380 results on '"Richard K. Lee"'
Search Results
2. Hematogenous Macrophages Contribute to Fibrotic Scar Formation After Optic Nerve Crush
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Huiyi Jin, Yuan Liu, Xiangxiang Liu, Mohamed M. Khodeiry, Jae K. Lee, and Richard K. Lee
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Cellular and Molecular Neuroscience ,Neurology ,Neuroscience (miscellaneous) - Published
- 2022
3. ShangRing versus Mogen clamp for early infant male circumcision in eastern sub-Saharan Africa: a multicentre, non-inferiority, adaptive, randomised controlled trial
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Spyridon P, Basourakos, Quincy G, Nang, Karla V, Ballman, Omar Al Hussein, Al Awamlh, Nahid, Punjani, Kaylee, Ho, Mark A, Barone, Quentin D, Awori, Daniel, Ouma, Jairus, Oketch, Alice E, Christensen, Augustino, Hellar, Maende, Makokha, Alphonce, Isangu, Robert, Salim, Jackson, Lija, Ronald H, Gray, Stephen, Kiboneka, Aggrey, Anok, Godfrey, Kigozi, Regina, Nakabuye, Charles, Ddamulira, Andrew, Mulooki, Silas, Odiya, Rose, Nazziwa, Marc, Goldstein, Philip S, Li, and Richard K, Lee
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Adult ,Male ,Adolescent ,Circumcision, Male ,Infant, Newborn ,Humans ,Infant ,Pain ,Anesthesia ,Uganda ,General Medicine ,Kenya - Abstract
Use of medical devices represents a unique opportunity to facilitate scale-up of early infant male circumcision (EIMC) across sub-Saharan Africa. The ShangRing, a circumcision device prequalified by WHO, is approved for use in adults and adolescents and requires topical anaesthesia only. We aimed to investigate the safety and efficacy of the ShangRing versus the Mogen clamp for EIMC in infants across eastern sub-Saharan Africa.In this multicentre, non-inferiority, open-label, randomised controlled trial, we enrolled healthy male infants (aged60 days), with a gestational age of at least 37 weeks and a birthweight of at least 2·5 kg, from 11 community and referral centres in Kenya, Tanzania, and Uganda. Infants were randomly assigned (1:1) by a computer-generated text message service to undergo EIMC by either the ShangRing or the Mogen clamp. The primary endpoint was safety, defined as the number and severity of adverse events (AEs), analysed in the intention-to-treat population (all infants who underwent an EIMC procedure) with a non-inferiority margin of 2% for the difference in moderate and severe AEs. This trial is registered with Clinical.gov, NCT03338699, and is complete.Between Sept 17, 2018, and Dec 20, 2019, a total of 1420 infants were assessed for eligibility, of whom 1378 (97·0%) were enrolled. 689 (50·0%) infants were randomly assigned to undergo EIMC by ShangRing and 689 (50·0%) by Mogen clamp. 43 (6·2%) adverse events were observed in the ShangRing group and 61 (8·9%) in the Mogen clamp group (p=0·078). The most common treatment-related AE was intraoperative pain (Neonatal Infant Pain Scale score ≥5), with 19 (2·8%) events in the ShangRing and 23 (3·3%) in the Mogel clamp group. Rates of moderate and severe AEs were similar between both groups (29 [4·2%] in the ShangRing group vs 30 [4·4%] in the Mogen clamp group; difference -0·1%; one-sided 95% CI upper limit of 1·7%; p=0·89). No treatment-related deaths were reported.Use of the ShangRing device for EIMC showed safety, achieved high caregiver satisfaction, and did not differ from the Mogen clamp in other key measures. The ShangRing could be used by health systems and international organisations to further scale up EIMC across sub-Saharan Africa.BillMelinda Gates Foundation.
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- 2022
4. Slow-coagulation transscleral cyclophotocoagulation laser treatment for medically uncontrolled secondary aphakic adult glaucoma
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Abdelrahman M. Elhusseiny, Mohamed M. Khodeiry, Xiangxiang Liu, Mohamed S. Sayed, and Richard K. Lee
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Ophthalmology - Published
- 2023
5. Clinical Factors Impacting Outcomes From Failed Trabeculectomy Leading to Glaucoma Drainage Device Implantation and Subsequent Penetrating Keratoplasty
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Jessica Chen, Abdelrahman M. Elhusseiny, Mohamed M. Khodeiry, Michael P. Smith, Mohamed S. Sayed, Michael Banitt, William Feuer, Sonia H. Yoo, and Richard K. Lee
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Ophthalmology - Published
- 2023
6. MP49-08 SHANGRING VERSUS THE MOGEN CLAMP FOR EARLY INFANT MALE CIRCUMCISION (EIMC): A COST-COMPARATIVE ANALYSIS IN KENYA, TANZANIA AND UGANDA
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Mary O. Strasser, Lina Posada, Nahid Punjani, Spyridon Basourakos, Godfrey Kigozi, Quentin Awori, Alice Christensen, Mark Barone, Karla Ballman, Marc Goldstein, Alvin Mushlin, Philip Li, and Richard K. Lee
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Urology - Published
- 2023
7. Mitochondrial TXNRD2 and ME3 Genetic Risk Scores Are Associated with Specific Primary Open-Angle Glaucoma Phenotypes
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Inas F. Aboobakar, Tyler G. Kinzy, Yan Zhao, Baojian Fan, Louis R. Pasquale, Ayub Qassim, Antonia Kolovos, Joshua M. Schmidt, Jamie E. Craig, Jessica N. Cooke Bailey, Janey L. Wiggs, R. Rand Allingham, Murray Brilliant, Donald L. Budenz, John H. Fingert, Douglas Gaasterland, Teresa Gaasterland, Jonathan L. Haines, Michael A. Hauser, Richard K. Lee, Paul R. Lichter, Yutao Liu, Syoko Moroi, Jonathan Myers, Margaret Pericak-Vance, Anthony Realini, Doug Rhee, Julia E. Richards, Robert Ritch, Joel S. Schuman, William K. Scott, Kuldev Singh, Arthur J. Sit, Douglas Vollrath, Robert N. Weinreb, Gadi Wollstein, and Donald J. Zack
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Ophthalmology - Published
- 2023
8. Effect of varicoceles on spermatogenesis
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Caroline Kang, Philip S. Li, Marc Goldstein, Richard K. Lee, and Nahid Punjani
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Male ,0301 basic medicine ,Infertility ,endocrine system ,medicine.medical_specialty ,Varicocele ,Urology ,Biology ,urologic and male genital diseases ,Asymptomatic ,Spermatic cord ,Male infertility ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Humans ,Testosterone ,Spermatogenesis ,Infertility, Male ,urogenital system ,Cell Biology ,medicine.disease ,Sperm ,030104 developmental biology ,medicine.anatomical_structure ,medicine.symptom ,030217 neurology & neurosurgery ,Developmental Biology - Abstract
Varicoceles are dilated veins within the spermatic cord and a relatively common occurrence in men. Fortunately, the large majority of men are asymptomatic, however, a proportion of men with varicoceles can suffer from infertility and testosterone deficiency. Sperm and testosterone are produced within the testis, and any alteration to the testicular environment can negatively affect the cells responsible for these processes. The negative impact of varicoceles on testicular function occurs mainly due to increased oxidative stress within the testicular parenchyma which is thought to be caused by scrotal hyperthermia, testicular hypoxia, and blood-testis barrier disruption. Management of varicoceles involves ligation or percutaneous embolization of the dilated veins. Repair of varicoceles can improve semen parameters and fertility, along with serum testosterone concentration. In this review, we discuss the pathophysiology of varicoceles, their impact on testicular function, and management.
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- 2022
9. Burden of Trabeculectomy and Glaucoma Drainage Implantation after Laser Trabeculoplasty
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Louis R. Pasquale, Richard K. Lee, and Rachel H. Lee
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medicine.medical_specialty ,Intraocular pressure ,genetic structures ,Minimally invasive glaucoma surgery ,Open angle glaucoma ,business.industry ,medicine.medical_treatment ,Hazard ratio ,Ocular hypertension ,Glaucoma ,General Medicine ,medicine.disease ,eye diseases ,Ophthalmology ,medicine ,Glaucoma surgery ,Trabeculectomy ,sense organs ,business - Abstract
Purpose To evaluate the burden of incisional glaucoma surgery (trabeculectomy and glaucoma drainage device implantation) after laser trabeculoplasty (LTP) in the United States. Design Retrospective, matched, case-comparison study. Participants Medicare beneficiaries who underwent LTP between January 2012 and December 2014 were identified using the 5% Medicare Current Beneficiary Survey. Methods Subjects aged 35 years or older at the time of LTP with ocular hypertension, suspected glaucoma, or mild open-angle glaucoma (OAG) were matched to a comparison group without LTP on the basis of age, gender, race, geographic region, and glaucoma diagnosis codes. Survival analysis and Cox proportional hazard analysis were performed. Main Outcome Measures Primary analysis included risk of incisional glaucoma surgery. Secondary analysis included risk of conversion to moderate or severe OAG based on billing data. Results The mean age of study participants was 75.0 ± 8.9 years. After 2 years, 40 of 2435 eyes required incisional glaucoma surgery after LTP, and 51 of 2435 eyes required glaucoma surgery in the comparison group (P = 0.27, adjusted for covariates). Regardless of intervention, Black Americans were more likely to require glaucoma surgery (hazard ratio [HR], 1.89; 95% confidence interval [CI], 1.13–3.17). Patients with a diagnosis of OAG were more likely to require surgery than glaucoma suspects (HR, 2.03; 95% CI, 1.12–3.69). Black Americans were also more likely to require surgery or convert to more severe glaucoma (HR, 3.21; 95% CI, 1.92–5.37) versus White Americans. Conclusions Laser trabeculoplasty did not alter the need for subsequent incisional glaucoma surgery among glaucoma suspects or patients with mild OAG. Regardless of treatment with LTP, African heritage and OAG diagnosis status were risk factors for requiring glaucoma surgery.
