Central Macular Thickness in Children with Myopia, Emmetropia, and Hyperopia: An Optical Coherence Tomography Study

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Retinal Nerve Fiber Layer Thickness in Myopic, Emmetropic, and Hyperopic Children

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Incidence and Risk Factors for Retinopathy of Prematurity in Multiple Gestations: a Chinese population study

To determine the incidence and risk factors of retinopathy of prematurity (ROP) among new-born Chinese infants of multiple gestations. A retrospective review of medical records was performed for all neonates of multiple gestations screened for ROP between January 2007 and December 2012 in 2 neonatal intensive care units in Hong Kong. Screening was offered to very low birth weight (VLBW; ≤1500g) and/or preterm (gestation ≤32 weeks) neonates using the Royal College of Ophthalmologists ROP guideline and the International Classification of ROP by 3 pediatric ophthalmologists. Maternal and neonatal covariates were analyzed using univariate and multivariate regression analyses for both ROP and Type 1 ROP. A total of 153 Chinese infants of multiple gestations were included in the study. The mean gestational age (GA) was 30.8±2.4 weeks and the mean birth weight (BW) was 1284.8±267.4g. The incidence of ROP and Type 1 ROP was 11.8% and 3.9%, respectively. On univariate analysis, younger GA, lighter birth weight, postnatal hypotension, inotropes use, bronchopulmonary disease, and intraventricular hemorrhage were common independent risk factors for the development of ROP and Type 1 ROP (all P≤0.04). On multivariate analysis, younger GA, surfactant use, invasive mechanical ventilation, higher mean oxygen concentration, thrombocytopenia, intraventricular hemorrahage, total parental nutrition, and hypoglycemia were significant risk factors for ROP. For Type 1 ROP, there were no significant dependent risk factors. In preterm Chinese infants born from multiple gestations, prematurity, lighter weight, postnatal hypotension, inotropes use, bronchopulmonary dysplasia, and an intraventricular hemorrhage were common independent risk factors for the development of ROP and Type 1 ROP.published_or_final_versio

Differences in risk factors for retinopathy of prematurity development in paired twins: A Chinese population study

2014-2015 > Academic research: refereed > Publication in refereed journalVersion of RecordPublishe

Retinal microvascular parameters are not associated with reduced renal function in a study of individuals with type 2 diabetes

Abstract The eye provides an opportunistic “window” to view the microcirculation. There is published evidence of an association between retinal microvascular calibre and renal function measured by estimated glomerular filtration rate (eGFR) in individuals with diabetes mellitus. Beyond vascular calibre, few studies have considered other microvascular geometrical features. Here we report novel null findings for measures of vascular spread (vessel fractal dimension), tortuosity, and branching patterns and their relationship with renal function in type 2 diabetes over a mean of 3 years. We performed a nested case-control comparison of multiple retinal vascular parameters between individuals with type 2 diabetes and stable (non-progressors) versus declining (progressors) eGFR across two time points within a subset of 1072 participants from the GoDARTS study cohort. Retinal microvascular were measured using VAMPIRE 3.1 software. In unadjusted analyses and following adjustment for age, gender, systolic blood pressure, HbA1C, and diabetic retinopathy, no associations between baseline retinal vascular parameters and risk of eGFR progression were observed. Cross-sectional analysis of follow-up data showed a significant association between retinal arteriolar diameter and eGFR, but this was not maintained following adjustment. These findings are consistent with a lack of predictive capacity for progressive loss of renal function in type 2 diabetes

Individualised variable-interval risk-based screening for sight-threatening diabetic retinopathy: the Liverpool Risk Calculation Engine

