myopia (-9.0 -4.0 x 171 and -9.5 -4.5 x 74). The patient then underwent cataract surgery with IOL implantation for cataract development. The double-K clinical history method was utilized, and satisfactory IOL power prediction results were obtained. Two no-history IOL power calculation methods (Rosa correcting factor method and Ferrara theoretical variable refractive index method), which involved axial length-dependent modification of the keratometer-measured corneal radius, and 1 no-history IOL power calculation method (Shammas' method), which involved axial length-independent modification of the keratometer-measured corneal power, were tested on these 2 eyes.In both eyes, the double-K SRK-T clinical history method gave small IOL prediction errors (-0.66 and -0.81 D). The Shammas' no-history method gave a slightly higher IOL prediction error in the right eye (-1.67 D) and a small IOL prediction error in the left eye (-0.74 D). Unacceptable IOL power prediction errors would have resulted if Rosa's correcting factor method (-8.07 and -8.35 D) or Ferrara's theoretical variable refractive index method (-17.56 and -18.51 D) had been applied. When we utilized Rosa's method for the IOL power calculation by assuming that the previous ALK had fully corrected the refractive error, the predicted IOL powers were very close to the benchmark IOL powers (IOL power prediction errors: 1.16 and 0.37 D). When we utilized Ferrara's method with the same assumption, the IOL power prediction errors remained high (-6.32 and -7.16 D).For patients who have had previous myopic ALK (and whose eyes are highly undercorrected) and who require cataract surgery and for whom the pre-ALK history is available, the double-K method appears to yield excellent predictive results. However, if the pre-ALK history is not available, the Shammas' no-history method appears to yield better results than the Rosa's or the Ferrara's method. High undercorrection by the previous ALK might have been one of the major reasons why Rosa's method resulted in a high IOL prediction error in these 2 eyes. The cause for the marked IOL prediction error by Ferrara's method in this case, however, remains to be determined.

Purpose To determine the keratometric index based on actual measurements of the anterior and posterior corneal surfaces using a rotating Scheimpflug camera (Pentacam, Oculus) and evaluate the accuracy of this keratometric index in estimating total and posterior corneal powers. Setting Departments of Ophthalmology, Taipei Medical University Hospital and Taipei City Hospital, Taipei, Taiwan. Methods The right eye of 221 subjects was measured with the Pentacam system. The radius of the best-fit sphere for the anterior corneal surface (r ant ) and posterior corneal surface (r post ), mean radius of simulated keratometry (r simK ), and central corneal thickness were obtained. The ratio of r ant to r post (AP ratio) and keratometric index were calculated in each eye. Results The means for r ant , r post , r simK , and AP ratio were 7.75 mm ± 0.28 (SD), 6.34 ± 0.28 mm, 7.75 ± 0.27 mm, and 1.223 ± 0.034 mm, respectively. These parameters were normally distributed. The mean calculated keratometric index (N cal ) was 1.3281 ± 0.0018. Using the keratometric indices of 1.3281 (N cal ), 1.3315 (Gullstrand schematic eye), and 1.3375 (conventional), the mean arithmetic and absolute estimation errors for the total corneal power were, 0.00 ± 0.24 diopter (D) and 0.17 ± 0.17 D, 0.43 ± 0.23 D and 0.45 ± 0.21 D, and 1.21 ± 0.24 D and 1.21 ± 0.24 D, respectively. The total corneal power was predicted to within ±0.50 D of the actual value in 95.0%, 60.2%, and 0.9% of eyes, respectively. The mean arithmetic and absolute estimation errors for the posterior corneal power using an AP ratio of 1.223 (this study) or 1.132 (Gullstrand schematic eye) were 0.00 ± 0.17 D and 0.13 ± 0.12 D and 0.47 ± 0.18 D and 0.47 ± 0.17 D, respectively. The posterior corneal power was estimated to within ±0.50 D of the actual value in 97.7% and 60.2% of eyes, respectively. Conclusion Using the Pentacam-derived keratometric index improved the prediction accuracies of total and posterior corneal powers.