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- 2022
10. Timing for maximum anaesthetic effect of topical cream during early infant circumcision (EIC) in Rakai, Uganda
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Stephen Kiboneka, Aggrey Anok, Regina Nakabuye, Silas Odiya, Julius Magembe, Rose Nazziwa, Charles Ddamulira, Andrew Mulooki, Ronald Moses Galiwango, Stephen Watya, Philip S. Li, Richard K. Lee, Ronald H. Gray, Godfrey Kigozi, and Edward Nelson Kankaka
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General Medicine - Published
- 2023
11. Analysis of Socioeconomic Factors Affecting Follow-Up in a Glaucoma Screening Program
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Patrick C Staropoli, Richard K Lee, Zachary A Kroeger, Karina Somohano, Matthew Feldman, Jennifer D Verriotto, Adam Aldahan, Potyra R Rosa, William J Feuer, D. Diane Zheng, David J Lee, and Byron L Lam
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Ophthalmology ,glaucoma ,socioeconomics ,genetic structures ,follow-up ,Clinical Ophthalmology ,epidemiology ,sense organs ,eye diseases ,Original Research - Abstract
Patrick C Staropoli, 1 Richard K Lee, 1 Zachary A Kroger, 2 Karina Somohano, 3 Matthew Feldman, 4 Jennifer D Verriotto, 1 Adam Aldahan, 5 Potyra R Rosa, 1 William J Feuer, 1 D Diane Zheng, 6 David J Lee, 1, 6 Byron L Lam 1 1Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA; 2Ophthalmology Department, Baylor College of Medicine, Houston, TX, USA; 3Ophthalmology Department, New York Presbyterian Hospital, New York, NY, USA; 4Neurology Department, University of Miami Miller School of Medicine, Miami, FL, USA; 5Dermatology Department, University of Minnesota, Minneapolis, MN, USA; 6Department of Public Health Sciences, University Miami School of Medicine, Miami, FL, USACorrespondence: Byron L LamBascom Palmer Eye Institute, 900 NW 17 Street, Miami, FL, 33136, USATel +1 305-326-6021Fax +1 305 326 6114Email blam@med.miami.eduPurpose: To determine what socioeconomic factors affect follow-up in a glaucoma screening program.Patients and Methods: This was a retrospective cohort study of six health fairs in South Florida from October 2012 to March 2013 among socially and economically disadvantaged populations. Visual acuity (VA), intraocular pressure (IOP), cup-to-disc ratio (CDR), and visual field testing were obtained to identify glaucoma suspects. Glaucoma suspects were defined as having intraocular pressure ≥ 24 mm Hg, cup-to-disc ratio of ≥ 0.6 in either eye, or glaucomatous defects on visual field testing. In July 2015, telephone surveys were administered to assess follow up and socioeconomic factors.Results: Seventy-two out of 144 (50%) glaucoma suspects responded to the survey and were included in the analysis. Of the 72 respondents, average age was 52.8 years old and 65% were female. The most common race was African American (69%) and ethnicity was Haitian (51%). Glaucoma suspects who followed up were significantly more likely to have health insurance compared to those who did not follow up (74% vs 43%, p = 0.014). No significant difference in follow-up based on age (p = 0.125), education (p = 0.151), gender (p = 0.48), or ethnicity (p = 0.707) was identified. Of the 30 respondents, who did not follow up, the most common reasons were “no insurance” (57%, 17/30) and “not worried” (33%, 10/30).Conclusion: Insurance was the main socioeconomic factor in determining whether glaucoma suspects followed up after community health screenings. Streamlining social services could increase clinical access of glaucoma suspects.Keywords: epidemiology, follow-up, glaucoma, socioeconomics
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- 2021
12. Retina Vascular Structures near the Optic Disc and in the Macula in Primary Angle-Closure Suspects
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Richard K. Lee, Mengya Zhao, Merry Zc Ruan, Yue Yang, Min Fu, Qian Liu, Ying Han, Kai Cao, Shuning Li, Zhongyin Hu, Fancheng Yan, Fei Xiang, Wudi Fan, Hui Feng, and Xiaohua Pan
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medicine.medical_specialty ,Retina ,business.industry ,Optic Disk ,Angiography ,Closure (topology) ,Retinal Vessels ,General Medicine ,Sensory Systems ,Cellular and Molecular Neuroscience ,Ophthalmology ,Cross-Sectional Studies ,medicine.anatomical_structure ,medicine ,Humans ,Macula Lutea ,business ,Tomography, Optical Coherence ,Optic disc - Abstract
Introduction: The main aim of this article was to study the retinal peripapillary and macular vascular structures in eyes with primary angle-closure suspects (PACS) using optical coherence tomography angiography (OCTA). Methods: In this cross-sectional study, control and PACS subjects were recruited from a community screening. Only one eye per subject was used for analysis. All participants underwent a questionnaire survey, physical and ophthalmic examinations, ocular biometry measurements, and OCTA. We compared basic demographics and vessel structure parameters between control and PACS eyes. Univariate and multivariate linear regression analyses were performed to investigate factors associated with vascular parameters in both groups. Results: Data from 254 subjects including 155 PACS and 99 controls were analyzed. In the peripapillary region, PACS eyes showed similar retina nerve fiber layer (RNFL) and vessel densities (VDs) including and excluding large vessels compared to control eyes. Compared to control eyes, all macular OCTA parameters showed significant differences in PACS eyes, including decreased superficial VD (p = 0.006) and deep VD (p = 0.004), larger fovea avascular zone (FAZ) area (p = 0.006), and longer FAZ perimeter (p = 0.004). Gender (p = 0.039), age (p < 0.001), and Garway-Heath superior hemisphere RNFL (p < 0.001) were risk factors influencing optic disc VD excluding large vessels. Axial length was the major factor affecting macula superficial and deep VDs (p = 0.004 and 0.001 respectively), while PACS was an independent factor associated with larger FAZ perimeter (p = 0.046). Conclusion: While PACS and control eyes have comparable RNFL and vascular structure around the optic nerve head, macular vascular structures are significantly different.
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- 2021
13. Cost-analysis of Surgical Intraocular Pressure Management in Glaucoma
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Abdelrahman M. Elhusseiny, Richard K. Lee, Nicolas A. Yannuzzi, Mohamed M. Khodeiry, and William E. Smiddy
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medicine.medical_specialty ,Intraocular pressure ,Visual acuity ,Trabeculoplasty ,genetic structures ,Selective laser trabeculoplasty ,medicine.medical_treatment ,Glaucoma ,Trabeculectomy ,Medicare ,Surgical methods ,Tonometry, Ocular ,Ophthalmology ,medicine ,Humans ,Intraocular Pressure ,health care economics and organizations ,Aged ,business.industry ,medicine.disease ,United States ,eye diseases ,Treatment Outcome ,Cost analysis ,Laser Therapy ,sense organs ,medicine.symptom ,business - Abstract
PRCIS The multiplicity of treatment options for lowering intraocular pressure (IOP) is both a blessing and a challenge. Some attention to cost-analysis might assist in choosing an optimal therapy, especially in a cost-constrained, international setting. PURPOSE The aim of this study was to quantify and to analyze the relative cost of various glaucoma surgical procedures and selective laser trabeculoplasty surgery per mm Hg IOP reduction ($/mm Hg) since standard cost-utility methods are not well suited to the study of glaucoma which characteristically only claims visual acuity in its end stages. METHODS Published glaucoma treatment studies were reviewed to quantitate the reduction of mean IOP and glaucoma medications for a given treatment modality. A US perspective was adopted, using Medicare allowable costs were used to calculate a newly introduced parameter-cost per mm Hg IOP reduction-at 1 year postoperatively. RESULTS The cost per mm Hg IOP reduction after 1 year of treatment ranged from $190/mm Hg for trabeculectomy to $1376/mm Hg for iStent. For reference, the cost of selective later trabeculoplasty surgery was $121/mm Hg. After the first year, cost/mm Hg ranged from $12 to $61/mm Hg. CONCLUSIONS Conventional glaucoma surgeries and selective laser trabeculoplasty surgery were the most cost-efficient surgical methods to lower IOP compared with the various minimally invasive glaucoma surgeries options. They may be more appropriate management when cost is an important issue.
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- 2021
14. Treatment Outcomes of Slow Coagulation Transscleral Cyclophotocoagulation In Pseudophakic Patients with Medically Uncontrolled Glaucoma
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Richard K. Lee, Mohamed M. Khodeiry, William J. Feuer, Mohamed S. Sayed, Huda Sheheitli, and Patrice J. Persad
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Intraocular pressure ,medicine.medical_specialty ,Visual acuity ,genetic structures ,medicine.medical_treatment ,Treatment outcome ,Glaucoma ,03 medical and health sciences ,0302 clinical medicine ,Ophthalmology ,Humans ,Medicine ,In patient ,High group ,Intraocular Pressure ,Aged ,Retrospective Studies ,030304 developmental biology ,Aged, 80 and over ,0303 health sciences ,Laser Coagulation ,Glaucoma medication ,business.industry ,Ciliary Body ,medicine.disease ,eye diseases ,Safety profile ,Treatment Outcome ,030221 ophthalmology & optometry ,sense organs ,medicine.symptom ,business ,Sclera - Abstract
Reporting treatment outcomes of slow coagulation transscleral cyclophotocoagulation (TSCPC) as an initial surgical intervention in pseudophakic patients with glaucoma.Retrospective case series.This single academic center study reviewed 74 pseudophakic patients who had a diagnosis of glaucoma and no previous glaucoma surgeries (mean age 82.6 ± 12.5 years; mean follow-up 18.7 ± 9.1 months). The intervention used was slow coagulation continuous wave TSCPC (1250-mW power and 4-second duration). The primary outcome measure was surgical success defined as an intraocular pressure (IOP) of 6-21 mm Hg with a ≥20% reduction from baseline, no reoperation for glaucoma, and no loss of light-perception vision. Secondary outcome measures included glaucoma medication use, visual acuity (VA), and complications.IOP decreased from 27.5 ± 9.8 mm Hg preoperatively to 16.1 ± 6.3 mm Hg postoperatively (P.001). The preoperative number of glaucoma medications was 4.1 ± 0.9 and 3.1 ± 1.3 post-TSCPC (P.001). The cumulative probabilities of success at 1 and 2 years were 60.6 % and 58.5%, respectively. When patients were divided into 2 groups based on their baseline IOP being21 mm Hg (high group) or ≤21 mm Hg (low group), success rates at 2 years were 64.9% and 45.5%, respectively (P = .144). The mean logarithm of the minimum angle of resolution VA changed from 0.70 ± 0.64 to 1.04 ± 0.87 at the last follow-up visit (P = .01). No serious complications were observed and most of the complications were mild and transient.Slow coagulation TSCPC has good efficiency, especially in patients with baseline IOP21 mm Hg, and safety profile as an initial surgical intervention in pseudophakic patients with glaucoma.
