Charles C. Lin, MD

All Publications

• Tissue Loss During Eye Bank Processing. JAMA ophthalmology Naranjo, A., Clover, J., Chamberlain, W., Stoeger, C. G., Lin, C. C., Rose-Nussbaumer, J. 2024

  View details for DOI 10.1001/jamaophthalmol.2024.1336

  View details for PubMedID 38753323

• Using Electronic Health Record Data to Determine the Safety of Aqueous Humor Liquid Biopsies for Molecular Analyses. Ophthalmology science Wolf, J., Chemudupati, T., Kumar, A., Franco, J. A., Montague, A. A., Lin, C. C., Lee, W. S., Fisher, A. C., Goldberg, J. L., Mruthyunjaya, P., Chang, R. T., Mahajan, V. B. 2024; 4 (5): 100517

  Abstract

  Knowing the surgical safety of anterior chamber liquid biopsies will support the increased use of proteomics and other molecular analyses to better understand disease mechanisms and therapeutic responses in patients and clinical trials. Manual review of operative notes from different surgeons and procedures in electronic health records (EHRs) is cumbersome, but free-text software tools could facilitate efficient searches.Retrospective case series.A total of 1418 aqueous humor liquid biopsies from patients undergoing intraocular surgery.Free-text EHR searches were performed using the Stanford Research Repository cohort discovery tool to identify complications associated with anterior chamber paracentesis and subsequent endophthalmitis. Complications of the surgery unrelated to the biopsy were not reviewed.Biopsy-associated intraoperative complications and endophthalmitis.A total of 1418 aqueous humor liquid biopsies were performed by 17 experienced surgeons. EHR free-text searches were 100% error-free for surgical complications, >99% for endophthalmitis (<1% false positive), and >93.6% for anesthesia type, requiring manual review for only a limited number of cases. More than 85% of cases were performed under local anesthesia without ocular muscle akinesia. Although the most common indication was cataract (50.1%), other diagnoses included glaucoma, diabetic retinopathy, uveitis, age-related macular degeneration, endophthalmitis, retinitis pigmentosa, and uveal melanoma. A 50- to 100-μL sample was collected in all cases using either a 30-gauge needle or a blunt cannula via a paracentesis. The median follow-up was >7 months. There was only one minor complication (0.07%) identified: a case of a small tear in Descemet membrane without long-term sequelae. No other complications occurred, including other corneal injuries, lens or iris trauma, hyphema, or suprachoroidal hemorrhage. There was no case of postoperative endophthalmitis.Anterior chamber liquid biopsy during intraocular surgery is a safe procedure and may be considered for large-scale collection of aqueous humor samples for molecular analyses. Free-text EHR searches are an efficient approach to reviewing intraoperative procedures.Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

  View details for DOI 10.1016/j.xops.2024.100517

  View details for PubMedID 38881613

  View details for PubMedCentralID PMC11179400

• Descemet Endothelial Thickness Comparison Trial 1 (DETECT 1): outcome masked, placebo-controlled trial comparing two types of corneal transplant surgeries and effect of rho kinase inhibitors on endothelial cell loss protocol. BMJ open ophthalmology Chamberlain, W., Lin, C. C., Li, J. Y., Gensheimer, W., Clover, J., Jeng, B. H., Varnado, N., Abdelrahman, S., Arnold, B. F., Lietman, T. M., Rose-Nussbaumer, J. 2024; 9 (1)

  Abstract

  It remains uncertain which endothelial keratoplasty (EK) technique yields the best outcomes while maintaining safety, particularly in eyes with coexisting ocular conditions. Moreover, the impact of endothelial cell loss (ECL) on long-term graft survival requires further investigation. Adjuvant ripasudil, a rho kinase inhibitor, may address the challenge of ECL in corneal transplantation. This paper presents the protocol for the Descemet Endothelial Thickness Comparison Trial 1 (DETECT 1), a multicentre, outcome-masked, randomised, placebo-controlled, four-arm clinical trial.A total of 160 eligible patients with endothelial dysfunction will be enrolled from five participating sites in the USA. The patients will be randomly assigned in a 2×2 factorial design to one of the following treatment groups: group 1-ultrathin Descemet stripping endothelial keratoplasty (UT-DSAEK) plus topical ripasudil 0.4%; group 2-UT-DSAEK plus topical placebo; group 3-Descemet membrane endothelial keratoplasty (DMEK) plus topical ripasudil 0.4% and group 4-DMEK plus topical placebo. Primary outcomes include the best spectacle-corrected visual acuity at 12 months and ECL at 12 months. Secondary outcomes include visual acuity at different time points, vision-related quality of life, endothelial cell morphology and cost-effectiveness.The study outcomes will be analysed using mixed effects linear regression models, taking into account the treatment arms and relevant covariates. Adverse events, including rebubble procedures, graft failure and graft rejection, will be documented and analysed using appropriate statistical methods.DETECT I aims to provide evidence on the comparative effectiveness of UT-DSAEK and DMEK, as well as the potential benefits of adjuvant topical ripasudil in reducing ECL. The results of this trial will contribute to optimising corneal transplantation techniques and improving long-term graft survival, while also exploring the cost-effectiveness of these interventions. Dissemination of findings through peer-reviewed publications and national/international meetings will facilitate knowledge translation and guide clinical practice in the field of corneal transplantation.A data and safety monitoring committee (DSMC) has been empaneled by the NEI.All study protocols will be subject to review and approval by WCG IRB as the single IRB of record.This study will comply with the National Institute of Health (NIH) Data Sharing Policy and Policy on the Dissemination of NIH-Funded Clinical Trial Information and the Clinical Trials Registration and Results Information Submission rule. Data from the trial will be made available on reasonable request.

  View details for DOI 10.1136/bmjophth-2023-001454

  View details for PubMedID 38286566

• Toric Monofocal Intraocular Lenses for the Correction of Astigmatism during Cataract Surgery: A Report by the American Academy of Ophthalmology. Ophthalmology Al-Mohtaseb, Z., Steigleman, W. A., Pantanelli, S. M., Lin, C. C., Hatch, K. M., Rose-Nussbaumer, J. R., Santhiago, M., Olsen, T. W., Kim, S. J., Schallhorn, J. M. 2023

  Abstract

  To review the published literature evaluating the visual and refractive outcomes and rotational stability of eyes implanted with toric monofocal intraocular lenses (IOLs) for the correction of keratometric astigmatism during cataract surgery and to compare those outcomes with outcomes of eyes implanted with nontoric monofocal IOLs and other astigmatism management methods performed during cataract surgery. This assessment was restricted to the toric IOLs available in the United States.A literature search of English-language publications in the PubMed database was last conducted in July 2022. The search identified 906 potentially relevant citations, and after review of the abstracts, 63 were selected for full-text review. Twenty-one studies ultimately were determined to be relevant to the assessment criteria and were selected for inclusion. The panel methodologist assigned each a level of evidence rating; 12 studies were rated level I and 9 studies were rated level II.Eyes implanted with toric IOLs showed excellent postoperative uncorrected distance visual acuity (UCDVA), reduction of postoperative refractive astigmatism, and good rotational stability. Uncorrected distance visual acuity was better and postoperative cylinder was lower with toric IOLs, regardless of manufacturer, when compared with nontoric monofocal IOLs. Correcting pre-existing astigmatism with toric IOLs was more effective and predictable than using corneal relaxing incisions (CRIs), especially in the presence of higher magnitudes of astigmatism.Toric monofocal IOLs are effective in neutralizing pre-existing corneal astigmatism at the time of cataract surgery and result in better UCDVA and significant reductions in postoperative refractive astigmatism compared with nontoric monofocal IOLs. Toric IOLs result in better astigmatic correction than CRIs, particularly at high magnitudes of astigmatism.Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

  View details for DOI 10.1016/j.ophtha.2023.10.010

  View details for PubMedID 38149945

• Mediators of Visual Acuity in Descemet Membrane Endothelial Keratoplasty and Ultrathin Descemet Stripping Automated Endothelial Keratoplasty. Cornea Lin, C. C., Chamberlain, W. D., Kakigi, C., Arnold, B. F., Rose-Nussbaumer, J. 2023