We report 6 cases of indocyanine green (ICG)-related ocular toxicity after intravitreal ICG usage. Five cases had preoperative diagnosis of macular hole, 1 case had preoperative rhegmatogenous retinal detachment complicated with proliferative vitreoretinopathy. All cases received vitrectomy, ICG-assisted internal limiting membrane (ILM) peeling and air-fluid exchange. All eyes had residual ICG left at the end of surgery. Patients were followed up with indirect ophthalmoscopy, visual acuity, color fundus photography, fluorescein angiography, and ocular coherence tomography. Circular foveal retinal pigment epithelium atrophy larger than the area of macular hole and surrounding cuff was noted in 4 of 5 cases with preoperative macular hole. The other eye with preoperative diagnosis of macular hole had shallow anterior chamber and low intraocular pressure lasting for 1 week postoperatively. Diffuse retinal pigment epithelial atrophy was noted in the eye with preoperative proliferative vitreoretinopathy. Four eyes demonstrated optic atrophy postoperatively. Ocular toxicity caused by ICG may present as pigment epithelial atrophy, which is characteristically larger than the previous area of macular hole and surrounding cuff. Disc atrophy, retinal toxicity, and ocular hypotony were also observed in some cases. To prevent toxicity, residual ICG and ICG-stained ILM must be removed as completely as possible.

Background: To report an unusual case of multifocal choroidopathy with uveitis and cytomegalovirus (CMV) retinitis in a patient with acquired immunodeficiency syndrome (AIDS) after initially presenting with pulmonary tuberculosis (Mycobacterium kansasii). Case: Slit-lamp biomicroscopy and indirect ophthalmoscopic examination were done. Vitreous biopsy, pars plana vitrectomy, and retinal biopsy were performed. Computer tomography scan, magnetic resonance imaging and biopsy of the brain were also carried out. Observations: Multiple yellowish-white, round, slightly elevated subretinal pigment epithelium lesions were noted in areas devoid of the atrophic retina of previous CMV infection. Anterior uveitis and vitritis were also noted. Vitreous, retina, and brain biopsy did not offer any clue for diagnosis. The visual acuity improved later, along with recovered immunity under the anti-tuberculosis medications and the cocktail therapy for AIDS. Conclusions: Combined CMV retinitis and atypical tuberculosis chorioretinitis, although rare, can develop in the patients with AIDS. Systemic dissemination of atypical tuberculosis infection should be responsible for the choroidopathy in this patient.

Purpose: To investigate peptic ulcer disease and other possible risk factors in patients with central serous chorioretinopathy (CSR) using a population-based database. Methods: In this population-based retrospective cohort study, longitudinal data from the Taiwan National Health Insurance Research Database were analyzed. The study cohort comprised 835 patients with CSR and the control cohort comprised 4175 patients without CSR from January 2000 to December 2009. Conditional logistic regression was applied to examine the association of peptic ulcer disease and other possible risk factors for CSR, and stratified Cox regression models were applied to examine whether patients with CSR have an increased chance of peptic ulcer disease and hypertension development. Results: The identifiable risk factors for CSR included peptic ulcer disease (adjusted odd ratio: 1.39, P = 0.001) and higher monthly income (adjusted odd ratio: 1.30, P = 0.006). Patients with CSR also had a significantly higher chance of developing peptic ulcer disease after the diagnosis of CSR (adjusted odd ratio: 1.43, P = 0.009). Conclusion: Peptic ulcer disease and higher monthly income are independent risk factors for CSR. Whereas, patients with CSR also had increased risk for peptic ulcer development.

Previous epidemiologic studies that focused on the association between open-angle glaucoma (OAG) and dementia showed inconsistent results. In the present study, we explored the association between OAG and dementia in an ethnic Chinese (ie, Taiwanese) population using a population-based data set. We retrieved data on study subjects for this case-control study from the Longitudinal Health Insurance Database 2000. We identified 7770 patients who had a diagnosis of dementia as cases, and 7770 subjects matched in terms of sex and age, which were randomly extracted as controls. A conditional logistic regression conditioned on age group, sex, and index year was used to assess the association of dementia with previously diagnosed OAG among the sampled patients. Of 15 540 patients, 1.70% had prior OAG, including 2.02% of the dementia group and 1.38% of the controls. After adjusting for patient socioeconomic characteristics and comorbid medical disorders, dementia patients were more likely to have had prior OAG than controls (odds ratio (OR): 1.44; 95% confidence interval (CI): 1.12–1.85; P