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- 2021
15. Treatment Outcomes of Primary Transscleral Cyclophotocoagulation
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Richard K. Lee, Patrice J. Persad, Mohamed S. Sayed, William J. Feuer, and Huda Sheheitli
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Intraocular pressure ,medicine.medical_specialty ,Visual acuity ,genetic structures ,Ocular surgery ,Treatment outcome ,Glaucoma ,01 natural sciences ,03 medical and health sciences ,0302 clinical medicine ,Ciliary body ,Ophthalmology ,medicine ,Humans ,0101 mathematics ,High group ,Intraocular Pressure ,Retrospective Studies ,Laser Coagulation ,business.industry ,Ciliary Body ,010102 general mathematics ,General Medicine ,Light perception ,medicine.disease ,eye diseases ,Treatment Outcome ,medicine.anatomical_structure ,030221 ophthalmology & optometry ,sense organs ,medicine.symptom ,business - Abstract
To report treatment outcomes of primary transscleral cyclophotocoagulation (TSCPC) in glaucomatous eyes.Retrospective noncomparative study.Forty-eight eyes with a diagnosis of glaucoma and no previous incisional ocular surgery.Continuous-wave TSCPC was applied to the ciliary body.The primary outcome measure was surgical success defined as an IOP ≤ 21 mmHg and reduced by 20% or more from baseline, IOP5 mmHg, no reoperation for glaucoma, and no loss of light perception vision. Secondary outcome measures included visual acuity (VA) and complications.Glaucoma eyes were stratified into 2 groups: (1) those with pretreatment IOP21 mmHg (high group) and (2) those with pretreatment IOP ≤ 21 mmHg (low group). Mean ± standard deviation (SD) IOP at baseline was 30.6 ± 6.3 mmHg in the high group and 16.2 ± 2.8 mmHg in the low group. Mean ± SD number of glaucoma medications at baseline was 4.1 ± 0.8 in the high group and 3.6 ± 1.1 in the low group. Based on our success criteria, the cumulative probability of success during the first year of follow-up was 58.3% in the high group and 28.1% in the low group (P = 0.052). Postoperative mean IOP was significantly lower than baseline IOP in the high group at 1-, 3-, 6-, 12-, and 18-month postoperative visits (P0.05). No significant change was observed in IOP at follow-up visits after 1 month in the low IOP group. Throughout the first year of follow-up, both groups required fewer glaucoma medications compared with baseline at the 1-, 3-, 6-, and 12-month postoperative visits (P0.05). The most frequent cause of postoperative decrease in VA was cataract in 9 eyes. Decrease in vision resulting from glaucoma was observed in 3 eyes. Complications included prolonged inflammation (11 eyes), iris neovascularization (2 eyes), cystoid macular edema (4 eyes), and hyphema (1 eye). No severe or long-term complications were observed.Continuous-wave TSCPC was effective in lowering IOP in glaucoma patients without prior incisional ocular surgery whose disease was recalcitrant to medical therapy, particularly those with baseline IOP of more than 21 mmHg.
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- 2021
16. Adoption, Safety, and Retreatment Rates of Prostatic Urethral Lift for Benign Prostatic Enlargement
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Adonis Hijaz, Irina Jaeger, Richard K. Lee, Xian Wu, Spyridon P. Basourakos, Peter Y. Cai, Jonathan E. Shoag, and Christopher Gaffney
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Male ,Reoperation ,Suburethral Slings ,medicine.medical_specialty ,business.industry ,Urology ,Prostatic Hyperplasia ,Transurethral Resection of Prostate ,Endoscopy ,Length of Stay ,Middle Aged ,medicine.disease ,Patient Readmission ,Prostatic enlargement ,Lower urinary tract symptoms ,medicine ,Humans ,Laser Therapy ,business ,Aged ,Retrospective Studies ,Prostatic urethral lift - Abstract
Novel minimally invasive therapies like the prostatic urethral lift are among the many endoscopic options for the treatment of benign prostatic enlargement and lower urinary tract symptoms (BPE/LUTS). To further understand the relative uptake, complications and retreatment rates of contemporary endoscopic procedures for BPE/LUTS across diverse practice types, we performed a retrospective study of inpatient and ambulatory surgery encounters in the Premier Healthcare database.We included men who underwent endoscopic procedures for BPE/LUTS between 2000 and 2018. We determined the utilization of endoscopic therapies for BPE/LUTS, 30-day and 90-day readmission rates, and retreatment rate. Multivariable logistic regression was used to assess the association of procedure type with outcomes for the 3 most commonly performed procedures.We identified 175,150 men treated with endoscopic surgery for BPE/LUTS. The annual percent utilization of the prostatic urethral lift increased from1% in 2014 to 10.4% in 2018. Compared to transurethral resection of the prostate and prostate photovaporization, prostatic urethral lift was associated with a lower odds of readmission at 30 (OR 0.58, p0.01) and 90 (OR 0.55, p0.01) days and a higher odds of retreatment within 2 years of followup (OR 1.78, p0.01).Providers have rapidly adopted prostatic urethral lift which accounted for more than 1 in 10 endoscopic procedures captured for BPE/LUTS in 2018. Men treated with prostatic urethral lift are readmitted less within 30 and 90 days but are more likely to be retreated within 2 years of their index procedure as compared to men treated with transurethral resection of the prostate or prostate photovaporization.
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- 2021
17. Influence of Department Leadership on Scholarly Productivity and Research Funding in Academic Urology
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Edward M. Schaeffer, Richard K. Lee, Jim C. Hu, Spyridon P. Basourakos, Jonathan V. Klarich, Ashwin Ramaswamy, Armando Pichs, and Dolores J. Lamb
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medicine.medical_specialty ,business.industry ,Urology ,030232 urology & nephrology ,Scopus ,Nih funding ,Academic achievement ,humanities ,03 medical and health sciences ,0302 clinical medicine ,030220 oncology & carcinogenesis ,Medicine ,business ,Productivity - Abstract
Objective To determine whether the academic achievement of Department Chairperson (DC) and Research Director (RD), when present, is associated with increased scholarly productivity and National Institutes of Health (NIH) funding of faculty members in academic urology departments. Materials and Methods We identified the DC, RD and faculty members of 145 academic urology departments. The scholarly productivity and NIH funding for each individual faculty member was assessed from 2018 to 2019 using an h-index extrapolated from the Scopus database and the NIH RePORTER tool, respectively. The Spearman correlation coefficient was employed to define the correlation of these parameters. Hypothesis testing was conducted using the Mann-Whitney U test. Results After excluding 13 departments due to missing faculty listing, our final sample included 132 departments and 2227 faculty members. In 2018, the NIH provided $55,243,658 in urology research grants to 24.2% of departments and 4.0% of faculty members. Of departments with NIH funding, 68.8% employed a RD. DC and RD h-index were positively correlated with departmental h-index. DC h-index positively correlated with department NIH funding. Moreover, NIH funding was significantly higher for departments with a RD vs those without a RD ($1,268,028 vs $62,941, P Conclusion Academic success of a DC and RD was associated with urology departmental scholarly productivity and NIH funding. The presence of a RD, funded or unfunded, was associated with increased departmental NIH funding.
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- 2021
18. RGC-Net: An Automatic Reconstruction and Quantification Algorithm for Retinal Ganglion Cells Based on Deep Learning
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Rui Ma, Lili Hao, Yudong Tao, Ximena Mendoza, Mohamed Khodeiry, Yuan Liu, Mei-Ling Shyu, and Richard K. Lee
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Ophthalmology ,Biomedical Engineering - Published
- 2023
19. MP18-19 URODYNAMICS (UDS) USAGE FOR BENIGN PROSTATIC HYPERPLASIA (BPH)
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Samantha L. Thorogood, Tenny R. Zhang, Christina Sze, Mary O. Strasser, Gina DeMeo, Richard K. Lee, Bilal Chughtai, Alexis Te, and Jim C. Hu
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Urology - Published
- 2022
20. MP04-09 TRENDS IN HOLMIUM LASER ENUCLEATION OF THE PROSTATE FOR TREATMENT OF BENIGN PROSTATIC HYPERPLASIA
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Tenny R. Zhang, Mary O. Strasser, Samantha L. Thorogood, Christina Sze, Bilal Chughtai, Alexis Te, Richard K. Lee, and Jim C. Hu
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Urology - Published
- 2022
21. MP01-07 FACTORS ASSOCIATED WITH USE OF PROSTATIC URETHRAL LIFT (PUL)
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Samantha L. Thorogood, Tenny R. Zhang, Christina Sze, Gina DeMeo, Mary O. Strasser, Richard K. Lee, Bilal Chughtai, Alexis Te, and Jim C. Hu
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Urology - Published
- 2022
22. Cell transplantation to replace retinal ganglion cells faces challenges – the Switchboard Dilemma
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Yuan Liu and Richard K. Lee
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Retina ,Retinal pigment epithelium ,business.industry ,photoreceptors ,Review ,optic nerve regeneration ,Retinal ganglion ,lcsh:RC346-429 ,Transplantation ,medicine.anatomical_structure ,Developmental Neuroscience ,Retinal ganglion cell ,retinal ganglion cells ,stem cells ,retina degeneration ,cell transplantation ,medicine ,sense organs ,Stem cell ,Induced pluripotent stem cell ,business ,Neuroscience ,lcsh:Neurology. Diseases of the nervous system ,Adult stem cell - Abstract
The mammalian retina displays incomplete intrinsic regenerative capacities; therefore, retina degeneration is a major cause of irreversible blindness such as glaucoma, age-related macular degeneration and diabetic retinopathy. These diseases lead to the loss of retinal cells and serious vision loss in the late stage. Stem cell transplantation is a great promising novel treatment for these incurable retinal degenerative diseases and represents an exciting area of regenerative neurotherapy. Several suitable stem cell sources for transplantation including human embryonic stem cells, induced pluripotent stem cells and adult stem cells have been identified as promising target populations. However, the retina is an elegant neuronal complex composed of various types of cells with different functions. The replacement of these different types of cells by transplantation should be addressed separately. So far, retinal pigment epithelium transplantation has achieved the most advanced stage of clinical trials, while transplantation of retinal neurons such as retinal ganglion cells and photoreceptors has been mostly studied in pre-clinical animal models. In this review, we opine on the key problems that need to be addressed before stem cells transplantation, especially for replacing injured retinal ganglion cells, may be used practically for treatment. A key problem we have called the Switchboard Dilemma is a major block to have functional retinal ganglion cell replacement. We use the public switchboard telephone network as an example to illustrate different difficulties for replacing damaged components in the retina that allow for visual signaling. Retinal ganglion cell transplantation is confronted by significant hurdles, because retinal ganglion cells receive signals from different interneurons, integrate and send signals to the correct targets of the visual system, which functions similar to the switchboard in a telephone network - therefore the Switchboard Dilemma.
