Population seroprevalence of antibody to influenza A(H7N9) virus, Guangzhou, China

BACKGROUND: Since the identification in early 2013 of severe disease caused by influenza A(H7N9) virus infection, there have been few attempts to characterize the full severity profile of human infections. Our objective was to estimate the number and severity of H7N9 infections in Guangzhou, using a serological study. METHODS: We collected residual sera from patients of all ages admitted to a hospital in the city of Guangzhou in southern China in 2013 and 2014. We screened the sera using a haemagglutination inhibition assay against a pseudovirus containing the H7 and N9 of A/Anhui/1/2013(H7N9), and samples with a screening titer ≥10 were further tested by standard hemagglutination-inhibition and virus neutralization assays for influenza A(H7N9). We used a statistical model to interpret the information on antibody titers in the residual sera, assuming that the residual sera provided a representative picture of A(H7N9) infections in the general population, accounting for potential cross-reactions. RESULTS: We collected a total of 5360 residual sera from December 2013 to April 2014 and from October 2014 to December 2014, and found two specimens that tested positive for H7N9 antibody at haemagglutination inhibition titer ≥40 and a neutralization titer ≥40. Based on this, we estimated that 64,000 (95 % credibility interval: 7300, 190,000) human infections with influenza A(H7N9) virus occurred in Guangzhou in early 2014, with an infection-fatality risk of 3.6 deaths (95 % credibility interval: 0.47, 15) per 10,000 infections. CONCLUSIONS: Our study suggested that the number of influenza A(H7N9) virus infections in Guangzhou substantially exceeded the number of laboratory-confirmed cases there, albeit with considerable imprecision. Our study was limited by the small number of positive specimens identified, and larger serologic studies would be valuable. Our analytic framework would be useful if larger serologic studies are done.published_or_final_versio

Effect of latanoprost on IOP

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Immediate diode laser peripheral iridoplasty as treatment of acute attack of primary angle closure glaucoma: A preliminary study

Purpose: To study the efficacy and safety of diode laser peripheral iridoplasty as a first-line treatment of acute primary angle-closure glaucoma (PACG) without the use of systemic anti-glaucoma medications. Patients and Methods: Nine consecutive patients with acute PACG were recruited into the study. Each patient received topical pilocarpine (4%), timolol (0.5%), apraclonidine (1%), and immediate diode laser peripheral iridoplasty as primary treatment. The intraocular pressures (IOPs) 15, 30, and 60 minutes after diode laser peripheral iridoplasty were documented by Goldmann applanation tonometry. Results: The mean IOP of this group of patients was reduced from 66.3 ± 9.7 mm Hg, before diode laser peripheral iridoplasty, to 36.6 ± 16.4 mm Hg at 15 minutes, 26.3 ± 12.6 mm Hg at 30 minutes, and 18.9 ± 8.4 mm Hg at 60 minutes after diode laser peripheral iridoplasty. In seven of the nine patients, the corneal edema cleared up 1 hour after diode laser peripheral iridoplasty. In the remaining patient, the cornea cleared up 12 hours after diode laser peripheral iridoplasty. No significant complications were encountered. Conclusion: Diode laser peripheral iridoplasty, together with topical antiglaucoma medications without adjunctive systemic carbonic anhydrase inhibitors and hyperosmotic agents, appeared to be effective and safe in controlling the IOP in acute PACG.link_to_subscribed_fulltex