To investigate the risk for Parkinson disease during a 3-year follow-up period after a diagnosis of neovascular age-related macular degeneration (AMD) using a nationwide population-based dataset in Taiwan.A retrospective matched-cohort study.We identified 877subjects with neovascular AMD as the study cohort and randomly selected 8770 subjects for a comparison cohort. Each subject was individually followed for a 3-year period to identify those who subsequently developed Parkinson disease. Stratified Cox proportional hazard regressions were performed as a means of comparing the 3-year risk of subsequent Parkinson disease between the study and comparison cohorts.The incidence rate of Parkinson disease was 5.32 (95% confidence interval [CI]: 3.03-8.72) per 1000 person-years in patients with neovascular AMD and 2.09 (95% CI: 1.59-2.70) per 1000 person-years in comparison patients. The log-rank test indicated that subjects with neovascular AMD had a significantly lower 3-year Parkinson disease-free survival rate than comparison subjects (P.001). After censoring cases in which patients died during the follow-up period and adjusting for monthly income, geographic region, hypertension, diabetes, hyperlipidemia, and coronary heart disease, the hazard ratio of Parkinson disease during the 3-year follow-up period for subjects with neovascular AMD was 2.57 (95% CI: 1.42-4.64) that of comparison subjects.In this study, subjects with neovascular AMD were found to be at a significant risk of Parkinson disease during a 3-year follow-up period after their diagnosis among Taiwanese Chinese. Further study is needed to confirm our findings and explore the underlying pathomechanism.

Metastasis is the most life-threatening complication in all cancers. The chemokine receptor 4 (CXCR4) is expressed at high levels in many breast-cancer tumors and may modulate metastasis. We compared the time-to-metastasis and the sites of metastasis between breast-cancer tumors expressing CXCR4 at high or low levels. We enrolled 191 early breast cancer patients in our study. The expression of CXCR4 was evaluated using immunohistochemical staining, and the patients were divided into low-level (CXCR4−) and high-level (CXCR4+) CXCR4 expression groups. Associations between the patients’ level of CXCR4 expression and their basic clinical characteristics, time-to-metastasis, and metastatic sites were examined using a Cox proportional-hazards regression model. A total of 107 CXCR4+ patients (56 %) were identified. No statistical differences were evident in basic characteristics between the CXCR4+ and CXCR4− groups. The CXCR4+ group had a higher incidence of distant metastasis during the first year (10.3 % versus 1.1 %, P = 0.009) and shorter event-free survival (17.43 months versus 27.5 months, P = 0.026) than those of the CXCR4− group. The CXCR4+ group also had a higher incidence of bone metastasis (P = 0.008) than the CXCR4− group. No significant difference in metastasis sites in other organs was observed between the two groups. A high level of CXCR4 expression in breast cancer is associated with early distant and bone metastases. The CXCR4+ phenotype may be a useful predictor for the prevention of early treatment failure and bone metastasis in breast cancer patients. This retrospective study shows that a high expression of CXCR4 in breast cancer is associated with earlier distant metastasis and bone metastasis in breast cancer.

Previous studies had reported an increased prevalence of glaucoma in patients with obstructive sleep apnea (OSA). However, the risk of open-angle glaucoma (OAG) among patients with OSA remains unclear. Using a nationwide, population-based dataset in Taiwan, this study aimed to examine the prevalence and risk of OAG among patients with OSA during a 5-year follow-up period after a diagnosis of OSA.A retrospective, matched-cohort study.This study used data sourced from the Longitudinal Health Insurance Database 2000. We included 1012 subjects with OSA in the study cohort and randomly selected 6072 subjects in the comparison group.Each subject in this study was individually traced for a 5-year period to identify those subjects who subsequently received a diagnosis of OAG. Cox proportional hazards regression was performed to calculate the 5-year risk of OAG between the study and comparison cohorts.The incidence and risk of OAG between the study and comparison groups.During the 5-year follow-up period, the incidence rate per 1000 person-years was 11.26 (95% confidence interval [CI], 8.61-14.49) and 6.76 (95% CI, 5.80-7.83) for subjects with and without OSA, respectively. After adjusting for monthly income, geographic region, diabetes, hypertension, coronary heart disease, obesity, hyperlipidemia, renal disease, hypothyroidism, and the number of outpatient visits for ophthalmologic care during the follow-up period, stratified Cox proportional hazards regression revealed that the hazard ratio for OAG within the 5-year period for subjects with OSA was 1.67 (95% CI, 1.30-2.17; P0.001) that of comparison subjects.Our results suggest that OSA is associated with an increased risk of subsequent OAG diagnosis during a 5-year follow-up period.The authors have no proprietary or commercial interest in any of the materials discussed in this article.