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- 2021
23. Optimizing Nonsurgical Treatments of Overactive Bladder in the United States
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Richard K. Lee, Benjamin M. Brucker, and Diane K. Newman
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medicine.medical_specialty ,Activities of daily living ,Urology ,030232 urology & nephrology ,MEDLINE ,Adrenergic beta-3 Receptor Agonists ,Human sexuality ,Muscarinic Antagonists ,03 medical and health sciences ,0302 clinical medicine ,Patient satisfaction ,Quality of life (healthcare) ,Behavior Therapy ,Activities of Daily Living ,medicine ,Humans ,Botulinum Toxins, Type A ,Intensive care medicine ,Urinary Bladder, Overactive ,business.industry ,Guideline ,medicine.disease ,Overactive bladder syndrome ,United States ,Neuromuscular Agents ,Overactive bladder ,030220 oncology & carcinogenesis ,Practice Guidelines as Topic ,Quality of Life ,Transcutaneous Electric Nerve Stimulation ,business - Abstract
Overactive bladder syndrome is a prevalent condition impacting quality of life, activities of daily living, work productivity, physical and psychological health, sleep, and sexuality. Published guideline recommendations and effective behavioral, pharmacologic, and neuromodulatory therapies exist; however, adherence can be poor. Clinicians have important roles educating patients, setting treatment expectations, and providing follow-up. Determining patient goals, routinely assessing and adjusting therapy, and combining treatment strategies may improve outcomes. We review the benefits and challenges of overactive bladder treatments and propose approaches to improve patient management, with the goals of initiating therapy earlier and achieving better patient satisfaction, functioning, and quality of life.
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- 2020
24. Clinical Outcomes of Slow-Coagulation Continuous-Wave Transscleral Cyclophotocoagulation Laser for Treatment of Glaucoma
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Mohamed M. Khodeiry, Xiangxiang Liu, and Richard K. Lee
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Ophthalmology ,Laser Coagulation ,Treatment Outcome ,Lasers ,Ciliary Body ,Humans ,Glaucoma ,General Medicine ,Article ,Intraocular Pressure ,Sclera ,Retrospective Studies - Abstract
PURPOSE OF REVIEW: The complications and inadequate efficacy of prior cyclodestructive procedures limited their role in glaucoma management. Recent advances in treatment techniques and parameters for laser cyclophotocoagulation has expanded its role in today’s glaucoma practice. In this review, we discuss the treatment outcomes of slow-coagulation continuous-wave transscleral cyclophotocoagulation (CW-TSCPC) as a glaucoma surgical procedure for multiple types of glaucoma in lowering intraocular pressure (IOP). RECENT FINDINGS: Slow-coagulation TSCPC is a relatively new technique for CW-TSCPC that, unlike the “pop” power titration technique of laser energy delivery, aims to avoid the production of the “pop” sound that signals explosive inflammatory energy delivery to the ciliary body and nearby tissue. In slow coagulation TSCPC, laser energy is applied in a fixed and lower amount over a longer duration, compared to the conventional pop technique. This laser energy approach leads to more stable, reliable, titratable and selective ciliary body ablation for control of intraocular pressure, especially relative to the controversial current use of micro-pulse TSCPC. SUMMARY: Slow-coagulation CW-TSCPC can be used safely, efficiently, reproducibly, and efficaciously in wide range of glaucoma types including those with no history of incisional surgeries, good visual acuity, and medically refractory glaucomas.
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- 2022
25. Treatment of urethral stricture disease in women: A multi‐institutional collaborative project from the SUFU research network
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Maude Carmel, Bahaa S. Malaeb, Jennifer T. Anger, Blayne Welk, George Lin, Charles R. Powell, Doreen E. Chung, Jessica DeLong, Lindsey Cox, Aqsa Khan, Casey G. Kowalik, Scotty McKay, Susan MacDonald, Christopher S. Elliott, Yu Zheng, Judith C. Hagedorn, Hanna Stambakio, Eileen R. Brandes, Kamran P. Sajadi, Priyanka Gupta, Una J. Lee, Angelo E. Gousse, Ehab Eltahawy, Wagner Aparecido França, Giulia I. Lane, Annah Vollstedt, Priya Padmanabhan, Richard K. Lee, Didi Theva, Ariana L Smith, Suzette E. Sutherland, Rachel High, Alvaro Lucioni, and Anne P. Cameron
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medicine.medical_specialty ,030219 obstetrics & reproductive medicine ,Urethral stricture ,business.industry ,Proportional hazards model ,Urology ,Urethroplasty ,medicine.medical_treatment ,Confounding ,030232 urology & nephrology ,Retrospective cohort study ,Disease ,medicine.disease ,Surgery ,03 medical and health sciences ,0302 clinical medicine ,Urethra ,medicine.anatomical_structure ,medicine ,Neurology (clinical) ,business ,Survival analysis - Abstract
Aim Female urethral stricture disease is rare and has several surgical approaches including endoscopic dilations (ENDO), urethroplasty with local vaginal tissue flap (ULT) or urethroplasty with free graft (UFG). This study aims to describe the contemporary management of female urethral stricture disease and to evaluate the outcomes of these three surgical approaches. Methods This is a multi-institutional, retrospective cohort study evaluating operative treatment for female urethral stricture. Surgeries were grouped into three categories: ENDO, ULT, and UFG. Time from surgery to stricture recurrence by surgery type was analyzed using a Kaplan-Meier time to event analysis. To adjust for confounders, a Cox proportional hazard model was fit for time to stricture recurrence. Results Two-hundred and ten patients met the inclusion criteria across 23 sites. Overall, 64% (n = 115/180) of women remained recurrence free at median follow-up of 14.6 months (IQR, 3-37). In unadjusted analysis, recurrence-free rates differed between surgery categories with 68% ENDO, 77% UFG and 83% ULT patients being recurrence free at 12 months. In the Cox model, recurrence rates also differed between surgery categories; women undergoing ULT and UFG having had 66% and 49% less risk of recurrence, respectively, compared to those undergoing ENDO. When comparing ULT to UFG directly, there was no significant difference of recurrence. Conclusion This retrospective multi-institutional study of female urethral stricture demonstrates that patients undergoing endoscopic management have a higher risk of recurrence compared to those undergoing either urethroplasty with local flap or free graft.
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- 2020
26. Surgical management of uveitis-glaucoma-hyphema syndrome
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Richard K. Lee, Abdelrahman M. Elhusseiny, and William E. Smiddy
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medicine.medical_specialty ,genetic structures ,medicine.medical_treatment ,Uveitis-glaucoma-hyphema syndrome ,vitrectomy ,Glaucoma ,Vitrectomy ,Intraocular lens ,03 medical and health sciences ,0302 clinical medicine ,lcsh:Ophthalmology ,Clinical Research ,secondary glaucoma ,Ophthalmology ,medicine ,Effective treatment ,Hyphema ,business.industry ,medicine.disease ,eye diseases ,lcsh:RE1-994 ,Vitreous hemorrhage ,030221 ophthalmology & optometry ,sense organs ,business ,intraocular lens complications ,Uveitis - Abstract
Aim To report outcomes of patients after intraocular lens (IOL) repositioning or exchange for the version of the uveitis-glaucoma-hyphema (UGH) syndrome that does not include closed loop anterior chamber IOL (nUGH). Methods Chart review of patients with nUGH who underwent IOL repositioning or exchange by one surgeon were reviewed. The main outcome measures were best corrected visual acuity (BCVA) as a decimal fraction preoperatively and postoperatively after IOL repositioning or exchange. Clinical findings evaluated included the presence of uveitis, hyphema, elevated intraocular pressure (IOP), and other complications such as pigment dispersion or vitreous hemorrhage. The number of anti-inflammatory and glaucoma medications were assessed before and after IOL repositioning or exchange. Results The study included 14 pseudophakic eyes. The median time at the onset of contemporary UGH after cataract extraction and IOL implantation (CE/IOL) was 7.5y. IOL repositioning or exchange was performed at a mean duration of 8.1±4.7mo (median: 4mo) after onset of UGH. The mean BCVA was improved from 0.45±0.26 preoperatively after onset of UGH syndrome to 0.76±0.22 (P=0.016) after IOL repositioning or exchange. Among the 14 eyes, uveitis, elevated IOP, and hyphema were present preoperatively in 13, 13, and 6 eyes, respectively. Uveitis and hyphema resolved in all cases after IOL surgery. The mean IOP was reduced from 26.4±4.5 mm Hg preoperatively to 14.7±4.9 postoperatively (P=0.01). The mean number of glaucoma medications used was reduced from 1.7±1.1 medications preoperatively to 0.8±1.08 (P=0.04) postoperatively. Conclusion IOL repositioning or exchange is an effective treatment in many cases for medically resistant contemporary UGH syndrome.
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- 2020
27. The Balance between Open and Robotic Training among Graduating Urology Residents—Does Surgical Technique Need Monitoring?
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Suzanne B. Merrill, Brian S. Sohl, Adam C. Reese, Richard K. Lee, Jay D. Raman, Dipen J. Parekh, Thomas J. Guzzo, John H. Lynch, R. Houston Thompson, Stanley Zaslau, Daniel H. Williams, Erik Lehman, Baruch M. Grob, and Patrick J. Shenot
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Male ,medicine.medical_specialty ,Index (economics) ,business.industry ,Urology ,030232 urology & nephrology ,Internship and Residency ,Robotic Surgical Procedures ,Open learning ,United States ,Accreditation ,03 medical and health sciences ,0302 clinical medicine ,Education, Medical, Graduate ,Humans ,Urologic Surgical Procedures ,Medicine ,Female ,Medical physics ,Clinical Competence ,business ,Retrospective Studies ,Balance (ability) ,Graduation - Abstract
A minimum number of index procedures is required for graduation. Without thresholds for surgical technique, it is unclear if robotic and open learning is balanced. We assessed the distribution of robotic and open surgeries performed by residents upon graduation.Voluntary Accreditation Council for Graduate Medical Education resident case logs from 11 institutions were de-identified and trends in robotic and open major surgeries were compared using Wilcoxon rank sum and 2-sample t-tests.A total of 89,199 major cases were recorded by 209 graduates from 2011 to 2017. The median proportion of robotic cases increased from 2011 to 2017 in reconstruction (4.7% to 15.2%), oncology (27.5% to 54.2%) and pediatrics (0% to 10.9%) (all values p0.001). Robotic and open cases remained most divergent in reconstruction, with a median of 12 robotic (IQR 9-19) to 70 open cases (IQR 55-106) being performed by residents in 2017. Similar observations occurred in pediatrics. In oncology the number of robotic procedures superseded that of open in 2016 and rose to a median of 148 robotic (IQR 108-214) to 121 open cases (IQR 90-169) in 2017, with the driver being robotic prostatectomy. Substantial differences in surgical technique were observed between institutions and among graduates from the same institution.Although robotic volume is increasing, the balance of surgical technique and the pace of change differ in reconstruction, oncology and pediatrics, as well as among individual institutions and graduates themselves. This raises questions about whether more specific guidelines are needed to ensure equity and standardization in training.