  Abstract

  The aim of this study was to investigate mediators of visual acuity in ultrathin Descemet stripping automated endothelial keratoplasty (UT-DSAEK) compared with Descemet membrane endothelial keratoplasty (DMEK).This was a prespecified secondary analysis of the Descemet Endothelial Thickness Comparison Trial, a prospective, randomized controlled trial comparing UT-DSAEK with DMEK. Subjects with Fuchs endothelial dystrophy or pseudophakic bullous keratopathy presenting to 2 academic centers were enrolled and randomized to either UT-DSAEK (n = 25 eyes) or DMEK (n = 25 eyes). Higher order aberrations (HOAs) and corneal densitometry were measured with Pentacam Scheimpflug imaging at 3, 6, 12, and 24 months.The posterior corneal surface at the 6.0-mm optical zone had significantly less total HOAs (P <0.001) in the DMEK group compared with UT-DSAEK at 24 months. Anterior and posterior corneal densitometry improved from baseline to 24 months for both UT-DSAEK and DMEK, but there was no significant difference between the 2 groups. Corneal densitometry and posterior HOAs were both associated with best-corrected visual acuity (P <0.05). DMEK had 1.3 logarithm of the minimum angle of resolution better visual acuity compared with UT-DSAEK at 24 months. Approximately 64% of this effect was mediated through posterior HOAs, whereas none was mediated through anterior HOAs or densitometry.Decreased posterior HOAs mediate better visual acuity and account for improved vision after DMEK compared with UT-DSAEK. Corneal light scatter as measured by densitometry is similar between UT-DSAEK and DMEK, indicating that the increased thickness and stromal-stromal interface in UT-DSAEK do not significantly affect visual acuity.

  View details for DOI 10.1097/ICO.0000000000003434

  View details for PubMedID 37986182

• Clinical characteristics and management of non-infectious necrotizing scleritis Khatri, A., Uludag, G., Akhavanrezayat, A., Karaca, I., Yavari, N., Than, N., Shin, Y., Yasar, C., Ahmed, M., Mobasserian, A., Jison, L., Xian, T., Lin, C., Yu, C., Nguyen, Q. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2023

  View details for Web of Science ID 001053795605349

• Effect of Simultaneous Endothelial Keratoplasty and Cataract Surgery: A Secondary Analysis of the Descemet Endothelial Thickness Comparison Trial. Cornea Chamberlain, W., Lin, C. C., Yue, J., Cavallino, V., Benetz, B. A., Lass, J. H., Arnold, B., Lietman, T. M., Rose-Nussbaumer, J. 2023

  Abstract

  Combining cataract surgery with endothelial keratoplasty (triple EK) is a common practice and may be safer because it commits the patient to only one surgery. This study aimed to determine whether outcomes of pseudophakic endothelial keratoplasty and triple EK have similar outcomes.This was a non-prespecified secondary analysis of a multicenter, double-masked, randomized, controlled clinical trial. Enrollment centers included the Casey Eye Institute at Oregon Health and Sciences University and the Byers Eye Institute at Stanford University. Patients with damaged or diseased endothelium and were considered good candidates for either Descemet membrane endothelial keratoplasty or ultrathin Descemet stripping automated endothelial keratoplasty were randomized to one of the two surgeries 1-2 days prior to surgery. If the patient had a cataract, they underwent simultaneous cataract surgery. The primary outcome was visual acuity at 6 months. Visual acuity at 3, 12, and 24 months, 3, 6, 12, and 24 month endothelial cell density and intraoperative and postoperative complications were also recorded.Those who had pseudophakic EK generally were older, more likely to be male, and more likely to have worse baseline vision with higher corneal densitometry values. After controlling for baseline visual acuity and type of keratoplasty, those that underwent Triple-EK had 0.09 better LogMAR lines better visual acuity at 6 (95% CI -0.17 to -0.10; P = 0.02) and 12 months (95% CI -0.21 to -0.07; P = 0.03). Although those receiving Triple- EK had nearly one-half LogMAR line better visual acuity at 24 months, it was no longer statistically significant (95% CI -0.20 to -0.05; P = 0.36). There was no statistically significant difference in ECD between groups at any timepoint. Those undergoing triple EK were more likely to have at least one adverse event (P = 0.02).Earlier intervention with Triple-EK may improve visual acuity outcomes after endothelial keratoplasty compared with staged procedures, but may also increase the risks of adverse events including the need for re-bubble.NCT02373137.

  View details for DOI 10.1097/ICO.0000000000003306

  View details for PubMedID 37167477

• Preparing the Ocular Surface for a Boston Keratoprosthesis Type 1 Through En Bloc Minor Salivary Gland Transplantation and Mucous Membrane Grafting in End-Stage Stevens-Johnson Syndrome. Cornea Arboleda, A., Phansalkar, R., Amescua, G., Lee, W. S., Brandt, J. D., Mannis, M. J., Kossler, A. L., Lin, C. C. 2023

  Abstract

  This case describes the successful visual restoration of a patient with end-stage Stevens-Johnson syndrome (SJS) with a severely keratinized ocular surface.This study is a case report.A 67-year-old man with SJS secondary to allopurinol sought visual rehabilitation options. His ocular surface was severely compromised from sequelae of chronic SJS, leaving him with light perception vision bilaterally. The left eye was completely keratinized with severe ankyloblepharon. The right eye had failed penetrating keratoplasty, limbal stem cell deficiency, and a keratinized ocular surface. The patient declined both a Boston type 2 keratoprosthesis and a modified osteo-odonto keratoprosthesis. Therefore, a staged approach was pursued with (1) systemic methotrexate to control ocular surface inflammation, (2) minor salivary gland transplant to increase ocular surface lubrication, (3) lid margin mucous membrane graft to reduce keratinization, and finally, (4) Boston type 1 keratoprosthesis for visual restoration. After minor salivary gland transplant and mucous membrane graft, the Schirmer score improved from 0 mm to 3 mm with improvement in ocular surface keratinization. This approach successfully restored the vision to 20/60, and the patient has retained the keratoprosthesis for over 2 years.Sight restoration options are limited in patients with end-stage SJS with a keratinized ocular surface, aqueous and mucin deficiency, corneal opacification, and limbal stem cell deficiency. This case demonstrates successful ocular surface rehabilitation and vision restoration in such a patient through a multifaceted approach that resulted in successful implantation and retention of a Boston type 1 keratoprosthesis.

  View details for DOI 10.1097/ICO.0000000000003262

  View details for PubMedID 37159138

• Descemet stripping only for Descemet's membrane detachment and sectoral corneal edema. American journal of ophthalmology case reports Khan, N. C., Lin, C. C. 2023; 29: 101784

  Abstract

  To describe a case of corneal decompensation in the setting of a Descemet's membrane detachment that developed following aborted Hydrus minimally invasive glaucoma surgery (MIGS) that was successfully treated with a Descemet's stripping only procedure.A 75 year-old female patient presented with symptomatic corneal decompensation following complicated Hydrus MIGS surgery. Ocular coherence tomography demonstrated an inferonasal Descemet's detachment with overlying edema. Specular microscopy revealed undetectable cells centrally but a peripheral cell density of 1446 cells/mm2. The Descemet's detachment did not respond to an intracameral air injection and a subsequent Descemet's stripping only procedure was performed. The corneal edema resolved by postoperative week 6. At postoperative month 2, best corrected visual acuity was 20/40 and specular microscopy demonstrated central cell density of 975 cells/mm2.Descemet's stripping only can be an effective treatment for some cases of corneal decompensation that occur in the setting of a Descemet's membrane detachment from complicated intraocular surgery, such as in this case with MIGS surgery.

  View details for DOI 10.1016/j.ajoc.2022.101784

  View details for PubMedID 36619161

  View details for PubMedCentralID PMC9811206

• Intraoperative optical coherence tomography-guided deep anterior lamellar keratoplasty. Taiwan journal of ophthalmology Lin, C. C., Lee, W. S. 2023; 13 (1): 106-109

  Abstract

  Gauging stromal dissection depth is crucial to successfully perform deep anterior lamellar keratoplasty (DALK) surgery. Intraoperative optical coherence tomography (iOCT) offers a promising tool to aid DALK surgery but visualization of surgical maneuvers is impaired due to artifacts from metallic instruments. We describe a novel surgical technique utilizing suture-assisted iOCT guidance that facilitates clear visualization of corneal dissection planes during DALK. A stromal dissection tunnel is performed with a Fogla probe and its depth is subsequently identified by threading a 1 cm segment of 8-0 nylon into the tunnel. In contrast to the Fogla probe, the 8-0 nylon is conspicuously highlighted on iOCT. If the tunnel is too superficial, a separate, deeper stromal tunnel can be created and visualized again with the 8-0 nylon suture and iOCT. This iterative process facilitates a deep stromal dissection, increasing the probability of successful big-bubble formation and Descemet baring DALK surgery. This technique was utilized for a successful big-bubble DALK in a patient with severe keratoconus.