Aims/hypothesis Individualised variable-interval risk-based screening offers better targeting and improved cost-effectiveness in screening for diabetic retinopathy. We developed a generalisable risk calculation engine (RCE) to assign personalised intervals linked to local population characteristics, and explored differences in assignment compared with current practice. Methods Data from 5 years of photographic screening and primary care for people with diabetes, screen negative at the first of > 1 episode, were combined in a purpose-built near-real-time warehouse. Covariates were selected from a dataset created using mixed qualitative/quantitative methods. Markov modelling predicted progression to screen-positive (referable diabetic retinopathy) against the local cohort history. Retinopathy grade informed baseline risk and multiple imputation dealt with missing data. Acceptable intervals (6, 12, 24 months) and risk threshold (2.5%) were established with patients and professional end users. Results Data were from 11,806 people with diabetes (46,525 episodes, 388 screen-positive). Covariates with sufficient predictive value were: duration of known disease, HbA1c, age, systolic BP and total cholesterol. Corrected AUC (95% CIs) were: 6 months 0.88 (0.83, 0.93), 12 months 0.90 (0.87, 0.93) and 24 months 0.91 (0.87, 0.94). Sensitivities/specificities for a 2.5% risk were: 6 months 0.61, 0.93, 12 months 0.67, 0.90 and 24 months 0.82, 0.81. Implementing individualised RCE-based intervals would reduce the proportion of people becoming screen-positive before the allocated screening date by > 50% and the number of episodes by 30%. Conclusions/interpretation The Liverpool RCE shows sufficient performance for a local introduction into practice before wider implementation, subject to external validation. This approach offers potential enhancements of screening in improved local applicability, targeting and cost-effectiveness

Sunitinib-induced hyperammonaemia in a patient with pancreatic neuroendocrine tumour

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Regorafenib for metastatic colorectal cancer in community setting: a multicenter retrospective analysis in Hong Kong

This free journal suppl. entitled: ESMO 17th World Congress on Gastrointestinal Cancer, 1-4 July 2015, Barcelona, SpainPoster Presentation: no. P-270INTRODUCTION: The efficacy of regorafenib in refractory metastatic colorectal cancer has been demonstrated in two international phase III randomized controlled trials, the CORRECT and the CONCUR study, but the data in community setting is scarce. To evaluate the use of regorafenib in community setting, we perform a multicenter retrospective analysis in Hong Kong. METHODS: Patients were eligible for treatment with regorafenib if they have failed all available systemic agents including fluoropyrimidine, oxaliplatin, irinotecan, bevacizumab, and cetuximab or panitumumab if RAS wild-type tumor. Individual patient data was retrieved from the Department of Clinical Oncology and the Department of Medicine, Queen Mary Hospital and the Department of Clinical Oncology, Pamela Youde Nethersole Eastern Hospital, Hong Kong. Beside demographic, efficacy and toxicity data, pattern of prescription and treatment suspension were collected. RESULTS: From July 2013 to January 2015, 28 patients were treated with regorafenib for metastatic colorectal cancer in a non-clinical trial setting. The median age of patients was 62 (Range 45-77) and most of them had good performance status (ECOG 0-1: 89.3%). Majority of patients presented with synchronous metastasis (64.3%) and had metastases involving multiple organs at the time of regorafenib treatment (92.9%). Sixty-four percent of tumors were RAS wild-type. Patients have received a median of three prior lines of treatment and the median time interval from date of first line therapy to the start of regorafenib was 24.3 months. A total of 87 treatment cycles were prescribed in the 28 patients. Fifteen patients were started at 160mg daily and 9 of them required further dose reduction or suspension during subsequent cycles. Irrespective of the starting dose, 77% of additional dose reduction occurred at the first and second cycles. The main reason for dose reduction or treatment suspension was due to hand-foot syndrome followed by deranged liver function. For those who started at lower dose or required dose reduction during treatment, 14 of 22 patients were able to re-escalate the dose. Adverse events of any grade occurred in all patients. There was one case of grade 4 anaemia due to per rectal bleeding but no treatment related death was observed. The commonest grade 3 non-haematologic adverse event were hand-foot syndrome (25%), elevated AST (14.3%)/ ALT (10.7%), elevated bilirubin (3.6%), hypoalbuminaemia (3.6%), fatigue (3.6%), diarrhea (3.6%) and bleeding (3.6%). The most common grade 3 haematologic adverse events were anaemia (7.1%) and thrombocytopenia (3.6%). After a median follow-up of 4.9 months: 18 patients have progressed and the median progression-free survival was 3.2 months (95% CI 2.5-3.9 months) while 11 patients have died and the median survival was 6.1 months (95% CI: 1.4-10.9 months). Treatment response was uncommon and only 1 patient (3.6%) achieved a partial response and another 17 patients (60.7%) had stable disease at 8 weeks. Nine of nineteen patients were able to receive further systemic treatment after stopping regorafenib. CONCLUSION: The efficacy and toxicity profile of regorafenib in the community setting were comparable to those reported in phase III clinical trials. Dose reduction and treatment interruption was common but dose re-escalation is feasible.link_to_OA_fulltex