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- 2020
28. Overactive Bladder in Women: an Update for Primary Care Physicians
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Omar Al Hussein Alawamlh, Bashir Al Hussein Al Awamlh, Una Lee, and Richard K. Lee
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medicine.medical_specialty ,030219 obstetrics & reproductive medicine ,Side effect ,medicine.drug_class ,business.industry ,Incidence (epidemiology) ,Urinary system ,030232 urology & nephrology ,medicine.disease ,Biochemistry ,03 medical and health sciences ,0302 clinical medicine ,Overactive bladder ,Lower urinary tract symptoms ,medicine ,Anticholinergic ,Dementia ,Mirabegron ,Intensive care medicine ,business ,Molecular Biology ,medicine.drug - Abstract
Overactive bladder (OAB) is a widely prevalent urinary condition affecting women of all ages, with increasing incidence in advancing age. A primary care provider is likely to encounter a significant proportion of women experiencing lower urinary tract symptoms (LUTS). This review serves primary care physicians as a thorough reference for a common condition causing LUTS in women. Most emerging data addressing overactive bladder relates to the different treatment modalities available. The side effect profile of antimuscarinic drugs remains an ongoing concern among OAB patients, especially with recent data linking the use of this class of drugs with Alzheimer’s and future development of dementia. In addition, it was recently demonstrated that individuals taking medications of medium-to-high anticholinergic activity had reduced brain glucose metabolism and increased brain atrophy. Combination treatments seem to be more efficacious than monotherapies, as has been proven when using mirabegron with antimuscarinics. Many studies have also validated the use of neuromodulation as a safe and effective treatment for OAB. Overactive bladder is a widely prevalent urinary condition affecting women of all ages. It is regarded as multifactorial with several proposed theories to explain its occurrence. Several tests are available to aid in diagnosing OAB. Symptom severity and patient-related factors including patient preferences drive treatment.
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- 2020
29. Validation of MRI quantitative susceptibility mapping of superparamagnetic iron oxide nanoparticles for hyperthermia applications in live subjects
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Kelly M. Gillen, Padraic O' Malley, Ju-Young Kim, Yogindra Vedvyas, Zhe Liu, Richard K. Lee, Kofi Deh, Dina Bedretdinova, Yi Wang, Pascal Spincemaille, Moonsoo M. Jin, Marjan Zaman, and Thanh D. Nguyen
- Subjects
Hyperthermia ,Male ,Superparamagnetic iron oxide nanoparticles ,Cancer therapy ,Contrast Media ,lcsh:Medicine ,Therapeutics ,Adenocarcinoma ,Ferric Compounds ,Article ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,Mice ,0302 clinical medicine ,Targeted therapies ,Subcutaneous Tissue ,Mice, Inbred NOD ,Cell Line, Tumor ,Positron Emission Tomography Computed Tomography ,Injection site ,medicine ,Image Processing, Computer-Assisted ,Distribution (pharmacology) ,Animals ,Tissue Distribution ,lcsh:Science ,Radioisotopes ,Multidisciplinary ,Chemistry ,lcsh:R ,Prostatic Neoplasms ,Quantitative susceptibility mapping ,Hyperthermia, Induced ,medicine.disease ,Magnetic Resonance Imaging ,Xenograft Model Antitumor Assays ,Ferrosoferric Oxide ,Tumor Burden ,Ferumoxytol ,Heat generation ,Nanoparticles ,lcsh:Q ,Zirconium ,Radiopharmaceuticals ,Biomedical engineering ,030217 neurology & neurosurgery - Abstract
The use of magnetic fluid hyperthermia (MFH) for cancer therapy has shown promise but lacks suitable methods for quantifying exogenous irons such as superparamagnetic iron oxide (SPIO) nanoparticles as a source of heat generation under an alternating magnetic field (AMF). Application of quantitative susceptibility mapping (QSM) technique to prediction of SPIO in preclinical models has been challenging due to a large variation of susceptibility values, chemical shift from tissue fat, and noisier data arising from the higher resolution required to visualize the anatomy of small animals. In this study, we developed a robust QSM for the SPIO ferumoxytol in live mice to examine its potential application in MFH for cancer therapy. We demonstrated that QSM was able to simultaneously detect high level ferumoxytol accumulation in the liver and low level localization near the periphery of tumors. Detection of ferumoxytol distribution in the body by QSM, however, required imaging prior to and post ferumoxytol injection to discriminate exogenous iron susceptibility from other endogenous sources. Intratumoral injection of ferumoxytol combined with AMF produced a ferumoxytol-dose dependent tumor killing. Histology of tumor sections corroborated QSM visualization of ferumoxytol distribution near the tumor periphery, and confirmed the spatial correlation of cell death with ferumoxytol distribution. Due to the dissipation of SPIOs from the injection site, quantitative mapping of SPIO distribution will aid in estimating a change in temperature in tissues, thereby maximizing MFH effects on tumors and minimizing side-effects by avoiding unwanted tissue heating.
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- 2020
30. Hematogenous Macrophages Contribute to Fibrotic Scar Formation After Optic Nerve Crush
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Huiyi, Jin, Yuan, Liu, Xiangxiang, Liu, Mohamed M, Khodeiry, Jae K, Lee, and Richard K, Lee
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Mice ,Cicatrix ,Disease Models, Animal ,Nerve Crush ,Optic Nerve Injuries ,Macrophages ,Animals ,Optic Nerve ,Mice, Transgenic ,Fibrosis ,Nerve Regeneration - Abstract
Although glial scar formation has been extensively studied after optic nerve injury, the existence and characteristics of traumatic optic nerve fibrotic scar formation have not been previously characterized. Recent evidence suggests infiltrating macrophages are involved in pathological processes after optic nerve crush (ONC), but their role in fibrotic scar formation is unknown. Using wild-type and transgenic mouse models with optic nerve crush injury, we show that macrophages infiltrate and associate with fibroblasts in the traumatic optic nerve lesion fibrotic scar. We dissected the role of hematogenous and resident macrophages, labeled with Dil liposomes intravenously administered, and observed that hematogenous macrophages (Dil
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- 2022
31. The Effect of Changing Fellowship Interview Format on Candidate Ranking Variabilities: The COVID-19 Experience
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Ta Chen Chang, Elizabeth A. Hodapp, Richard K. Parrish, Alana L. Grajewski, Steven J. Gedde, Richard K. Lee, Sarah R. Wellik, Anna K. Junk, Luis Vazquez, Swarup S. Swaminathan, Elena Bitrian, Adam L. Rothman, and Elizabeth A. Vanner
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Ophthalmology ,Article Subject - Abstract
Purpose. This study investigated the effect of interview format changes (in-person to virtual, one-to-one to multiple-to-one) necessitated by the COVID-19 travel restrictions on preliminary fellowship candidate ranking variabilities. Design. Cross-sectional observational study. Method. In 2018 and 2019, the glaucoma fellowship interviews were conducted in-person in a one-to-one format, whereas in 2020, interviews were virtual and in a multiple (interviewers)-to-one (candidate) format. We compared ranking ranges of interviewers within the same virtual room (WSR) and not within the same virtual room (NWSR) to assess the effect of WSR versus NWSR on ranking variabilities. We also compared ranking categories (“accept,” “alternate,” and “pass”) agreements between 2018, 2019, and 2020 to assess the effect of virtual versus in-person interviews on ranking variabilities. Results. NWSR and WSR mean rankings differed by 1.33 (95% confidence interval difference 0.61 to 2.04, p = 0.0003), with WSR interviewers having less variability than NWSR pairs. The variability between 2018/2019 (in-person interviews) and 2020 (virtual interviews) showed no differences between in-person and virtual interviews (weighted Kappa statistic 0.086 for 2018, 0.158 for 2019, and 0.101 for 2020; p
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- 2022
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32. Outcomes of primary surgical treatment of medically recalcitrant post-keratoplasty glaucoma with transscleral cyclophotocoagulation
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Mohamed M. Khodeiry, Xiangxiang Liu, Mohamed S. Sayed, and Richard K. Lee
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Ophthalmology ,General Medicine - Abstract
Purpose To report the outcomes of slow-coagulation continuous-wave transscleral cyclophotocoagulation (CW-TSCPC) in post-keratoplasty glaucoma refractory to medical therapy. Methods Medical records of 47 patients (mean age of 70.7 ± 15.7 years and follow-up of 13.9 ± 7.1 months) were retrospectively enrolled. All patients had the diagnosis of secondary glaucoma after penetrating keratoplasty (PKP; n = 28) or Descemet's stripping automated endothelial keratoplasty (DSAEK; n = 19) with no previous history of incisional glaucoma or TSCPC surgeries. Study participants underwent slow-coagulation CW-TSCPC (1250-milliwatt power and 4-second duration). Results A statically significant reduction of IOP from 31.8 ± 8.0 mmHg preoperatively to 16.9 ± 9.0 mmHg postoperatively was noted ( p Conclusions Our study suggests that slow-coagulation TSCPC may be a safe and efficient surgical glaucoma treatment modality in patients with medically uncontrolled post-keratoplasty glaucoma.
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- 2023
33. Outcomes of the Shunt Tube Exposure Prevention Study
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Celso Tello, Hosam Sheha, Mohamed S. Sayed, Lama A. Al-Aswad, and Richard K. Lee
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Pars plana ,medicine.medical_specialty ,Intraocular pressure ,Visual acuity ,genetic structures ,medicine.medical_treatment ,Glaucoma ,01 natural sciences ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Glaucoma surgery ,Pericardium ,Trabeculectomy ,0101 mathematics ,Prospective cohort study ,business.industry ,010102 general mathematics ,General Medicine ,medicine.disease ,eye diseases ,Surgery ,medicine.anatomical_structure ,030221 ophthalmology & optometry ,sense organs ,medicine.symptom ,business - Abstract
Purpose To compare the long-term safety and efficacy of amniotic membrane–umbilical cord (AM–UC) and pericardium patch grafts in reducing glaucoma shunt tube exposure. Design Multicenter, prospective, randomized clinical trial. Participants Adults with uncontrolled glaucoma undergoing glaucoma drainage device (GDD) implantation. Methods Patients were randomized to receive GDD with either AM-UC or pericardium patch grafts to cover GDD tubes. Patients were followed up clinically with anterior segment (AS) OCT to assess patch graft stability and host–tissue integration prospectively. Main Outcome Measures Tube exposure, graft thinning, and graft-related complications. Results A total of 81 eyes of 81 patients (50 women, 31 men) with a mean age of 67±13 years underwent GGD implantation using Baerveldt (n = 72) or Ahmed valve (n = 9). Tubes were inserted in the anterior chamber (n = 71), sulcus (n = 6), or pars plana (n = 4). Tube ligation was performed with Baerveldt GDD along with fenestration (n = 51) or orphan trabeculectomy (n = 21). Tubes were covered with AM–UC (n = 41) or pericardium (n = 40). The mean follow-up time was 29±8 months (range, 13–40 months). Tube exposure occurred in 1 eye (2%) in the AM–UC group at 3 months and in 2 eyes (5%) in the pericardium group at 2 and 6 months (P = 0.54). Sequential AS OCT showed better host–tissue integration and significantly less graft thinning in the AM–UC group. Early graft thinning (≤3 months) occurred in 5 eyes (12%) in the AM–UC group and in 17 eyes (43%) in the pericardium group (P = 0.002). Late thinning occurred in 2 eyes (5%) and 11 eyes (28%) in the AM–UC and pericardium groups, respectively (P = 0.007). Graft translucency and cosmetic appearance of the AM–UC graft were superior to those of the pericardium graft. No evidence of graft rejection or infection was associated with the patch grafts in either group. Conclusions Amniotic membrane–umbilical cord grafts are well tolerated and offer an alternative to pericardium for safe and stable tube shunt coverage. Its high-tensile strength, low immunogenicity, and excellent host–tissue integration significantly reduced graft thinning.