  View details for DOI 10.4103/tjo.TJO-D-22-00151

  View details for PubMedID 37252175

  View details for PubMedCentralID PMC10220450

• Intraoperative optical coherence tomography-guided deep anterior lamellar keratoplasty TAIWAN JOURNAL OF OPHTHALMOLOGY Lin, C., Lee, W. 2023; 13 (1): 106-109

  View details for DOI 10.4103/tjo.TJO-D-22-00151

  View details for Web of Science ID 000961070300019

• Re: Lin et al.: Femtosecond laser-assisted cataract surgery: A Report by the American Academy of Ophthalmology (Ophthalmology. 2022;129:946-954) REPLY OPHTHALMOLOGY Lin, C. C., Kim, S. J., Schallhorn, J. M. 2022; 129 (12): E159-E160

  View details for Web of Science ID 000936528400005

• A Randomized Trial of Topical Fibrinogen-Depleted Human Platelet Lysate Treatment of Dry Eye Secondary to Chronic Graft-versus-Host Disease. Ophthalmology science Sugar, A., Hussain, M., Chamberlain, W., Dana, R., Kelly, D. P., Ta, C., Irvine, J., Daluvoy, M., Perez, V., Olson, J., Jhanji, V., Walts, T. A., Stulting, R. D., Waller, E. K., Jagirdar, N., Cambium Dry Eye Study Group, Sugar, A., Mian, S., Shtein, R., Soong, H. K., Hussain, M., Chamberlain, W., Nanji, A., Clements, J., Maykovski, J., Labadzinzki, P. C., Dana, R., Jin, J., Ciolino, J., Caccaviello, J., Kelly, D. P., Habibi, R., Ta, C., Yu, C., Lin, C., Hirabayashi, K., Valerio, G., Kawale, S., Nunez, M., Irvine, J., Lee, O., Chu, M., Daluvoy, M., Perez, V., Balajonda, E., Hawks, T., Olson, J., Maltry, A., Hou, J., Elasky, W., Jhanji, V., Carla Aubourg, R., Stulting, R. D., Waller, E., Jagirdar, N., Walts, T. 2022; 2 (3): 100176

  Abstract

  Purpose: The purpose of the study was to evaluate, as a pilot trial, safety and tolerability of CAM-101 10% and 30% topical ophthalmic fibrinogen-depleted human platelet lysate (FD hPL) solution in patients with dry eye disease (DED) secondary to graft-versus-host disease (GvHD) after 6 weeks of treatment.Design: A phase I/II, pilot, prospective, multicenter, randomized, double-masked clinical trial.Participants: Patients with DED secondary to GvHD.Methods: Sixty-four adult patients were stratified by "symptom severity" (Ocular Surface Disease Index [OSDI], ocular discomfort Visual Analog Scale (VAS), ocular symptom frequency, and use of artificial tears) and then randomized 1:1:1 to CAM-101 (FD hPL) at 10% or 30% concentration or an electrolyte (Plasma-Lyte A) vehicle control, 1 drop in both eyes, 4 times daily, for 42 days. After 42 days, control patients were offered 42 days of open-label treatment with 30% FD hPL.Main Outcome Measures: Primary outcome safety measures were ocular and systemic adverse events and the number of patients in each group with clinically significant change from normal to abnormal in any ocular findings. Secondary outcomes were changes from baseline to day 42 in ocular discomfort, OSDI, fluorescein corneal staining, and lissamine green conjunctival staining relative to the vehicle control. The ocular symptom frequency was assessed on a 100-point VAS.Results: FD hPL 10% and 30% were safe and well tolerated. Relative to the vehicle control, significant decreases from baseline to day 42 were seen in the FD hPL 30% group with regard to ocular discomfort (mean decrease=-18.04; P=0.018), frequency of burning/stinging (-20.23; P=0.022), eye discomfort (-32.97; P < 0.001), eye dryness (-21.61; P=0.020), pain (-15.12; P=0.044), photophobia (-24.33; P=0.0125), and grittiness (-20.08; P=0.0185). Decreases were also seen for itching and foreign body sensation, though not statistically significant. Improvements were seen in tear breakup time (mean increase= 1.30 seconds; P=0.082) and the investigator's global evaluation 4-point scale (mean decrease=-0.86; P=0.026). Corneal fluorescein staining was not improved. The OSDI had a mean decrease of-8.88 compared to the vehicle, although not statistically significant.Conclusions: Fibrinogen-depleted human platelet lysate appears to be well tolerated, with no significant toxicity at concentrations of 10% and 30%. These initial data suggest some efficacy, especially for subjective outcome measures relative to baseline assessments and treatment with the vehicle, but larger studies are needed to confirm these effects.

  View details for DOI 10.1016/j.xops.2022.100176

  View details for PubMedID 36245754

• Changes in Corneal Power up to Two Years after Endothelial Keratoplasty: Results from the Randomized Controlled DETECT Trial. American journal of ophthalmology Chamberlain, W., Shen, E., Werner, S., Lin, C., Rose-Nussbaumer, J. 2022

  Abstract

  PURPOSE: To compare changes in corneal power measurements after Descemet membrane endothelial keratoplasty (DMEK) vs. ultrathin Descemet stripping automated endothelial keratoplasty (UT-DSAEK).SETTING: Hospital centers DESIGN: : Post-hoc sub-analysis of the randomized controlled DETECT Trial METHODS: : 50 eyes (38 patients) with endothelial dysfunction from Fuchs' endothelial dystrophy or pseudophakic bullous keratopathy were randomized to DMEK or UT-DSAEK 1 to 2 days prior to surgery. Total Corneal Refractive Power (TCRP) and anterior/posterior simulated keratometry were obtained using Scheimpflug imaging preoperatively (baseline) and postoperatively at 3, 6, 12, and 24 months. Spectacle refractions were performed at 6, 12, and 24 months after surgery.RESULTS: Mean hyperopic shift of TCRP from baseline to 12 months was 0.80±1.1 (p=0.002) in the DMEK group and 0.69±0.84 (p<0.001) in the UT-DSAEK group. Posterior corneal curvature (Km) steepened (more negative dioptric power) by 0.42±0.10 (p<0.001) in DMEK and 0.54±0.09 (p<0.001) in UT-DSAEK. Mean change in TCRP and posterior corneal curvature did not differ between DMEK and UT-DSAEK (TCRP, p=0.71; posterior Km, p=0.36).CONCLUSIONS: Sustained steepening in posterior corneal curvature with loss in total corneal power contributes to hyperopic shifts after endothelial keratoplasty. Changes in corneal measurements do not differ between DMEK and UT-DSAEK.

  View details for DOI 10.1016/j.ajo.2022.07.009

  View details for PubMedID 35870491

• PRAME Immunohistochemistry in Conjunctival Melanocytic Lesions Dryden, I., Steinbergs, K., Ahmadian, S., Lin, C., Mruthyunjaya, P., Lin, J. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2022

  View details for Web of Science ID 000844437002195

• Femtosecond Laser-Assisted Cataract Surgery: A Report by the American Academy of Ophthalmology. Ophthalmology Lin, C. C., Rose-Nussbaumer, J. R., Al-Mohtaseb, Z. N., Pantanelli, S. M., Steigleman, W. A., Hatch, K. M., Santhiago, M. R., Kim, S. J., Schallhorn, J. M. 2022

  Abstract

  PURPOSE: To evaluate refractive outcomes, safety, and cost-effectiveness of femtosecond laser-assisted cataract surgery (FLACS) compared with phacoemulsification cataract surgery (PCS).METHODS: A PubMed search of FLACS was conducted in August 2020. A total of 727 abstracts were reviewed and 33 were selected for full-text review. Twelve articles met inclusion criteria and were included in this assessment. The panel methodologist assigned a level of evidence rating of I to all 12 studies.RESULTS: No significant differences were found in mean uncorrected distance visual acuity, best-corrected distance visual acuity, or the percentage of eyes within ± 0.5 and ± 1 diopter of intended refractive target between FLACS and PCS. Intraoperative and postoperative complication rates were similar between the 2 groups, and most studies showed no difference in endothelial cell loss between FLACS and PCS at various time points between 1 and 6 months. In large randomized controlled studies in the United Kingdom and France, FLACS was less cost-effective than PCS.CONCLUSIONS: Both FLACS and PCS have similar excellent safety and refractive outcomes. At this time, one technique is not superior to the other, but economic analyses performed in some populations have shown that FLACS is less cost-effective.