Five-year follow up of selective laser trabeculoplasty in Chinese eyes

Purpose: To study the effectiveness and safety of selective laser trabeculoplasty (SLT) on primary open-angle glaucoma and ocular hypertension in Chinese eyes. Methods: This was a prospective randomized controlled clinical study in which 58 eyes of 29 patients with primary open-angle glaucoma or ocular hypertension were included. One eye of each patient was randomized to receive SLT (Group 1) and the fellow eyes received medical treatment (Group 2). Patients were evaluated after laser treatment at 2 h, 1 day, 1 week, 2 weeks, 1 month, 3 months, 6 months, and then yearly. Results: All patients (13 male, 16 female) were Chinese. The mean age was 51.9 ± 14.7 years. The mean baseline intraocular pressure was 26.8 ± 5.6 mmHg in group 1 and 26.2 ± 4.2 mmHg in group 2 (P = 0.62). The failure rate, defined as intraocular pressure >21 mmHg with maximal medications, was 17.2% in group 1 and 27.6% in group 2 at 5-year follow-up (P = 0.53). Fight eyes (27.6%) in group 1 required medications to control the intraocular pressure to below 21 mmHg. There was no statistically significant difference in the intraocular pressure reductions between the two groups at all time intervals (P > 0.05). The mean number of antiglaucoma medications was significantly lower in the SLT than the medical treatment group up to 5 years of follow up (P 5 mmHg was observed in three eyes (10.3%). Conclusion: With fewer medications, SLT gives similar intraocular pressure reduction to medical therapy alone in Chinese patients with primary open-angle glaucoma or ocular hypertension.link_to_subscribed_fulltex

Latanoprost versus timolol gel to prevent ocular hypertension after phacoemulsification and intraocular lens implantation

Purpose: To evaluate the efficacy of latanoprost and timolol gel in preventing ocular hypertension in the early period after phacoemulsification and posterior chamber intraocular lens (PC IOL) implantation. Setting: Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong, China. Methods: This prospective randomized double-masked clinical trial comprised patients with uncomplicated cataract having phacoemulsification with PC IOL implantation. They were randomly assigned to 1 of 3 groups: postoperative application of timolol 0.5% gel-forming solution (Timoptol-XE®) (Group 1), latanoprost 0.005% (Group 2), and control (Group 3). Intraocular pressure (IOP) was measured 2, 4, and 24 hours postoperatively. The anterior chamber was examined for the levels of cells and flare using slitlamp biomicroscopy. Results: Group 1 had a significantly greater reduction in mean IOP 2, 4, and 24 hours after phacoemulsification and PC IOL implantation than Group 3 (P .05). No excessive postoperative anterior chamber inflammation was observed in any group. Conclusions: A single dose of latanoprost given after phacoemulsification and PC IOL implantation did not produce a significant IOP-lowering effect when compared with a control group in the first 24 hours postoperatively. A single dose of timolol gel produced a significant postoperative IOP decrease as soon as 2 hours and up to 24 hours after surgery. Timolol gel and latanoprost are safe, but timolol is more effective than latanoprost in preventing postoperative ocular hypertension. (C) 2000 ASCRS and ESCRS.link_to_subscribed_fulltex

Efficacy and safety of inferior 180° goniosynechialysis followed by diode laser peripheral iridoplasty in the treatment of chronic angle-closure glaucoma

Purpose: To report the efficacy and safety of inferior 180° goniosynechialysis followed by diode laser peripheral iridoplasty in the treatment of chronic angle-closure glaucoma with total synechial angle closure. Methods: Five patients with chronic angle-closure glaucoma and total synechial angle closure whose intraocular pressures were higher than 21 mm Hg while taking maximally tolerated medications underwent goniosynechialysis followed by diode laser peripheral iridoplasty to the inferior half of the angle. Intraoperative complications, postoperative visual acuity, intraocular pressures, and complications were evaluated. Results: Five eyes of five patients received the operation and the mean follow-up was 7.6 months (range, 6-12 months). The mean preoperative intraocular pressure was 33.8 ± 5.8 mm Hg. The mean postoperative intraocular pressure at most recent follow-up was 15.8 ± 2.2 mm Hg. Postoperative complications included transient increase in intraocular pressure, hyphema, and cataract. The success rate (intraocular pressure less than 20 mm Hg with or without medication) was 80.0%. Conclusion: It appears that 180° goniosynechialysis followed by diode laser peripheral iridoplasty is an effective and safe surgical procedure for treating chronic angle-closure glaucoma with total synechial angle closure.link_to_subscribed_fulltex

Efficacy and safety of immediate anterior chamber paracentesis in the treatment of acute primary angle-closure glaucoma: A pilot study