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- 2019
34. Metastatic paraganglioma presenting as ajunctional scotoma
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Mohamed M. Khodeiry, John T. Lind, Joshua Pasol, Byron L. Lam, and Richard K. Lee
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Paraganglioma ,Ophthalmology ,Visual field defect ,Optic chiasm ,genetic structures ,Case Report ,Junctional scotoma ,sense organs ,RE1-994 ,eye diseases - Abstract
Purpose: To report a unique case of metastatic paraganglioma presenting as a junctional scotoma. Observations: A 38-year-old Caucasian man with a history of abdominal paraganglioma presented with minimally blurred vision 20/25 visual acuity in the left eye. The patient was found to have a junctional scotoma upon visual field testing. Cranial MRI revealed a large peri-clival mass compressing the pre-chiasmal optic nerves and other loci of metastatic disease. Intracranial masses, including metastases, can present with a relatively intact central acuity and nonspecific visual symptoms. Conclusions and Importance: To the best of our knowledge, this is the first report of metastatic paraganglioma causing a junctional scotoma. In cases with junctional scotoma, careful neuro-ophthalmic assessment and imaging are of paramount importance, even in patients with excellent visual acuity.
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- 2021
35. Gene therapy restores mitochondrial function and protects retinal ganglion cells in optic neuropathy induced by a mito-targeted mutant ND1 gene
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Yuan Liu, Jeremy D. Eastwood, Diego E. Alba, Sindhu Velmurugan, Ning Sun, Vittorio Porciatti, Richard K. Lee, William W. Hauswirth, John Guy, and Hong Yu
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Retinal Ganglion Cells ,Mice ,Electron Transport Complex I ,Genetics ,Molecular Medicine ,Animals ,Humans ,Genetic Therapy ,Optic Atrophy, Hereditary, Leber ,Dependovirus ,Molecular Biology ,DNA, Mitochondrial ,Mitochondria - Abstract
Therapies for genetic disorders caused by mutated mitochondrial DNA are an unmet need, in large part due barriers in delivering DNA to the organelle and the absence of relevant animal models. We injected into mouse eyes a mitochondrially targeted Adeno-Associated-Virus (MTS-AAV) to deliver the mutant human NADH ubiquinone oxidoreductase subunit I (hND1/m.3460 G A) responsible for Leber's hereditary optic neuropathy, the most common primary mitochondrial genetic disease. We show that the expression of the mutant hND1 delivered to retinal ganglion cells (RGC) layer colocalizes with the mitochondrial marker PORIN and the assembly of the expressed hND1 protein into host respiration complex I. The hND1-injected eyes exhibit hallmarks of the human disease with progressive loss of RGC function and number, as well as optic nerve degeneration. We also show that gene therapy in the hND1 eyes by means of an injection of a second MTS-AAV vector carrying wild-type human ND1 restores mitochondrial respiratory complex I activity, the rate of ATP synthesis and protects RGCs and their axons from dysfunction and degeneration. These results prove that MTS-AAV is a highly efficient gene delivery approach with the ability to create mito-animal models and has the therapeutic potential to treat mitochondrial genetic diseases.
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- 2021
36. Prognostic Value of Hepatocyte Growth Factor for Muscle-invasive Bladder Cancer
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Frederik König, Shahrokh F. Shariat, Reza Sari Motlagh, Richard K. Lee, Marco Moschini, Yair Lotan, Benjamin Pradere, Hadi Mostafaei, Satoshi Katayama, Mohammad Abufaraj, Abdulmajeed Aydh, Fahad Quhal, Pawel Rajwa, Pierre I. Karakiewicz, Jeremy Yuen-Chun Teoh, Eva Comperat, Keiichiro Mori, Nico C. Grossmann, Victor M. Schuettfort, Yasutomo Nasu, Quoc-Dien Trinh, Martin Haydter, and Ekaterina Laukhtina
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Cancer Research ,Bladder cancer ,Hepatocyte Growth Factor ,business.industry ,Muscles ,Muscle invasive ,General Medicine ,Cystectomy ,Prognosis ,medicine.disease ,Oncology ,Urinary Bladder Neoplasms ,medicine ,Cancer research ,Humans ,Hepatocyte growth factor ,business ,Value (mathematics) ,Retrospective Studies ,medicine.drug - Abstract
Purpose The HGF/MET pathway is involved in cell motility, angiogenesis, proliferation, and cancer invasion. We assessed the clinical utility of plasma HGF level as a prognostic biomarker in patients with MIBC. Methods We retrospectively analyzed 565 patients with MIBC who underwent radical cystectomy. Logistic regression and Cox regression models were used, and predictive accuracies were estimated using the area under the curve and concordance index. To estimate the clinical utility of HGF, DCA and MCID were applied. Results Plasma HGF level was significantly higher in patients with advanced pathologic stage and LN metastasis (p = 0.01 and p p p p p Conclusion Preoperative HGF identified MIBC patients who harbored features of clinically and biologically aggressive disease. Plasma HGF could serve, as part of a panel, as a biomarker to aid in preoperative treatment planning regarding intensity of treatment in patients with clinical MIBC.
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- 2021
37. Testicular Torsion and Spermatogenesis
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Omar Al Hussein, Alawamlh, Ryan, Flannigan, Russell, Hayden, Marc, Goldstein, Philip S, Li, and Richard K, Lee
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Male ,Rats, Sprague-Dawley ,Reperfusion Injury ,Testis ,Infant, Newborn ,Animals ,Humans ,Spermatogenesis ,Rats ,Spermatic Cord Torsion - Abstract
Testicular torsion (TT) is a common urologic emergency that can occur at any age. It is most common in newborns and during puberty. Prompt evaluation and management is required to salvage the testis following an episode of torsion. TT brings about damage to testicular tissue and spermatogenesis through various hypothesized mechanisms; however there is a consensus that the effects of ischemia, ischemia-reperfusion injury, and oxidative stress account for the most destructive effects. Numerous studies have examined the effects of various agents and therapies in limiting the effects of TT on the testis.
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- 2021
38. Technological Advancements in Male Infertility Microsurgery
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Marc Goldstein, Nahid Punjani, Richard K. Lee, Philip S. Li, and Caroline Kang
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medicine.medical_specialty ,Emerging technologies ,business.industry ,medicine.medical_treatment ,General Medicine ,Review ,microsurgery ,Microsurgery ,medicine.disease ,artificial intelligence ,male infertility ,Male infertility ,operating microscope ,medicine ,Medicine ,Medical physics ,business ,Operating microscope - Abstract
There have been significant advancements in male infertility microsurgery over time, and there continues to be significant promise for new and emerging techniques, technologies, and methodologies. In this review, we discuss the history of male infertility and the evolution of microsurgery, the essential role of education and training in male infertility microsurgery, and new technologies in this space. We also review the potentially important role of artificial intelligence (AI) in male infertility and microsurgery.
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- 2021
39. Distribution of rare LOXL1 missense alleles, haplotypes and diplotypes suggests association with reduced risk of glaucoma-related exfoliation syndrome
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J. H. Kang, R. Ritch, Tyler G. Kinzy, Tin Aung, Richard K. Lee, Louis R. Pasquale, Robert P. Igo, Chiea Chuen Khor, J. N. Cooke Bailey, Haines Jl, Margaret A. Pericak-Vance, Janey L. Wiggs, and Arthur J. Sit
- Subjects
Minor allele frequency ,Genetics ,Loss of heterozygosity ,Exact test ,Haplotype ,Genotype ,Missense mutation ,Allele ,Biology ,Exome ,eye diseases - Abstract
PurposeCommon LOXL1 protein-altering variants are significant genetic risk factors for exfoliation syndrome (XFS) and the related secondary glaucoma (XFG). A rare LOXL1 missense allele has been associated with protective effects in a Japanese cohort, suggesting that other rare alleles may also exhibit protective effects. The goal of this study was to assess the contributions of rare LOXL1 variants to XFS/XFG risk in cases and controls from the United States.MethodsLOXL1 rare (minor allele frequency less than 1%) variants were identified from Humanexome BeadArray (Illumina) data for 1118 XFS/XFG cases and 3661 controls. Distribution of rare variants, haplotypes (defined using IMPUTE2) and diplotypes were examined using the Fisher’s exact test. Rare variant allele distribution was confirmed in an independent set of primary open angle glaucoma (POAG) controls and multi-ethnic datasets. Correlation of LOXL1 common allele homozygosity with disease risk used data from gnomAD (gnomad.broadinstitute.org/) and an existing multi-ethnic meta-analysis.ResultsFour rare LOXL1 missense alleles were identified, and all were more common in controls (combined P= 7.6E-4), with two of these located in a LOXL1 intrinsic disordered region (IDR) known to be involved in LOXL1 aggregation. Haplotypes that included the rare or minor variants were more common in controls compared to cases (OR= 0.33, P=1.7E-8). Heterozygous diplotypes were significantly associated with reduced risk overall (OR= 0.45 P= 1.7 E-89) with the largest effects observed for diplotypes with more than one heterozygous genotype (OR= 0.05, P= 1.0E-39). A homozygous diplotype was associated with increased disease risk (OR= 6.8, P= 4.7E-157) and homozygosity was correlated with disease risk for common LOXL1 variants across multi-ethnic populations (Pearson= 0.92, PConclusionsUsing exome array data from XFS/XFG cases and controls from the United States, we identify 4 rare protective LOXL1 missense variants and show that the distribution of the corresponding haplotypes and diplotypes are associated with reduced risk of XFS/XFG. The diplotype results also demonstrate that LOXL1 allelic heterozygosity is protective while homozygosity is associated with increased disease risk. These results suggest that LOXL1 minor allele frequency variation among populations, with corresponding variation in genotype heterozgyosity and homozygosity, determines the XFS/XFG association effects and that genotypic effects may also impact protein aggregation involving intrinsic disordered regions.