  View details for DOI 10.1016/j.ophtha.2022.04.003

  View details for PubMedID 35570159

• Lirentelimab for Severe and Chronic Forms of Allergic Conjunctivitis. The Journal of allergy and clinical immunology Anesi, S. D., Tauber, J., Nguyen, Q. D., Chang, P., Berdy, G. J., Lin, C. C., Chu, D. S., Levine, H. T., Fernandez, A. D., Roy, N., Asbell, P. A., Kantor, A. M., Chang, A. T., Singh, B., Youngblood, B. A., Jeng, B. H., Jhanji, V., Rasmussen, H. S., Foster, C. S. 2022

  Abstract

  Allergic conjunctivitis (AC) is an ocular inflammatory disease with symptoms driven by eosinophils and mast cells. Allergic comorbidities are common. Current treatments are often ineffective in severe AC and limited by potential side effects. Lirentelimab is an anti-siglec-8 monoclonal antibody that depletes eosinophils and inhibits mast cells.Determine safety and preliminary efficacy of lirentelimab in an open-label, Phase 1b study.Patients with chronic, severely symptomatic atopic keratoconjunctivitis (AKC), vernal keratoconjunctivitis (VKC) and perennial allergic conjunctivitis (PAC), and who had history of topical or systemic corticosteroid use were enrolled to receive up to six monthly lirentelimab infusions (Dose 1: 0.3mg/kg, Dose 2: 1mg/kg, subsequent doses: 1 or 3mg/kg). Changes from baseline of peripheral blood eosinophils, changes in patient-reported symptoms (measured by daily allergic conjunctivitis symptom [ACS] questionnaire, including atopic comorbidities), changes in investigator-reported ocular signs and symptoms (OSS), quality of life, and changes in tear cytokine and chemokine levels were assessed.Thirty patients were enrolled (AKC n=13, VKC n=1, PAC n=16), 87% of whom had atopic comorbidities. Post-lirentelimab treatment, mean improvement was observed in ACS (-61%, 95%CI:-75%, -48%) and OSS (-53%; 95%CI:-76%, -31%), consistent across AKC, VKC, and PAC groups. There was substantial improvement in atopic comorbidities, with -55% (95%CI:-78%, -31%), -50%(95%CI:-82%, -19%), and -63%(95%CI:-87%, -38%) reduction of symptoms of atopic dermatitis, asthma, and rhinitis, respectively. Levels of key mediators of inflammation were reduced in patient tears post-lirentelimab treatment. The most common AEs were mild-to-moderate infusion related reactions.Lirentelimab was well tolerated, improved severe AC and concomitant atopic symptoms, and reduced inflammatory mediators in patient tears.

  View details for DOI 10.1016/j.jaci.2022.03.021

  View details for PubMedID 35390403

• Modified Gundersen Flap Using Inferior Palpebral-Bulbar Conjunctiva. Cornea Mekonnen, B., Kossler, A. L., Lin, C. C. 1800; 41 (2): 260-263

  Abstract

  PURPOSE: The purpose of this article was to describe a modification to the traditional Gundersen flap technique that expands eligible eyes to include those with severe conjunctival scarring and to report results from a clinical case.METHODS: A 68-year-old woman with a history of herpes simplex keratitis, multiple failed penetrating keratoplasties, lagophthalmos, persistent epithelial defect, and low visual potential in the left eye presented for the evaluation of a Gundersen flap. Severe superior bulbar conjunctival scarring precluded a traditional approach. A modified Gundersen flap technique using a contiguous flap of inferior palpebral-bulbar conjunctiva extending from the inferior tarsal border to the limbus was devised and performed.RESULTS: The modified Gundersen flap technique successfully stabilized the ocular surface, obviating the need for a cosmetically disfiguring permanent tarsorrhaphy or an evisceration.CONCLUSIONS: This modified Gundersen flap technique expands the indications to eyes with severe conjunctival scarring and can be offered in eyes with previous trabeculectomies, glaucoma drainage implants, and scleral buckles, which were previously excluded from the globe-preserving option.

  View details for DOI 10.1097/ICO.0000000000002823

  View details for PubMedID 35037907

• Differentiation of Active Corneal Infections From Healed Scars Using Deep Learning. Ophthalmology Tiwari, M., Piech, C., Baitemirova, M., Prajna, N. V., Srinivasan, M., Lalitha, P., Villegas, N., Balachandar, N., Chua, J. T., Redd, T., Lietman, T. M., Thrun, S., Lin, C. C. 2021

  Abstract

  OBJECTIVE: To develop and evaluate an automated, portable algorithm to differentiate active corneal ulcers from healed scars using only external photographs.DESIGN: A convolutional neural network was trained and tested using photographs of corneal ulcers and scars.SUBJECTS: De-identified photographs of corneal ulcers were obtained from the Steroids for Corneal Ulcers Trial (SCUT), Mycotic Ulcer Treatment Trial (MUTT), and Byers Eye Institute at Stanford University.METHODS: Photographs of corneal ulcers (n=1313) and scars (n=1132) from the SCUT and MUTT trials were used to train a convolutional neural network (CNN). The CNN was tested on two different patient populations from eye clinics in India (n=200) and the Byers Eye Institute at Stanford University (n=101). Accuracy was evaluated against gold standard clinical classifications. Feature importances for the trained model were visualized using Gradient-weighted Class Activation Mapping (Grad-CAM).MAIN OUTCOME MEASURE: Accuracy of the CNN was assessed via F1 score. Area under the receiver operating characteristic curve (ROC) was used to measure the precision-recall trade-off.RESULTS: The CNN correctly classified 115/123 active ulcers and 65/77 scars in corneal ulcer patients from India (F1 score: 92.0% (95% CI: 88.2 - 95.8%), sensitivity: 93.5% (95% CI: 89.1 - 97.9%), specificity: 84.42% (95% CI: 79.42 - 89.42%), ROC (AUC=0.9731)). The CNN correctly classified 43/55 active ulcers and 42/46 scars in corneal ulcer patients from Northern California (F1 score: 84.3% (95% CI: 77.2 - 91.4%), sensitivity: 78.2% (95% CI: 67.3 - 89.1%), specificity: 91.3% (95% CI: 85.8 - 96.8%), ROC (AUC=0.9474)). The CNN visualizations correlated with clinically relevant features such as corneal infiltrate, hypopyon, and conjunctival injection.CONCLUSION: The CNN classified corneal ulcers and scars with high accuracy and generalizes to patient populations outside of its training data. The CNN focuses on clinically relevant features when it makes a diagnosis. The CNN demonstrates potential as an inexpensive diagnostic approach that may aid triage in communities with limited access to eye care.