Objective: To study the safety and effectiveness of immediate anterior chamber paracentesis, combined with antiglaucomatous medications, in the intraocular pressure control and relief of symptoms of acute primary angle-closure glaucoma (PACG). Design: Prospective noncomparative case series. Participants: Eight consecutive patients with their first attack of acute PACG, with intraocular pressure ≥50 mmHg, were recruited into the study. Intervention: On presentation, each patient received topical pilocarpine (4%) and timolol (0.5%), immediate anterior chamber paracentesis, and systemic acetazolamide and mannitol as primary treatment. The intraocular pressures at 15 and 30 minutes, and then at 1, 2, 3, 12, and 24 hours, were documented by applanation tonometry. Main Outcome Measures: Symptoms, visual acuity, intraocular pressure, corneal edema, angle status on gonioscopy, pupillary size, and reaction. Results: Ten eyes of eight patients seen with acute PACG were recruited. The mean intraocular pressure was reduced from 66.6 ± 9.1 mmHg to 15.1 ± 3.5 mmHg immediately after paracentesis, and then to 17.1 ± 7.0 mmHg at 15 minutes, 21.7 ± 10.2 mmHg at 30 minutes, 22.7 ± 11.0 mmHg at 1 hour, and 20.1 ± 14.6 mmHg at 2 hours after paracentesis. The mean intraocular pressure was less than 21 mmHg at 2 hours and beyond. There was instant symptomatic relief for all patients. No complications from the paracentesis were encountered. Conclusions: From this preliminary study, immediate paracentesis seems to be safe and effective in controlling the intraocular pressure and eliminating symptoms in acute PACG. © 2002 by the American Academy of Ophthalmology.link_to_subscribed_fulltex

Paracentesis for angle closure glaucoma

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Argon laser peripheral iridoplasty versus conventional systemic medical therapy in treatment of acute primary angle-closure glaucoma: A prospective, randomized, controlled trial

Objective: To study whether argon laser peripheral iridoplasty (ALPI) is as effective and safe as conventional systemic medications in treatment of acute primary angle-closure glaucoma (PACG) when immediate laser peripheral iridotomy is neither possible nor safe. Design: Prospective, randomized, controlled trial. Participants: Seventy-three eyes of 64 consecutive patients with their first presentation of acute PACG, with intraocular pressure (IOP) levels of 40 mmHg or more, were recruited into the study. Intervention: The acute PACG eye of each consenting patient received topical pilocarpine (4%) and topical timolol (0.5%). The patients were then randomized into one of two treatment groups. The ALPI group received immediate ALPI under topical anesthesia. The medical treatment group was given 500 mg of intravenous acetazolamide, followed by oral acetazolamide 250 mg four times daily, and an oral potassium supplement until IOP levels normalized. Intravenous mannitol also was administered to the latter group if the presenting IOP was higher than 60 mmHg. The acute PACG eye of both groups continued to receive topical pilocarpine (1 %) until peripheral iridotomy could be performed. Main Outcome Measures: Intraocular pressure profile, corneal clarity, symptoms, visual acuity, angle status by indentation gonioscopy, and complications of treatment. Results: Thirty-three acute PACG eyes of 32 patients were randomized to receive immediate ALPI, whereas 40 acute PACG eyes of 32 patients had conventional systemic medical therapy. Both treatment groups were matched for age, duration of attack, and IOP at presentation. The ALPI-treated group had lower IOP levels than the medically treated group at 15 minutes, 30 minutes, and 1 hour after the start of treatment. The differences were statistically significant. The difference in IOP levels became statistically insignificant from 2 hours onward. The duration of attack did not affect the efficacy of ALPI in reducing IOP in acute PACG. No serious laser complications occurred, at least in the early postlaser period. Conclusions: Argon laser peripheral iridoplasty significantly is more effective than conventional systemic medications in reducing IOP levels in acute PACG in eyes not suitable for immediate laser peripheral iridotomy within the first 2 hours from the initiation of treatment. Argon laser peripheral iridoplasty is a safe and more effective alternative to conventional systemic medications in the management of acute PACG not amenable to immediate laser peripheral iridotomy. © 2002 by the American Academy of Ophthalmology.link_to_subscribed_fulltex