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- 2021
40. Proteomics of pseudoexfoliation materials in the anterior eye segment
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Jada, Morris, Ciara, Myer, Tara, Cornet, Anna K, Junk, Richard K, Lee, and Sanjoy K, Bhattacharya
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Proteomics ,Anterior Eye Segment ,Humans ,Exfoliation Syndrome ,Eye Proteins - Abstract
Pseudoexfoliation syndrome (PEX) is characterized by the production of white extracellular fluffy clumps of microfibrillar material that aggregates in various organs throughout the body but is known to cause disease in the eye. The accumulation of PEX material (PEXM) in the anterior segment ocular structures is believed to cause an increase in intraocular pressure (IOP) resulting in pseudoexfoliation glaucoma (PEXG). The onset of PEXG is often bilateral but asymmetric-one eye often presents with glaucoma prior to the other eye. Proteomics has been used to identify key proteins involved in PEXM formation with the end goal of developing effective treatments for PEX and PEXG which may act through inhibiting the formation of the PEX aggregates. To date, a variety of proteins with various molecular functions have been identified from extracted anterior segment structures and fluids, such as aqueous humor (AH) and blood serum of patients affected by PEX. From past studies, some proteins identified in AH, lens capsule epithelium, iris tissue, and blood serum samples include vitamin D binding protein (GC), apolipoprotein A4 (APOA4), lysyl oxidase like-1 (LOXL1), complement C3, beta-crystalline B1, and B2, and antithrombin-III (SERPINC1). Each of these proteins have been observed in eyes with PEX at varying levels within the different eye structures. In this review, we further examine the anterior segment ocular proteomics of PEXM from past studies to better understand the mechanism of PEX and PEXG development. Both genetic and environmental risk factors have been implicated to be involved in the development of PEX and PEXG. This field is at an early stage of investigation identifying how these factors modify proteins both at the expression and functional level to cause changes leading to the pathophysiology of PEX glaucoma.
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- 2021
41. Elderly woman with a bleb leak
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Catherine Q. Sun, Richard K. Lee, and Eileen C. Bowden
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Leak ,medicine.medical_specialty ,Bleb ,genetic structures ,business.industry ,Bleb-related infection ,Fistula ,Glaucoma ,Case Report ,RE1-994 ,Macular degeneration ,medicine.disease ,eye diseases ,Surgery ,Ophthalmology ,Intravitreal injection ,Conjunctival Cyst ,medicine ,Cyst ,sense organs ,Bleb (medicine) ,business ,Complication ,Filtering surgery - Abstract
Purpose To describe a unique incidence of inadvertent filtering bleb creation after intravitreal injections. Observations An 84-year-old woman with a history of wet age-related macular degeneration requiring intravitreal injections presented with a Seidel-positive conjunctival cyst. The cyst was in an area where she had received multiple injections and was suspected to be an inadvertent filtering bleb secondary to a full-thickness scleral hole created by these injections. She underwent surgical closure of the fistula and repair of the bleb. Conclusions and Importance This case emphasizes the importance of recognizing this potential complication of intraocular injections and outlines steps that should be taken to prevent poor outcomes and vision loss.
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- 2021
42. Primary slow-coagulation transscleral cyclophotocoagulation laser treatment for medically recalcitrant neovascular glaucoma
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Ying Han, Mohamed M Khodeiry, Alison J Lauter, Richard K. Lee, and Mohamed S Sayed
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medicine.medical_specialty ,Intraocular pressure ,Visual acuity ,genetic structures ,business.industry ,Laser treatment ,Glaucoma ,Neovascular glaucoma ,Retrospective cohort study ,medicine.disease ,Sensory Systems ,Surgery ,Cellular and Molecular Neuroscience ,Ophthalmology ,Postoperative visit ,medicine ,In patient ,medicine.symptom ,business - Abstract
AimsTo report treatment outcomes of slow-coagulation continuous-wave transscleral cyclophotocoagulation (TSCPC) as an initial surgical intervention in patients with neovascular glaucoma (NVG).MethodsA retrospective study including 53 patients (mean age of 69.6±16.6 years and mean follow-up of 12.7±8.9 months) with a diagnosis of NVG and no previous incisional glaucoma or cyclophotocoagulation surgeries. All patients underwent slow-coagulation continuous-wave TSCPC (1250-milliwatt power and 4-second duration).Primary outcome measure was surgical success defined as an intraocular pressure (IOP) from 6 to 21 mm Hg with a reduction ≥20% from baseline, no reoperation for glaucoma and no loss of light perception vision. Secondary outcome measures include IOP, glaucoma medications, visual acuity (VA) and complications.ResultsIOP decreased from 40.7±8.6 mm Hg preoperatively to 18.4±12.2 mm Hg postoperatively (pConclusionsSlow-coagulation TSCPC is an effective and relatively safe initial surgical intervention in medically uncontrolled NVG.
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- 2021
43. The association of cerebrospinal fluid pressure with optic nerve head and macular vessel density
- Author
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Qing Zhang, Mohamed M. Khodeiry, Jiawei Wang, Richard K. Lee, Yunxiao Sun, Ningli Wang, Danting Lin, and Xiangxiang Liu
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Adult ,medicine.medical_specialty ,genetic structures ,Optic Disk ,General Biochemistry, Genetics and Molecular Biology ,Ocular perfusion ,Vessel density ,Cerebrospinal Fluid Pressure ,Ophthalmology ,Healthy volunteers ,Medicine ,Humans ,Fluorescein Angiography ,Intraocular Pressure ,General Environmental Science ,business.industry ,Retinal Vessels ,Optical coherence tomography angiography ,eye diseases ,Blood pressure ,Optic nerve ,ON - Optic nerve ,sense organs ,Cerebrospinal fluid pressure ,General Agricultural and Biological Sciences ,business ,Glaucoma, Open-Angle ,Tomography, Optical Coherence - Abstract
The present study aims to investigate the effect of temporary cerebrospinal fluid pressure (CSFP) reduction on optic nerve head (ONH) and macular vessel density (VD) using optical coherence tomography angiography. Forty-four eyes of 44 adults with diagnostic lumbar puncture and CSFP reduction were recruited. Thirty-two eyes of 32 healthy volunteers were controls. ONH and macular VD images were evaluated differences between baseline and after CSFP reduction. The results showed that the mean CSFP decreased from (11.6±2.1) mmHg to (8.2±3.4) mmHg (P 0.05). In the study group, decreased VD in the macular parainferior region was associated with CSFP reduction (R2=0.192, P=0.003), the reduction of macular VD in parafoveal (R2=0.098, P=0.018), parainferior (R2=0.104, P=0.021), parasuperior (R2=0.059, P=0.058), paranasal (R2=0.057, P=0.042), paratemporal (R2=0.079, P=0.026) was associated with mean ocular perfusion pressure decrease following CSFP reduction. ONH vessel density did not differ after CSFP reduction (all P>0.05). In conclusion, macular vessel density decreased in association with CSFP reduction. Retinal vessel density in the macular region is more sensitive than that in peripapillary region after CSFP reduction.
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- 2021
44. Labeled quantitative proteomics dataset of optogenetics induced axon regeneration in mice
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Faith Christine Harvey, Ximena Mendoza, Yuan Liu, Richard K. Lee, and Sanjoy K. Bhattacharya
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Multidisciplinary - Abstract
This labeled quantitative proteomics dataset was collected from a transgenic channel rhodopsin mouse model (Chr2) subjected to light stimulation after traumatic optic nerve crush (ONC). Protein extraction was performed by careful mincing of the tissue in extraction buffer (TEAB, NaCl and SDS). Protein amounts were normalized across samples using dot blot densitometry and ImageJ software. Samples were labeled for quantification using a modified TMTpro™ 16plex Label Reagent Set (Thermo Scientific™) after performing an overnight trypsin digestion. Untargeted liquid chromatography-mass spectrometry was performed on an Easy-nLC 1000 liquid chromatograph coupled to a Q Exactive mass spectrometer (LC-MS/MS). Data analysis was performed using Proteome Discoverer™ 2.5 (Thermo Scientific™). This data has been deposited to the ProteomeXchange (PX) and is available through PRIDE with the identifier PXD032788.
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- 2022
45. Virtual Versus In-Person Surgical Fellowship Interviews and Ranking Variability: the COVID-19 Experience
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Adam L. Rothman, Elizabeth Hodapp, Elizabeth A Vanner, Richard K. Parrish, Elena Bitrian, Anna K. Junk, Swarup S. Swaminathan, Richard K. Lee, Alana L Grajewski, Sarah R. Wellik, Steven J. Gedde, Ta Chen Chang, and Luis E Vazquez
- Subjects
Surgical Fellowship Interviews ,Ranking Variability ,2019-20 coronavirus outbreak ,Coronavirus disease 2019 (COVID-19) ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,MEDLINE ,COVID-19 Experience ,Article ,Confidence interval ,Ranking (information retrieval) ,Cohen's kappa ,Virtual Versus In-Person ,Statistics ,Psychology - Abstract
Objective: To investigate the effect of interview format changes (in-person to virtual, one-to-one to multiple-to-one) necessitated by the COVID-19 travel restrictions on candidate ranking variabilities.Method: In 2018/2019, the glaucoma fellowship interviews were conducted in-person and one-to-one, whereas in 2020, interviews were virtual and multiple (interviewers)-to-one (candidate). We compared ranking ranges of interviewers within the same virtual room (WSR) and not within the same virtual room (NWSR) to assess the effect of this change on ranking variabilities. We also compared ranking categories (“accept,” “alternate,” and “pass”) agreements between in-person and virtual interviews to assess the effect of this change on ranking variabilities.Results: NWSR and WSR mean rankings differed by 1.33 (95% confidence interval difference 0.61 to 2.04, p = 0.0003), with WSR interviewers having less variability than NWSR pairs. The variability of in-person interviews and later virtual interviews showed no differences (weighted Kappa statistic 0.086 for 2018, 0.158 for 2019, and 0.101 for 2020; p < 0.05 for all years). The overall least attractive candidate has the lowest variability; the most attractive candidate has the second lowest variability.Conclusion: Grouping interviewers decreased ranking variabilities, while a change from in-person to virtual interview format did not increase the ranking variabilities.