  View details for DOI 10.1016/j.ophtha.2021.07.033

  View details for PubMedID 34352302

• Descemet Endothelial Thickness Comparison Trial: Two-Year Results from a Randomized Trial Comparing Ultrathin Descemet Stripping Automated Endothelial Keratoplasty with Descemet Membrane Endothelial Keratoplasty OPHTHALMOLOGY Rose-Nussbaumer, J., Lin, C. C., Austin, A., Liu, Z., Clover, J., McLeod, S. D., Porco, T. C., Lietman, T. M., Dresner, S. M., Benetz, B., Lass, J. H., Chamberlain, W. D. 2021; 128 (8): 1238-1240

  View details for Web of Science ID 000677479200023

• A novel device for descemetorhexis creation: 3D Printed Prototype Design and Ex Vivo Evaluation Buickians, D., Mbagwu, M., Lin, C. C., Myung, D. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2021

  View details for Web of Science ID 000690761100057

• Predictors of Vision-Related Quality of Life After Endothelial Keratoplasty in the Descemet Endothelial Thickness Comparison Trials. Cornea Pickel, J., Chamberlain, W. D., Lin, C. C., Austin, A., Clover, J., Lietman, T. M., Rose-Nussbaumer, J. 2021; 40 (4): 449–52

  Abstract

  PURPOSE: To determine which baseline characteristics are associated with vision-related quality of life (QOL) after endothelial keratoplasty.METHODS: A patient- and outcome-masked randomized clinical trial. Consecutive patients presenting with isolated endothelial disease requiring endothelial keratoplasty at Oregon Health Sciences University and Stanford University. Study eyes randomized to one of the 2 types of endothelial keratoplasty were given the national eye institute vision function questionnaire 25 at baseline and 12 months. In this prespecified secondary outcome, we assessed the role of recipient and donor characteristics as predictors of the 12-month national eye institute vision function questionnaire 25 change score.RESULTS: The mean vision function questionnaire (VFQ) score was 74 (SD 14) at baseline and increased to 82 (SD 12) at 3 months and 87 (SD 10) at 12 months. We were unable to find a difference in vision-related QOL in study participants who underwent Descemet membrane endothelial keratoplasty compared with ultrathin Descemet stripping endothelial keratoplasty [coef -0.98, 95% confidence interval (CI) -9.27 to 7.31; P = 0.82]. In multivariable analysis, patients who underwent endothelial keratoplasty in 2 eyes had approximately 8 points higher VFQ at 12 months after the second eye than those who had only one eye enrolled (95% CI 0.10-15.72; P = 0.047). Posterior densitometry produced an approximately 1-point increase each in the VFQ change score for each 1 grayscale unit increase at baseline (95% CI 0.26-1.81; P = 0.009). Although the sample size was small, a diagnosis of pseudophakic bullous keratopathy had approximately 19-points more improvement on average compared with Fuchs (95% CI 7.68-30.00; P = 0.001).CONCLUSIONS: Bilateral endothelial keratoplasty resulted in higher vision-related QOL compared with unilateral. Baseline densitometry, objective measure of corneal haze that predicts vision-related QOL, may play a role in monitoring disease progression.

  View details for DOI 10.1097/ICO.0000000000002431

  View details for PubMedID 33881810

• Successful interventions to improve efficiency and reduce patient visit duration in a retina practice. Retina (Philadelphia, Pa.) Lin, C. C., Li, A. S., Ma, H., Lin, X., Olivares, M. Z., Haubrich, A., Sanislo, S., Do, D. V. 2021

  Abstract

  PURPOSE: To reduce the total clinic visit duration among retina providers in an academic ophthalmology department.METHODS: All patient encounters across all providers in the department were analyzed to determine baseline clinic visit duration time, defined as the elapsed time between appointment time and checkout. To increase photography capacity, a major bottleneck identified through root cause analysis, four interventions were implemented: training ophthalmic technicians to perform fundus photography in addition to OCTs, relocating photography equipment to be adjacent to exam rooms, procuring three additional Optos widefield retinal photography units, and shifting staff schedules to better align with that of the providers. These interventions were implemented in the clinics of two retina providers.RESULTS: The average baseline visit duration for all patients across all providers was 87 minutes (19550 patient visits). The prior the average visit duration was 80 minutes for provider 1 (557 patient visits) and 81 minutes for provider 2 (1246 patient visits). In the four weeks after interventions were implemented, the average visit duration decreased to 60 minutes for provider 1 and 57 minutes for provider 2.CONCLUSIONS: A systematic approach and a multi-disciplinary team resulted in targeted, cost-effective interventions that reduced total visit durations.

  View details for DOI 10.1097/IAE.0000000000003169

  View details for PubMedID 33758134

• Comprehensive pathogen detection for ocular infections JOURNAL OF CLINICAL VIROLOGY Doan, T., Sahoo, M. K., Ruder, K., Huang, C., Zhong, L., Chen, C., Hinterwirth, A., Lin, C., Gonzales, J. A., Pinsky, B. A., Acharya, N. R. 2021; 136

  View details for Web of Science ID 000633136500007

• Comprehensive pathogen detection for ocular infections JOURNAL OF CLINICAL VIROLOGY Doan, T., Sahoo, M. K., Ruder, K., Huang, C., Zhong, L., Chen, C., Hinterwirth, A., Lin, C., Gonzales, J. A., Pinsky, B. A., Acharya, N. R. 2021; 136

  View details for Web of Science ID 000633136500010

• Comprehensive pathogen detection for ocular infections. Journal of clinical virology : the official publication of the Pan American Society for Clinical Virology Doan, T. n., Sahoo, M. K., Ruder, K. n., Huang, C. n., Zhong, L. n., Chen, C. n., Hinterwirth, A. n., Lin, C. n., Gonzales, J. A., Pinsky, B. A., Acharya, N. R. 2021; 136: 104759

  Abstract

  Molecular diagnostics such as pathogen-directed PCRs have transformed testing for ocular infections since the late 1990s. Although these assays remain important diagnostic tools for samples with low biomass, the lack of diagnostic range motivates alternative molecular approaches for ocular infections. The aim of this study was to determine the performance of a high-throughput RNA sequencing approach, RNA-seq, to detect infectious agents in ocular samples from patients with presumed ocular infections.We compared the performance of RNA-seq to pathogen-directed PCRs using remnant nucleic acids from 41 aqueous or vitreous samples of patients with presumed ocular infections. Pathogen-directed PCRs were performed at the CLIA-certified Stanford Clinical Virology Laboratory. RNA-seq was performed in a masked manner at the Proctor Foundation at the University of California San Francisco. Percent positive and negative agreement between the two testing approaches were calculated. Discordant results were subjected to orthogonal testing.The positive percent agreement between RNA-seq and pathogen-directed PCRs was 100% (95% confidence interval (CI): 78.5%-100%). The negative percent agreement was 92.6% (95% CI: 76.6%-97.9%). RNA-seq identified pathogens not on the differential diagnosis for 9.7% (4/41) of the samples. Two pathogens solely identified with RNA-seq were confirmed with orthogonal testing.RNA-seq can accurately identify common and rare pathogens in aqueous and vitreous samples of patients with presumed ocular infections. Such an unbiased approach to testing has the potential to improve diagnostics although practical clinical utility warrants additional studies.

  View details for DOI 10.1016/j.jcv.2021.104759

  View details for PubMedID 33609933

• Multifocal and Accommodating Intraocular Lenses for the Treatment of Presbyopia: A Report by the American Academy of Ophthalmology. Ophthalmology Schallhorn, J. M., Pantanelli, S. M., Lin, C. C., Al-Mohtaseb, Z. N., Steigleman, W. A., Santhiago, M. R., Olsen, T. W., Kim, S. J., Waite, A. M., Rose-Nussbaumer, J. R. 2021

  Abstract

  To review the published literature assessing the efficacy and safety of presbyopia-correcting intraocular lenses (IOLs) for the treatment of presbyopia after cataract removal.Literature searches were undertaken in January 2018 and September 2020 in the PubMed, Medline, and Cochrane Library databases. This yielded 761 articles, of which 34 met the criteria for inclusion in this assessment and were assigned a level of evidence rating by the panel methodologist. Thirteen studies were rated level I and 21 studies were rated level II.Presbyopia-correcting lenses were effective at improving distance and near visual acuity after cataract surgery. Near acuity at different focal lengths was related directly to the effective add power of multifocal and extended depth-of-focus (EDOF) IOLs. Most multifocal and EDOF lenses that were compared with a control monofocal lens demonstrated that patient-reported spectacle independence was superior to the monofocal lens. All patients who had multifocal and EDOF lenses implanted showed decreased contrast sensitivity and reported more visual phenomena as compared with control participants who received monofocal lenses.Presbyopia-correcting lenses improve uncorrected near and distance visual acuity and decrease spectacle dependence after cataract surgery. Mesopic contrast sensitivity is decreased compared with monofocal lenses, and patient-reported visual phenomena are more likely in patients receiving multifocal or EDOF lenses.