Open-angle glaucoma (OAG) is associated with systemic metabolic and cardiovascular disorders, and both share common risk factors with erectile dysfunction (ED). However, few studies have investigated the association of ED with OAG. This study aimed to estimate the association of ED with prior OAG by using a nationwide, population-based data with a retrospective case-control cohort design in Taiwan.Age-matched case-control study.We identified 4605 patients with ED as the cases and randomly selected 23 025 subjects as the controls (5 controls to 1 case).We used conditional logistic regression analysis to estimate the odds ratio and 95% confidence interval of having previously been diagnosed with OAG according to the presence/absence of ED after adjusting for patient's monthly income, geographical location, hypertension, diabetes, coronary heart disease, hyperlipidemia, obesity, and alcohol abuse.We identified OAG cases not only based on an International Classification of Diseases, Ninth Revision, Clinical Modification code, but also by the prescription of topical antiglaucoma medication.In total, prior OAG was found among 137 subjects (0.5 %); 53 individuals (1.1% of the ED patients) from the cases and 84 individuals (0.4% of patients without ED) from the controls. Conditional logistic regression analysis demonstrated that, after adjusting for potential confounders, patients with ED were more likely to have prior OAG than controls (odds ratio, 2.85; 95% confidence interval, 2.10-4.07).This study identifies a novel association between ED and prior OAG.

Background Taurine has chemical structure similar to an inhibitory neurotransmitter, γ-aminobutyric acid (GABA). Previous studies on GABA in the stomach suggest GABAergic neuron is involved in acid secretion, but the effects of taurine are poor understood. Methods The effects of taurine on acid secretion, signal transduction, and localization of taurinergic neurons were determined in the rat stomach using everted whole stomach, RIA kit and immunohistochemical methods. Results We used antibodies against taurine-synthesizing enzyme, cysteine sulfuric acid decarboxylase (CSAD), and taurine. CSAD- and taurine-positive cells were found in the muscle and mucosal layers. Distributions of CSAD- and taurine-positive cells in both mucosal and muscle layers were heterogeneous in the stomach. Taurine at 10-9~10-4 M induced acid secretion, and the maximum secretion was at 10-5 M, 1.6-fold higher than the spontaneous secretion. Taurine-induced acid secretion was completely inhibited by bicuculline and atropine but not by cimetidine, proglumide, or strychnine. Atropine and tetrodotoxin (TTX) completely inhibited the acid secretion induced by low concentrations of taurine and partially inhibited induced by high concentrations. Verapamil, a calcium blocker agent, inhibited acid output elicited by taurine. We assumed all Ca2+ channels involved in the response to these secretagogues were equally affected by verapamil. Intracellular cAMP (adenosine 3', 5'-monophosphat) in the stomach significantly increased with taurine treatment in a dose-dependent manner. High correlation (r=0.859, p < 0.001) of taurine concentrations with cAMP was observed. Conclusions Our results demonstrated for the first time in taurine-induced acid secretion due to increase intracellular calcium may act through the A type of GABA receptors, which are mainly located on cholinergic neurons though cAMP pathway and partially on nonneuronal cells in the rat stomach.