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- 2021
46. Noncancerous Genitourinary Conditions as a Public Health Priority: Conceptualizing the Hidden Burden
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Jason Lazar, Christine N. Loizou, Sonya S. Brady, Jim Hokanson, William Stuart Reynolds, Britt Conroy, Ryan S. Hsi, Jenna M. Norton, Christine K. Liu, Lona Mody, Christine Bradway, Saadia Miran, Nicole Zhang, Tamara Bavendam, Richard K. Lee, Karen Huss, Siobhan Sutcliffe, Michelle Kim, Adonis Hijaz, Cynthia Neill Epperson, and Annemarie Dowling-Castronovo
- Subjects
Gerontology ,medicine.medical_specialty ,business.industry ,Health Priorities ,Urology ,Public health ,Social ecology ,Interpersonal communication ,Conceptual framework ,Workforce ,Health care ,Medicine ,Life course approach ,Social ecological model ,Humans ,Public Health ,business ,Ecosystem - Abstract
Objective To provide a conceptual framework to guide investigations into burdens of noncancerous genitourinary conditions (NCGUCs), which are extensive and poorly understood. Methods The National Institute of Diabetes and Digestive and Kidney Diseases convened a workshop of diverse, interdisciplinary researchers and health professionals to identify known and hidden burdens of NCGUCs that must be measured to estimate the comprehensive burden. Following the meeting, a subgroup of attendees (authors of this article) continued to meet to conceptualize burden. Results The Hidden Burden of Noncancerous Genitourinary Conditions Framework includes impacts across multiple levels of well-being and social ecology, including individual (ie, biologic factors, lived experience, behaviors), interpersonal (eg, romantic partners, family members), organizational/institutional (eg, schools, workplaces), community (eg, public restroom infrastructure), societal (eg, health care and insurance systems, national workforce/economic output), and ecosystem (eg, landfill waste) effects. The framework acknowledges that NCGUCs can be a manifestation of underlying biological dysfunction, while also leading to biological impacts (generation and exacerbation of health conditions, treatment side effects). Conclusion NCGUCs confer a large, poorly understood burden to individuals and society. An evidence-base to describe the comprehensive burden is needed. Measurement of NCGUC burdens should incorporate multiple levels of well-being and social ecology, a life course perspective, and potential interactions between NCGUCs and genetics, sex, race, and gender. This approach would elucidate accumulated impacts and potential health inequities in experienced burdens. Uncovering the hidden burden of NCGUCs may draw attention and resources (eg, new research and improved treatments) to this important domain of health.
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- 2021
47. Genitourinary Infections Related to Circumcision and the Potential Impact on Male Infertility
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Philip S. Li, Joseph P. Alukal, Nahid Punjani, Quincy Nang, Spyridon P. Basourakos, Marc Goldstein, and Richard K. Lee
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Infertility ,Aging ,medicine.medical_specialty ,030219 obstetrics & reproductive medicine ,Chlamydia ,Genitourinary system ,business.industry ,Urology ,Health Policy ,Gonorrhea ,030232 urology & nephrology ,Public Health, Environmental and Occupational Health ,Balanitis ,medicine.disease ,Dermatology ,Chancroid ,03 medical and health sciences ,Psychiatry and Mental health ,0302 clinical medicine ,Reproductive Medicine ,medicine ,Infection control ,Pharmacology (medical) ,Syphilis ,business - Abstract
Male circumcision (MC) is one of the oldest surgical procedures still completed today. Medical indications for MC include phimosis, recurrent balanitis, cosmesis, and infection prevention. In this review, we mainly focus on the role of MC in the prevention of human immunodeficiency virus, human papillomavirus, herpes simplex virus, gonorrhea, chlamydia, chancroid, and syphilis, and the subsequent impact of these genitourinary infections on male fertility. Overall, many compelling data support that MC may play an essential role in both genitourinary infection prevention and male fertility.
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- 2021
48. Peripapillary Halo in Inflammatory Papillitis of Birdshot Chorioretinopathy
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Xiangxiang Liu, Richard K. Lee, Raquel Goldhardt, Thomas A. Albini, Mohamed S. Sayed, Giovanni Gregori, and Mohamed M. Khodeiry
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medicine.medical_specialty ,genetic structures ,peripapillary halo ,Optic neuropathy ,03 medical and health sciences ,chemistry.chemical_compound ,0302 clinical medicine ,Optical coherence tomography ,Ophthalmology ,medicine ,Peripapillary atrophy ,Original Research ,Retinal pigment epithelium ,optical coherence tomography ,medicine.diagnostic_test ,business.industry ,Fundus photography ,Clinical Ophthalmology ,Retinal ,optic nerve head ,medicine.disease ,Birdshot chorioretinopathy ,eye diseases ,medicine.anatomical_structure ,peripapillary atrophy ,chemistry ,030221 ophthalmology & optometry ,Optic nerve ,sense organs ,business ,030217 neurology & neurosurgery ,birdshot chorioretinitis - Abstract
Mohamed M Khodeiry,1,2 Xiangxiang Liu,1,3 Mohamed S Sayed,1 Raquel Goldhardt,1 Giovanni Gregori,1 Thomas A Albini,1 Richard K Lee1 1Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami Miller School of Medicine, Miami, FL, 33136, USA; 2Research Institute of Ophthalmology, Department of Ophthalmology, Giza, 12557, Egypt; 3Beijing Eye Institute, Beijing Tongren Eye Center, Beijing Tongren Eye Hospital, Capital Medical University, Beijing, 100730, People’s Republic of ChinaCorrespondence: Richard K LeeBascom Palmer Eye Institute, Department of Ophthalmology, University of Miami Miller School of Medicine, 900 NW 17 th Street, Miami, FL 33136, USATel +1 305 326-6400Fax +1 305 547-3658Email rlee@med.miami.eduPurpose: Peripapillary halos (PPH) are peripapillary changes observed surrounding the optic nerve head in normal eyes and eyes with different disorders. Recognizing the microstructure and mechanism of development of these halos will help clinicians understand the different associated retinal and optic nerve head pathologies. We describe the in vivo histological characteristics of PPH in birdshot chorioretinopathy (BSCR).Patients and Methods: This was a prospective observational case-series in a single tertiary referral center. Six eyes of three patients with PPH associated with BSCR were determined through clinical examination, fundus photography, and fundus autofluorescence (FAF). Patients underwent swept-source optical coherence tomography (SS-OCT) imaging of the optic nerve head and peripapillary region.Results: In SS-OCT B-scans across the area of PPH, we observed thinning and interruption of retinal pigment epithelium (RPE)-Bruch’s membrane complex. These halos are a circumferential form of alpha zone RPE-associated crescentic peripapillary atrophy (PPA), unlike the PPH observed with myopia and normal aging.Conclusion: PPH in BSCR patients may be a sign of prior inflammatory optic neuropathy.Keywords: birdshot chorioretinitis, optical coherence tomography, optic nerve head, peripapillary halo, peripapillary atrophy
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- 2021
49. Burden of Trabeculectomy and Glaucoma Drainage Implantation after Laser Trabeculoplasty: A Two-Year Follow-up Study
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Rachel H, Lee, Richard K, Lee, and Louis R, Pasquale
- Subjects
Aged, 80 and over ,Lasers ,Humans ,Glaucoma ,Ocular Hypertension ,Trabeculectomy ,Glaucoma Drainage Implants ,Medicare ,Glaucoma, Open-Angle ,United States ,Aged ,Follow-Up Studies ,Retrospective Studies - Abstract
To evaluate the burden of incisional glaucoma surgery (trabeculectomy and glaucoma drainage device implantation) after laser trabeculoplasty (LTP) in the United States.Retrospective, matched, case-comparison study.Medicare beneficiaries who underwent LTP between January 2012 and December 2014 were identified using the 5% Medicare Current Beneficiary Survey.Subjects aged 35 years or older at the time of LTP with ocular hypertension, suspected glaucoma, or mild open-angle glaucoma (OAG) were matched to a comparison group without LTP on the basis of age, gender, race, geographic region, and glaucoma diagnosis codes. Survival analysis and Cox proportional hazard analysis were performed.Primary analysis included risk of incisional glaucoma surgery. Secondary analysis included risk of conversion to moderate or severe OAG based on billing data.The mean age of study participants was 75.0 ± 8.9 years. After 2 years, 40 of 2435 eyes required incisional glaucoma surgery after LTP, and 51 of 2435 eyes required glaucoma surgery in the comparison group (P = 0.27, adjusted for covariates). Regardless of intervention, Black Americans were more likely to require glaucoma surgery (hazard ratio [HR], 1.89; 95% confidence interval [CI], 1.13-3.17). Patients with a diagnosis of OAG were more likely to require surgery than glaucoma suspects (HR, 2.03; 95% CI, 1.12-3.69). Black Americans were also more likely to require surgery or convert to more severe glaucoma (HR, 3.21; 95% CI, 1.92-5.37) versus White Americans.Laser trabeculoplasty did not alter the need for subsequent incisional glaucoma surgery among glaucoma suspects or patients with mild OAG. Regardless of treatment with LTP, African heritage and OAG diagnosis status were risk factors for requiring glaucoma surgery.
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- 2021
50. New Endoscopic In-office Surgical Therapies for Benign Prostatic Hyperplasia: A Systematic Review
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Spyridon P. Basourakos, Michael Tzeng, Jim C. Hu, Richard K. Lee, and Patrick Lewicki
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Male ,medicine.medical_specialty ,Urology ,030232 urology & nephrology ,Prostatic Hyperplasia ,Context (language use) ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Randomized controlled trial ,Lower Urinary Tract Symptoms ,Lower urinary tract symptoms ,law ,medicine ,Humans ,Prospective Studies ,Intensive care medicine ,Prostatic urethral lift ,Retrospective Studies ,Modalities ,business.industry ,Retrospective cohort study ,Hyperplasia ,medicine.disease ,Clinical trial ,Steam ,030220 oncology & carcinogenesis ,business - Abstract
Context In recent years, new technologies have been developed to treat benign prostatic enlargement (BPE). Three of these devices may be utilized in office and are promising additions. Objective To systematically review all clinical trials investigating prostatic urethral lift (PUL), water vapor thermal therapy (WVTT), and temporary implantable nitinol device (TIND), with emphasis on clinical efficacy and complications. Evidence acquisition We performed a systematic review of PubMed/Medline database in November 2020 according to Preferred Reporting Items for Systematic Review and Meta-analysis guidelines. Evidence synthesis Of 168 articles identified, 18 met the inclusion criteria. Evidence consisted of few randomized controlled trials, and multiple single-arm prospective and retrospective studies. Among the three modalities, PUL demonstrates rare occurrence of serious complications but higher retreatment rates at short- and long-term follow-up. WVTT offers lower retreatment rates with a similar safety profile. TIND studies report varying rates of retreatment and complications. All technologies offer low rates of erectile and ejaculatory dysfunction, although the risk appears to be highest for WVTT ( Conclusions Among the emerging technologies introduced to treat BPE, the in-office PUL, WVTT, and TIND systems are valuable additions to the current surgical options. These systems offer unique advantages that should be considered in the shared decision-making process. Patient summary In this report, we identified all clinical trials reporting on the efficacy and safety of the in-office prostatic urethral lift (PUL), water vapor thermal therapy (WVTT), and temporary implantable nitinol device (TIND) systems for the treatment of benign prostatic enlargement. We found that PUL and WVTT demonstrate acceptable outcomes in terms of functional improvement, retreatment, and complications. More data with longer follow-up are required to further evaluate TIND, but early results are promising.
- Published
- 2021
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