  View details for DOI 10.1016/j.ophtha.2021.03.013

  View details for PubMedID 33741376

• Intraocular Lens Power Calculation in Eyes with Previous Excimer Laser Surgery for Myopia: A Report by the American Academy of Ophthalmology. Ophthalmology Pantanelli, S. M., Lin, C. C., Al-Mohtaseb, Z. n., Rose-Nussbaumer, J. R., Santhiago, M. R., Steigleman, W. A., Schallhorn, J. M. 2021

  Abstract

  To review the literature to evaluate the outcomes of intraocular lens (IOL) power calculation in eyes with a history of myopic LASIK or photorefractive keratectomy (PRK).Literature searches were conducted in the PubMed database in January 2020. Separate searches relevant to cataract surgery outcomes and corneal refractive surgery returned 1169 and 162 relevant citations, respectively, and the full text of 24 was reviewed. Eleven studies met the inclusion criteria for this assessment; all were assigned a level III rating of evidence by the panel methodologist.When automated keratometry was used with a theoretical formula designed for eyes without previous laser vision correction, the mean prediction error (MPE) was universally positive (hyperopic), the mean absolute errors (MAEs) and median absolute errors (MedAEs) were relatively high (0.72-1.9 diopters [D] and 0.65-1.73 D, respectively), and a low (8%-40%) proportion of eyes were within 0.5 D of target spherical equivalent (SE). Formulas developed specifically for this population requiring both prerefractive surgery keratometry and manifest refraction (i.e., clinical history, corneal bypass, and Feiz-Mannis) produced a proportion of eyes within 0.5 D of target SE between 26% and 44%. Formulas requiring only preoperative keratometry or no history at all had lower MAEs (0.42-0.94 D) and MedAEs (0.30-0.81 D) and higher (30%-68%) proportions within 0.5 D of target SE. Strategies that averaged several methods yielded the lowest reported MedAEs (0.31-0.35 D) and highest (66%-68%) proportions within 0.5 D of target SE. Even after using the best-known methods, refractive outcomes were less accurate in eyes that had previous excimer laser surgery for myopia compared with those that did not have it.Calculation methods requiring both prerefractive surgery keratometry and manifest refraction are no longer considered the gold standard. Refractive outcomes of cataract surgery in eyes that had previous excimer laser surgery are less accurate than in eyes that did not. Patients should be advised of this refractive limitation when considering cataract surgery in the setting of previous corneal refractive surgery. Conclusions are limited by the small sample sizes and retrospective nature of nearly all existing literature in this domain.

  View details for DOI 10.1016/j.ophtha.2020.10.031

  View details for PubMedID 33500124

• Descemet Endothelial Thickness Comparison Trial: Two-year Results from a Randomized Trial Comparing Ultrathin Descemet Stripping Automated Endothelial Keratoplasty to Descemet Membrane Endothelial Keratoplasty. Ophthalmology Rose-Nussbaumer, J., Lin, C. C., Austin, A., Liu, Z., Clover, J., McLeod, S. D., Porco, T. C., Lietman, T. M., Dresner, S. M., Benetz, B. A., Lass, J. H., Chamberlain, W. 2020

  View details for DOI 10.1016/j.ophtha.2020.12.021

  View details for PubMedID 33359556

• Management of acute corneal hydrops with intracameral gas injection. American journal of ophthalmology case reports Sayadi, J. J., Lam, H., Lin, C. C., Myung, D. 2020; 20: 100994

  Abstract

  Purpose: To report two cases of severe acute corneal hydrops that were resolved by intracameral gas injection alone.Observations: Case 1 is a 27-year-old woman with bilateral severe keratoconus who developed sequential acute corneal hydrops in the right eye followed by the left eye that were each successfully treated using intracameral 20% sulfur hexafluoride gas injection. Case 2 is a 62-year-old man that developed a large fluid cleft beneath a pre-existing LASIK flap, which resolved with intracameral 20% sulfur hexafluoride gas injection without the need for corneal transplantation.Conclusions and importance: In acute corneal hydrops, intracameral gas injection to tamponade Descemet's membrane tears with decompression of stromal fluid can be an effective intervention to delay or avoid keratoplasty in individuals whose corneal hydrops does not improve with conventional medical management.

  View details for DOI 10.1016/j.ajoc.2020.100994

  View details for PubMedID 33319122

• Change in Central and Peripheral Corneal Thickness in UT-DSAEK and DMEK in the Descemet Endothelial Thickness Comparison Trial Gutowski, M., Rose-Nussbaumer, J., Lin, C., Austin, A., Labadzinzki, P., Clover, J., Chamberlain, W. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2020

  View details for Web of Science ID 000554528301272

• Phase 1b Study of AK002, an Anti-Siglec-8 Monoclonal Antibody, in Patients with Severe Allergic Conjunctivitis (KRONOS Study) Levine, H., Tauber, J., Nguyen, Q., Anesi, S., Chang, P., Berdy, G., Lin, C., Chu, D., Kantor, A., Rasmussen, H., Singh, B., Chang, A., Jeng, B., Jhanji, V., Foster, C. MOSBY-ELSEVIER. 2020: AB185

  View details for Web of Science ID 000517092700591

• Corneal Light Scatter After Ultrathin Descemet Stripping Automated Endothelial Keratoplasty Versus Descemet Membrane Endothelial Keratoplasty in Descemet Endothelial Thickness Comparison Trial: A Randomized Controlled Trial. Cornea Hirabayashi, K. E., Chamberlain, W., Rose-Nussbaumer, J., Austin, A., Stell, L., Lin, C. C. 2020

  Abstract

  PURPOSE: To compare the degree of corneal light scatter as measured by densitometry in ultrathin Descemet Stripping Automated Endothelial Keratoplasty (UT-DSAEK) and Descemet Membrane Endothelial Keratoplasty (DMEK) in the Descemet endothelial thickness comparison trial.METHODS: This was a prespecified secondary analysis of the Descemet endothelial thickness comparison trial, which was a prospective, randomized controlled trial. Subjects with isolated endothelial dysfunction were enrolled and were randomized to either UT-DSAEK or DMEK. Corneal opacity was quantitatively measured by Pentacam densitometry (OCULUS) at 3, 6, and 12 months.RESULTS: Fifty eyes of 38 patients were enrolled at the Casey Eye Institute at Oregon Health & Science University and the Byers Eye Institute at Stanford University. Corneal densitometry for the anterior and posterior layers improved in both UT-DSAEK and DMEK after surgery. The decrease was more pronounced in the posterior layer for both groups. However, there was no difference in the degree of corneal light scatter between UT-DSAEK and DMEK at postoperative month 12, and no difference in change in densitometry was observed between the 2 arms from baseline to month 12.CONCLUSIONS: Both UT-DSAEK and DMEK experience an improvement in the degree of corneal light scatter after surgery. However, there was no difference in densitometry between the 2 groups at month 12. Therefore, other factors such as higher order aberrations in the posterior cornea rather than stromal-stromal interface haze mediate the superior visual outcomes in DMEK compared with UT-DSAEK.

  View details for DOI 10.1097/ICO.0000000000002256

  View details for PubMedID 31939923

• The Stanford Acuity Test: A Precise Vision Test Using Bayesian Techniques and a Discovery in Human Visual Response Piech, C., Malik, A., Scott, L. M., Chang, R. T., Lin, C., Assoc Advancement Artificial Intelligence ASSOC ADVANCEMENT ARTIFICIAL INTELLIGENCE. 2020: 471-479

  View details for Web of Science ID 000667722800057

• Oral miltefosine for refractory Acanthamoeba keratitis. American journal of ophthalmology case reports Hirabayashi, K. E., Lin, C. C., Ta, C. N. 2019; 16: 100555

  Abstract

  Purpose: To report the first case of Acanthamoeba keratitis treated with oral miltefosine in the United States.Observations: A 17-year-old female with a history of orthokeratology contact lens wear presented after five months of left eye pain, redness, and photophobia. She was previously treated with antivirals and topical corticosteroids for presumed herpetic disease. She was found to have a large central ring infiltrate and corneal cultures were positive for Acanthamoeba. The infection progressed despite hourly PHMB 0.02% and chlorhexidine 0.02%, and oral vorizonazole. The patient was started on oral miltefosine 50 mg 3 times per day. Following one week of treatment, repeat cultures were positive for Acanthamoeba and therefore, the concentration of chlorhexidine was increased from 0.02% to 0.06% and PHMB was changed to propamidine isetionate (Brolene 0.1%). There was definite clinical improvement after five weeks of treatment with oral miltefosine, topical chlorhexidine 0.06% and propamidine isetionate 0.1%.Conclusions and importance: Acanthamoeba keratitis is a challenging entity to treat and often associated with a poor prognosis. Oral miltefosine may offer additional therapeutic benefit in cases of refractory Acanthamoeba keratitis.