Purpose Herpes zoster has been associated with immune suppression, as has an increased risk of cancer. This population-based follow-up study aimed to investigate the risk of a subsequent cancer diagnosis after herpes zoster ophthalmicus (HZO). Design A retrospective cohort study. Participants and Controls Retrospective claims data from the Taiwan National Health Insurance Research Database were analyzed. The study cohort comprised all patients with a diagnosis of HZO (International Classification of Diseases, 9th Revision, Clinical Modification code 053.2) in 2003 and 2004 (n=658). The comparison cohort consisted of randomly selected ambulatory care patients, 8 for every patient with HZO (n=5264) matched with the study group on age, gender, monthly income, and urbanization level of the patient's residence. Methods The Kaplan–Meier method was used to compute 1-year cancer-free survival rate. Stratified Cox proportional hazard regressions were carried out to compute the adjusted 1-year cancer-free survival rate after adjusting for potential confounding factors. Main Outcome Measures Subsequent claims for all study and comparison patients were captured over a 1-year follow-up period from their index ambulatory care visit to identify whether the patient received a cancer diagnosis during the follow-up period. Results During 1-year follow-up, cancer was diagnosed in 4.86% of patients with HZO and 0.53% of patients in the comparison cohort. Patients with HZO had significantly lower 1-year cancer-free survival rates than the comparison cohort. After adjusting for patient age, gender, monthly income, and urbanization level, patients with HZO were found to have a 9.25-fold (95% confidence interval, 5.51–15.55) risk of a subsequent cancer diagnosis than the matched comparison cohort. No significant differences in cancer type were observed between the 2 cohorts. Conclusions Herpes zoster ophthalmicus may be a marker of increased risk of being diagnosed with cancer in the following year. Financial Disclosure(s) The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Objective: To investigate the risk of stroke development following a diagnosis of herpes zoster ophthalmicus (HZO). Methods: Data were retrospectively collected from the Taiwan National Health Insurance Research Database. The study cohort comprised all patients with a diagnosis of HZO (ICD-9-CM code 053.2) in 2003 and 2004 (n = 658). The comparison cohort was comprised of randomly selected patients (3 for every HZO patient, n = 1974) matched with the study group in terms of age and gender. Patients were tracked from their index visits for 1 year. The Kaplan-Meier method was utilized to compute the 1-year stroke-free survival rate. Cox proportional hazard regressions were carried out to compute the adjusted 1-year stroke-free survival rate after adjusting for possible confounding factors. Results: Stroke developed in 8.1% of patients with HZO and 1.7% of patients in the comparison cohort during the 1-year follow-up period. HZO patients had significantly lower 1-year stroke-free survival rates than patients in the comparison cohort. After adjusting for patients9 demographic characteristics, selected comorbidities, and medication habits, HZO patients were found to have a 4.52-fold (95% confidence interval 2.45–8.33) higher risk of stroke than the matched comparison cohort. There was no significant difference in the rate of stroke development between patients who had received systemic antiviral treatment and those who had not. Conclusions: Herpes zoster ophthalmicus may represent a marker of increased risk of stroke development during the 1-year follow-up period.

Purpose: To evaluate the accuracy of corneal surgically induced astigmatism (SIA) estimation when neglecting the posterior corneal surface measurement. Methods: Fifty right eyes undergoing phacoemulsification were measured with a rotating Scheimpflug camera (Pentacam; Oculus Inc., Wetzlar, Germany) both before and after surgery. Clear corneal incisions with one suture were used in the phacoemulsification surgery. The keratometric corneal SIA (KSIA) was derived using the anterior corneal surface measurement and the keratometric index (1.3375) while neglecting the posterior corneal surface measurement. The Pentacam-derived total corneal SIA (PSIA) was derived by vergence tracing and polar value analysis [KP(135) and KP(180)] of the measurements on both corneal surfaces. Results: The mean arithmetic estimation errors of the KSIA for the PSIA were 0.16 ± 0.32 (−0.52 to 1.14) D for the KP(135), and −0.02 ± 0.30 (−0.75 to 1.29) D for the KP(180). There was a significant difference between the KP(135) components of the KSIA and PSIA. Bivariate analysis revealed a statistically significant difference between the combined means of the KSIA and PSIA. Overall, 24% had either a KP(135) component of the KSIA that differed by > 0.50 D from that of the PSIA or a KP(180) component of the KSIA that differed by > 0.50 D from that of the PSIA. The blurring strength caused by neglecting the posterior corneal measurement was > 0.50 D in 24% of eyes. Conclusion: Neglecting the posterior corneal surface measurement may lead to significant deviation in the corneal SIA estimation after phacoemulsification in a proportion of eyes.