  View details for DOI 10.1016/j.ajoc.2019.100555

  View details for PubMedID 31650083

• Effect of Unilateral Endothelial Keratoplasty on Vision-Related Quality-of-Life Outcomes in the Descemet Endothelial Thickness Comparison Trial (DETECT): A Secondary Analysis of a Randomized Clinical Trial JAMA OPHTHALMOLOGY Ang, M. J., Chamberlain, W., Lin, C. C., Pickel, J., Austin, A., Rose-Nussbaumer, J. 2019; 137 (7): 747–54

  View details for DOI 10.1001/jamaophthalmol.2019.0877

  View details for Web of Science ID 000481513900005

• Changes in Anterior and Posterior Corneal Astigmatism after Descemet Membrane Endothelial Keratoplasty versus Ultrathin Descemet Stripping Automated Endothelial Keratoplasty: Results from the Randomized Controlled DETECT Trial Werner, S., Rose-Nussbaumer, J., Lin, C., Austin, A., Chamberlain, W. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2019

  View details for Web of Science ID 000488800707027

• Corneal Higher-Order Aberrations in Descemet Membrane Endothelial Keratoplasty versus Ultrathin DSAEK in the Descemet Endothelial Thickness Comparison Trial A Randomized Clinical Trial OPHTHALMOLOGY Duggan, M. J., Rose-Nussbaumer, J., Lin, C. C., Austin, A., Labadzinzki, P. C., Chamberlain, W. D. 2019; 126 (7): 946–57

  View details for DOI 10.1016/j.ophtha.2019.02.007

  View details for Web of Science ID 000472015700015

• Characteristics of cataract surgery patients influencing patient satisfaction scores JOURNAL OF CATARACT AND REFRACTIVE SURGERY Lee, M. D., Chen, S. P., Chen, T. A., Leibold, C., Li, Z., Fisher, A., Lin, C. C., Singh, K., Chang, R. T. 2019; 45 (4): 437–42

  View details for DOI 10.1016/j.jcrs.2018.11.031

  View details for Web of Science ID 000464487400008

• Characteristics of cataract surgery patients influencing patient satisfaction scores. Journal of cataract and refractive surgery Lee, M. D., Chen, S. P., Chen, T. A., Leibold, C., Li, Z., Fisher, A. C., Lin, C. C., Singh, K., Chang, R. T. 2019

  Abstract

  PURPOSE: To determine factors that influence patient satisfaction scores in individuals who have recently had cataract surgery.SETTING: Byers Eye Institute, Palo Alto, California, USA.DESIGN: Prospective case series.METHODS: Selected questions from the Press Ganey survey and the National Eye Institute Visual Function Questionnaire-25 were administered to each patient immediately after completion of a clinic visit. The correlation between patient-specific variables and the answer to the survey question "likelihood of recommending our practice to others," a surrogate for overall patient satisfaction, was assessed using the Student t test. A logistical regression model was used to adjust for potentially confounding variables.RESULTS: One hundred forty-three patients were recruited from 4 providers; 57 (39.8%) were men, and the mean age was 70.0years±11.6 (SD). The main outcome was the proportion of scores less than 5, or "very good," for the likelihood of recommending the practice to others. There was a statistically significant association between a non-5 patient satisfaction score and self-reported ethnicity of Asian or Pacific Islandercompared with other ethnicities (odds ratio [OR], 2.3; 95% confidence interval [CI], 1.0-5.1; P=.049); other possible correlates were not statistically significant. The relationship persisted after adjustment for potential confounding variables (OR, 2.6; 95% CI, 1.1-6.3; P=.027).CONCLUSION: In postoperative cataract patients, Asian or Pacific Islander ethnicity, a factor out of the control of the provider and clinic staff, was associated with a lower overall Press Ganey patient satisfaction score compared with patients of all other ethnicities.

  View details for PubMedID 30824352

• Corneal Higher-Order Aberrations in DMEK versus UT-DSAEK in DETECT: A Randomized Clinical Trial. Ophthalmology Duggan, M. J., Rose-Nussbaumer, J., Lin, C. C., Austin, A., Labadzinzki, P. C., Chamberlain, W. D. 2019

  Abstract

  PURPOSE: To compare corneal higher-order aberrations (HOA) following ultrathin Descemet stripping automated endothelial keratoplasty (UT-DSAEK) and Descemet membrane endothelial keratoplasty (DMEK).DESIGN: Patient and outcome-masked, randomized controlled clinical trial.PARTICIPANTS: Patients with damaged or diseased endothelium from Fuchs endothelial dystrophy or pseudophakic bullous keratopathy who were considered good candidates for DMEK or UT-DSAEK.METHODS: Corneal anterior and posterior surface HOA were measured with Scheimpflug imaging before surgery and at 3, 6, and 12 months post-operatively. Zernike orders 3-8 were calculated at 4.0- and 6.0-mm-diameter optical zones (OZ). HOA after UT-DSAEK and DMEK were compared and correlation was performed between best spectacle-corrected visual acuity (BSCVA) and HOA at each time point.MAIN OUTCOME MEASURES: Higher-order aberrations of the anterior and posterior cornea, expressed as the root mean square deviation from a best fit sphere reference surface.RESULTS: At 3, 6, and 12 months after surgery, the posterior corneal surface had significantly less coma (P≤0.003) and total HOA (P≤0.001) in DMEK compared to UT-DSAEK (4.0- and 6.0-mm OZ). Posterior trefoil (P≤0.034), secondary astigmatism (P≤0.042), and tetrafoil (P≤0.045) were lower in DMEK than UT-DSAEK at 3, 6, or 12 months (either 4.0- or 6.0-mm OZ). There were no significant differences in anterior surface HOA between DMEK and UT-DSAEK at any time point. Compared to baseline, total posterior HOA was significantly increased (P≤0.036) in UT-DSAEK at 3, 6, and 12 months, in contrast to DMEK where it was significantly decreased (P≤0.044) at 6 and 12 months (4.0- and/or 6.0-mm OZ). At 6 and 12 months, posterior corneal total HOA correlated moderately with BSCVA (rho≤0.635, P≤0.001) (4.0- and 6.0-mm OZ). There were no moderate or strong correlations between anterior or combined corneal surface HOA at any time point after surgery.CONCLUSIONS: DMEK results in less posterior corneal HOA compared to UT-DSAEK. DMEK decreases and UT-DSAEK increases posterior corneal HOA compared to pre-surgical values. Total posterior corneal HOA correlates moderately with 6- and 12-month post-operative visual acuity and may partially account for the better visual acuity observed after DMEK.

  View details for PubMedID 30776384

• Effect of Unilateral Endothelial Keratoplasty on Vision-Related Quality-of-Life Outcomes in the Descemet Endothelial Thickness Comparison Trial (DETECT): A Secondary Analysis of a Randomized Clinical Trial. JAMA ophthalmology Ang, M. J., Chamberlain, W. n., Lin, C. C., Pickel, J. n., Austin, A. n., Rose-Nussbaumer, J. n. 2019