Background and Purpose— Varicella zoster virus-induced vasculopathy and postherpes zoster attack stroke syndromes have been reported previously; nevertheless, data regarding the exact prevalence and risk of stroke occurring postherpes zoster attack are still lacking. This study aims to investigate the frequency and risk of stroke after a herpes zoster attack using a nationwide, population-based study of a retrospective cohort design. Method— A total of 7760 patients who had received treatment for herpes zoster between 1997 and 2001 were included and matched with 23 280 randomly selected subjects. A 1-year stroke-free survival rate was then estimated using the Kaplan-Meier method. After adjusting for potential confounders, Cox proportional hazard regressions were carried out to compute the adjusted 1-year survival rate. Results— Of the sampled patients, 439 patients (1.41%) developed strokes within the 1-year follow-up period, that is, 133 individuals (1.71% of the patients with herpes zoster) from the study cohort and 306 individuals (1.31% of patients in the comparison cohort) from the comparison cohort. The log rank test indicated that patients with herpes zoster had significantly lower 1-year stroke-free survival rates than the control ( P Conclusion— The risk for stroke increased after a zoster attack. Although varicella zoster virus vasculopathy is a well-documented complication that may induce a stroke postherpes zoster attack, it does not fully account for the unexpectedly high risk of stroke in these patients.

Most marketed artificial tears are substitutes for the aqueous layers of the tear film; therefore, frequent instillation of artificial tears is necessary. Newer gel-, cellulose-, and mineral oil-based formulations have been designed to overcome the disadvantages of current aqueous tear substitutes by offering prolonged retention times.The aim of this study was to compare the efficacy, safety, and local tolerance of artificial tears containing carbomer-based lipids or hydroxypropyl (HP)-guar gel in patients with dry eye syndrome.A 4-week, prospective, randomized, parallel-group, comparative, noninferiority study was conducted at the Taipei Medical University Hospital (Taipei, Taiwan) in patients with dry eye syndrome who were randomly assigned to 1 of 2 treatment groups: the carbomer-based lipid-containing (CBLC) gel group and the HP-guar gel group. The primary end point was global assessment of study treatment by the patients at weeks 2 and 4. All patients met the diagnostic criteria of impaired tear function and ocular surface abnormalities. Outcomes measured at baseline and 2 and 4 weeks included Schirmer's test values, tear breakup time (TBUT), and a patient subjective assessment of symptoms. Safety and tolerability were assessed by clinically significant changes in terms of incidence of adverse events and conducted by unmasked investigators.A total of 30 Taiwanese patients with dry eye syndrome were included and randomly assigned to the 2 treatment groups: the mean (SD) age was 40.37 (14.96) years in the CBLC gel group and 49.49 (12.20) years in the HP-guar gel group. At baseline, the mean (SD) Schirmer's test value was 4.53 (2.28) mm in the right eye and 5.13 (2.42) mm in the left eye in the CBLC gel group; 4.40 (2.16) mm in the right eye and 4.20 (1.78) mm in the left eye for the HP-guar gel group. The mean (SD) for both eyes was 4.83 (2.36) mm in the CBLC gel group and 4.30 (2.08) mm in the HP-guar gel group. There was no statistically significant difference between Schirmer's scores at baseline. Patients in both treatment groups experienced an improvement from baseline in symptoms and signs, Schirmer's test value, and TBUT at 2 and 4 weeks after treatment. The Schirmer's test score increased to a mean of 8.20 (4.49) mm in the right eye and 9.33 (4.94) mm in the left eye in the CBLC gel group after 2 weeks, and increased to 10.07 (5.56) mm in the right eye and 10.86 (5.58) mm in the left eye after 4 weeks. The increases in Schirmer's test score and TBUT were also observed in the HP-guar gel group. The Schirmer's test score increased to 5.13 (2.18) mm in the right eye and 5.60 (2.74) mm in the left eye after 2 weeks, and increased to 6.93 (3.37) mm in the right eye and 6.53 (3.16) mm in the left eye after 4 weeks. The increase in Schirmer's test values in both eyes was significantly greater at 2 and 4 weeks in the CBLC gel group than that in the HP-guar gel artificial tear group (all, P0.05). Subjective patient assessment was better with the CBLC group (excellent and good reported by 26.6% and 73.4%, respectively, of the CBLC gel group vs 13.4% and 33.4% of the HP-guar gel group at 4 weeks; both, P = 0.004).Both artificial tear formulations were effective in relieving dry eye syndrome in these patients. The tolerance of CBLC gel artificial tears was comparable to that of HP-guar gel artificial tears.

To investigate the risk of open-angle glaucoma (OAG) after a diagnosis of hypothyroidism.A retrospective, population-based follow-up study using an administrative database.The study group comprised 257 hypothyroidism patients. The comparison group included 2056 subjects.Data were retrospectively collected from the Taiwan Longitudinal Health Insurance Database. The study cohort comprised patients aged ≥ 60 who received a first diagnosis of hypothyroidism (International Classification of Diseases, Ninth Revision, Clinical Modification code 244.9) from 1997 to 2001 (n = 257). The comparison cohort consisted of randomly selected patients without hypothyroidism who were aged ≥ 60 and had no diagnosis of glaucoma before 2001 (8 for every OAG patient; n = 2056). Each sampled patient was tracked for 5 years from their index visit. Cox proportional hazard regressions were used to compute the 5-year OAG-free survival rate, after adjusting for possible confounding factors.The risk of developing OAG during the 5-year follow-up period.Open-angle glaucoma developed in 7.4% of patients with hypothyroidism and 3.8% of patients in the comparison cohort during the follow-up period. Hypothyroid patients had a significantly lower 5-year OAG-free survival rate than patients in the comparison cohort. After adjusting for patients' age, gender, monthly income, urbanization level, and comorbid medical disorders, hypothyroidism patients were found to have a 1.78-fold (95% confidence interval [CI], 1.04-3.06) greater risk of developing OAG than the comparison cohort. This association remained significant in untreated hypothyroidism patients (adjusted hazard ratio [HR], 2.37; 95% CI, 1.10-5.09) and became statistically nonsignificant in patients treated with levothyroxine (adjusted HR, 1.73; 95% CI, 0.89-3.38).Hypothyroid patients had a significantly increased risk of OAG development during the 5-year follow-up period. Levothyroxine seemed to be protective.

To determine the prevalence of selected comorbidities in patients with open-angle glaucoma (OAG) and whether these comorbidities are more prevalent among individuals with OAG than those without OAG.A retrospective, nationwide, case-control study using an administrative database.The study group comprised 76,673 OAG patients. The comparison group comprised 230,019 subjects matched to the study cohort.Data were collected retrospectively from the Taiwan National Health Insurance Research Database. The study cohort comprised all patients with a diagnosis of OAG (International Classification of Diseases, 9th Revision, Clinical Modification codes 365.1-365.11) in 2005 (n = 76,673). The comparison cohort comprised randomly selected patients (3 for every 1 OAG patient; n = 230,019) matched with the study group in terms of age, gender, urbanization level, and monthly income. In total, 31 medical comorbidities were selected based mainly on the Elixhauser Comorbidity Index. Separate conditional logistic regression analyses were used to estimate the adjusted odds ratio for each of the medical comorbidities between patients with and without OAG.The prevalences of selected comorbidities.More than half (50.5%) of the OAG patients had hypertension, and more than 30% had hyperlipidemia or diabetes (30.5% and 30.2%, respectively). The prevalences of 28 of 31 comorbidities were significantly higher for OAG patients than subjects without glaucoma after adjusting for age, gender, urbanization level, and monthly income. The adjusted odds ratio was more than 1.50 for hypertension, hyperlipidemia, systemic lupus erythematosus, diabetes, hypothyroidism, fluid and electrolyte disorders, depression, and psychosis. Among the studied comorbidities, the prevalence difference of the OAG group minus the control group was 3% or higher for hypertension, hyperlipidemia, stroke, diabetes, liver disease, and peptic ulcer.Open-angle glaucoma patients are significantly more likely to have comorbidities, many of which can be life threatening or can affect the quality of life appreciably.The author(s) have no proprietary or commercial interest in any materials discussedin this article

Background and Purpose— Although open-angle glaucoma (OAG) is associated with some of the risk factors of stroke development, there is still no published study addressing whether OAG increases the risk of stroke development. We investigated the risk of stroke development after a diagnosis of OAG. Methods— Data were retrospectively collected from the Taiwan National Health Insurance Research Database, which is comprised of 1 073 891 random subjects from among Taiwan’s 23 million residents. The study cohort comprised all patients with a diagnosis of OAG (International Classification of Diseases, 9th Revision, Clinical Modification code 365.1 to 365.11) in 2001 (n=4032). The comparison cohort was comprised of randomly selected patients (5 for every patient with OAG, n=20 160) matched with the study group in terms of age, gender, geographic location, and comorbid medical disorders. Patients were tracked from their index visits for 5 years. Cox proportional hazard regression was used to compute the 5-year stroke-free survival rate after adjusting for possible confounding factors. Results— Stroke developed in 14.9% of patients with OAG and 9.5% of patients in the comparison cohort during the 5-year follow-up period. Patients with OAG had significantly lower 5-year stroke-free survival rates than patients in the comparison cohort. After adjusting for patients’ demographic characteristics and selected comorbidities, patients with OAG were found to have a 1.52-fold (95% CI, 1.40 to 1.72) higher risk of having a stroke than the matched comparison cohort. Conclusions— Patients with OAG demonstrated a significantly increased risk of stroke development during the 5-year follow-up period.

The aim was to study the association of surgeon age with operative outcomes for primary rhegmatogenous retinal detachment (RRD) in Taiwan. A total of 7427 adult patients of primary RRD who were treated by 284 ophthalmologists with scleral buckling (SB), pars plana vitrectomy (PPV), or their combination from 2002 to 2004 were identified in the Taiwan National Health Insurance Research Database. The adjusted odds ratios (OR) of 180-day readmission between ophthalmologist age groups were calculated. For SB, patients treated by ophthalmologists aged ⩾51 years had a greater 180-day readmission rate (OR=1.44, 95% confidence interval (CI)=1.01–2.07, P

Purpose To evaluate the accuracy of corneal astigmatism estimation by neglecting the posterior corneal surface measurement. Design Prospective, observational study. Methods The right eyes of 493 subjects were measured with a rotating Scheimpflug camera (Pentacam; Oculus, Wetzlar, Germany). The keratometric corneal astigmatism (KA) was obtained by using the anterior corneal surface measurement and the keratometric index (1.3375) while neglecting the posterior corneal surface measurement. The Pentacam-derived total corneal astigmatism (PA) was derived by doubled-angle vector analysis of the astigmatisms on both corneal surfaces. Results The mean arithmetic and absolute estimation errors of the KA magnitude for the PA magnitude were −0.06 ± 0.28 diopters (D) (range, −0.59 to 0.91 D) and 0.24 ± 0.16 D (range, 0 to 0.91 D), respectively. The mean arithmetic and absolute estimation errors of the KA angle for the PA angle were −0.6 degrees ± 12.7 degrees (range, −69.9 degrees to 83.4 degrees) and 7.4 degrees ± 10.3 degrees (range, 0 degrees to 83.4 degrees), respectively. Among all eyes, 142 eyes (28.8%) had either a KA magnitude that differed by > 0.50 D from the PA magnitude or a KA angle that differed by > 10 degrees from the PA angle. For the 282 eyes with a KA magnitude exceeding 1.0 D (that are candidates for intraoperative correction of a preexisting astigmatism during cataract surgery), 29 eyes (10.3%) had either a KA magnitude that differed by > 0.50 D from the PA magnitude or a KA angle that differed by > 10 degrees from the PA angle. Conclusions Neglecting the posterior corneal surface measurement may lead to significant deviation in the corneal astigmatism estimation in a proportion of eyes.

Purpose To describe a no-history method of estimating the effective lens position (ELP) for double-K intraocular lens (IOL) power calculation in eyes that had previous refractive surgery. Setting Departments of Ophthalmology, Taipei Medical University Hospital and Taipei City Hospital, Taipei, Taiwan. Methods The corneal height (H m ) and anterior chamber diameter (AG m ) in 106 unoperated eyes were measured using a rotating Scheimpflug camera. The theoretical anterior corneal radius (R rt ) was then derived from H m and AG m by regression and rearrangement of the Fyodorov equation. The ELP estimate was then calculated from R rt . The performance of this ELP estimation method in double-K IOL power calculation and the performance of other methods were compared retrospectively in 11 eyes having cataract surgery that had previous refractive surgery. The refractive results 9 to 12 weeks after cataract surgery were selected for data analysis. Results The new ELP estimation method, combined with the BESSt formula or the Savini et al. method for estimating post refractive–surgery corneal power (K post ) in the double-K SRK/T formula, provided the best IOL power prediction results. The mean arithmetic and absolute IOL prediction errors were −0.05 ± 0.62 diopters (D) and 0.49 ± 0.34 D, respectively, when combined with the BESSt formula and 0.03 ± 0.73 D and 0.60 ± 0.36 D, respectively, when combined with the Savini et al. method. With either combination, all 11 eyes were within ±1.00 D of the refractive prediction error. Conclusion This ELP estimation method may be helpful for IOL power calculation in post refractive–surgery eyes when historical data are unavailable.