  Abstract

  Vision-related quality of life can be a valuable outcome for some interventions in ophthalmology. In the primary Descemet Endothelial Thickness Comparison Trial (DETECT), Descemet membrane endothelial keratoplasty (DMEK) had superior postoperative visual acuity compared with ultrathin Descemet stripping automated endothelial keratoplasty (UT-DSAEK). It is of interest to determine whether this trend extends to quality of life.To determine the effect of UT-DSAEK and DMEK on vision-related quality of life.A prespecified secondary analysis of a 2-surgeon patient- and outcome-masked randomized clinical trial was conducted at the Casey Eye Institute in Portland, Oregon, and Byers Eye Institute in Palo Alto, California. The study was conducted between January 20, 2015, and April 26, 2017. DETECT enrolled 38 individuals and included 50 eyes with isolated endothelial dysfunction; for this analysis, the second eye from a single participant was excluded along with any questionnaires in the first eye after second eye surgery for evaluation of 38 eyes at baseline and 3 months and 26 eyes at 12 months. Mean (SD) baseline visual acuity was 0.35 (0.31) logMAR in the DMEK arm and 0.28 (0.22) logMAR in the UT-DSAEK arm. Each arm consisted of 19 participants: 18 individuals with Fuchs dystrophy and 1 participant with pseudophakic bullous keratopathy.Study eyes were randomized to receive either UT-DSAEK or DMEK.Responses to the National Eye Institute (NEI) Visual Function Questionnaire-39 (VFQ-39) administered at baseline and 3 and 12 months postoperatively were analyzed using the NEI-defined traditional subscales and composite score on a 100-point scale and with a Rasch-refined analysis.There were more women in both arms of the study (UT-DSAEK, 12 [63%]; DMEK, 11 [58%]); mean (SD) age was 68 (11) years in the UT-DSAEK arm and 68 (4) years in the DMEK arm. Overall, study participants experienced a 9.1-point improvement in NEI VFQ-39 composite score at 3 months compared with baseline (N = 38; 95% CI, 4.9-13.3; P < .001), and an 11.6-point improvement at 12 months compared with baseline (n = 26; 95% CI, 6.8-16.4; P < .001). Eyes randomized to DMEK had 0.9 points more improvement in NEI VFQ-39 composite score at 3 months compared with UT-DSAEK after controlling for baseline NEI VFQ-39 (95% CI, -6.2 to 8.0; P = .80).Improvement in vision-related quality of life was not shown to be greater with DMEK compared with UT-DSAEK.ClinicalTrials.gov identifier: NCT02373137.

  View details for PubMedID 31046075

• Ocular manifestations of herpes simplex virus. Current opinion in ophthalmology Valerio, G. S., Lin, C. C. 2019

  Abstract

  To review ocular manifestations and complications of herpes simplex virus (HSV) and discuss recent advancements in diagnostic and treatment strategy.In-vivo confocal microscopy has expanded our understanding of corneal nerve degeneration, corneal dendritic cell activity, and changes in biomechanical properties in HSV keratitis. Although currently available only as a research tool, metagenomic deep sequencing has the potential to improve diagnostic accuracy beyond the well established PCR technology, especially in atypical cases. Development of an HSV vaccine has shown some encouraging results in a murine model. New treatment options for neurotrophic cornea offer promise, specifically cenegermin nerve growth factor.Ocular herpes simplex infection and its complications continue to cause significant visual burden and decreased quality of life. Familiarity with its clinical features, wider adoption of viral PCR diagnostic technology, and recognition of the need for long-term maintenance medications for recurrent or chronic cases form the basis for effective management. Metagenomic deep sequencing, the development of a herpes vaccine, and cenegermin nerve growth factor offer promise as diagnostic, preventive, and therapeutic options, respectively.

  View details for DOI 10.1097/ICU.0000000000000618

  View details for PubMedID 31567695

• Intraoperative Optical Coherence Tomography in DALK MASTERING DALK: A VIDEO TEXTBOOK ON DEEP ANTERIOR LAMELLAR KERATOPLASTY Hirabayashi, K. E., Lin, C. C., Jacob, S. 2019: 93–103

  View details for Web of Science ID 000488309600009

• Descemet Stripping Only for a Chronic Descemet Detachment After Cataract Surgery. Cornea Hirabayashi, K. E., Mark, D. n., Lau, J. n., Lin, C. C. 2019

  Abstract

  To describe a case of postsurgical corneal decompensation in a patient with Fuchs endothelial dystrophy with a sectoral Descemet detachment and corneal edema that was successfully managed with a targeted Descemet stripping only (DSO) procedure.This is a case report and review of the literature.A female patient with Fuchs endothelial dystrophy presented with a 6-month history of a persistent sectoral Descemet membrane detachment after cataract surgery with overlying corneal edema. Specular microscopy demonstrated moderate cell dropout with a cell density of 929 cells/mm in the affected eye. Intracameral air injection was attempted without improvement, and a sectoral DSO procedure was performed. Netarsudil and prednisolone were used postoperatively, and she demonstrated gradual improvement with resolution of the edema by postoperative week 10 and a central endothelial cell density of 675 cells/mm by postoperative month 8.DSO is a viable therapy in certain cases of postsurgical corneal decompensation.

  View details for DOI 10.1097/ICO.0000000000002195

  View details for PubMedID 31725698

• Descemet Endothelial Thickness Comparison Trial A Randomized Trial Comparing Ultrathin Descemet Stripping Automated Endothelial Keratoplasty with Descemet Membrane Endothelial Keratoplasty OPHTHALMOLOGY Chamberlain, W., Lin, C. C., Austin, A., Schubach, N., Clover, J., McLeod, S. D., Porco, T. C., Lietman, T. M., Rose-Nussbaumer, J. 2019; 126 (1): 19–26

  Abstract

  To compare clinical outcomes of ultrathin Descemet stripping automated endothelial keratoplasty (UT-DSAEK) and Descemet membrane endothelial keratoplasty (DMEK) in the treatment of corneal endothelial dysfunction.Patient and outcome-masked, randomized controlled clinical trial.Patients with damaged or diseased endothelium from Fuchs endothelial dystrophy or pseudophakic bullous keratopathy who were considered good candidates for DMEK or UT-DSAEK.Study eyes were randomized by the eye bank to UT-DSAEK or DMEK 1 to 2 days before surgery.The primary outcome of the trial was best spectacle-corrected visual acuity (BSCVA) at 6 months. Secondary outcomes included 3- and 12-month BSCVA; 3-, 6-, and 12-month endothelial cell counts; intraoperative and postoperative complications; and change in pachymetry.A total of 216 patients with endothelial dysfunction were screened, and 50 eyes of 38 patients were enrolled by 2 surgeons at Casey Eye Institute at Oregon Health & Science University in Portland, Oregon, and at Byers Eye Institute at Stanford University in Palo Alto, California. Overall, we found DMEK to have better visual acuity outcomes compared with UT-DSAEK after correcting for baseline visual acuity: compared with UT-DSAEK, those randomized to DMEK had 1.5 lines better BSCVA at 3 months (95% confidence interval [CI], 2.5-0.6 lines better; P = 0.002), 1.8 lines better BSCVA at 6 months (95% CI, 2.8-1.0 lines better; P < 0.001), and 1.4 lines better BSCVA at 12 months (95% CI, 2.2-0.7 lines better; P < 0.001). Average endothelial cell counts were 1963 cells/mm2 in DMEK and 2113 cells/mm2 in UT-DSAEK at 6 months (P = 0.17) and 1855 cells/mm2 in DMEK and 2070 cells/mm2 in UT-DSAEK at 12 months (P = 0.051). Intraoperative and postoperative complication rates were similar between groups.Descemet membrane endothelial keratoplasty had superior visual acuity results compared with UT-DSAEK at 3, 6, and 12 months in patients with isolated endothelial dysfunction with similar complication rates.

  View details for PubMedID 29945801

• Rescue technique for a partially expulsed descemet membrane endothelial keratoplasty (DMEK) graft. American journal of ophthalmology case reports Lee, M. D., Chen, L. Y., Lin, C. C. 2018; 11: 13–16

  Abstract

  Purpose: To describe a novel surgical technique to rescue a partially expulsed DMEK graft after insertion.Observations: We present a case of a 66-year-old woman with visually significant Fuchs endothelial dystrophy who underwent a DMEK surgery complicated by partial expulsion of the DMEK graft during insertion. To rescue the graft, MicroSurgical Technology (MST) forceps were inserted through a nasal paracentesis to grasp the DMEK graft and redirect it back into the anterior chamber. The surgical technique and postoperative outcomes are described. The partially expulsed graft was centered and attached successfully during surgery. Postoperatively, the patient required two rebubbling procedures, but achieved best-corrected visual acuity of 20/20 vision 1 month after surgery.Conclusions: and Importance: We describe an underreported complication and present a novel rescue technique for a partially expulsed DMEK graft that is effective and minimizes manipulation of the graft.

  View details for PubMedID 30057965

• DMEK results in significantly less higher-order aberration than UT-DSAEK: Results from the DETECT trial. Duggan, M., Rose-Nussbaumer, J., Lin, C. C., Austin, A., Chamberlain, W. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2018

  View details for Web of Science ID 000442912504200

• Characteristics of cataract surgery patients influencing Press Ganey patient satisfaction scores Lee, M., Chen, S., Chen, T., Fisher, A., Lin, C. C., Singh, K., Chang, R. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2018

  View details for Web of Science ID 000442932804255

• Impact of Race on Press Ganey Measures of Ophthalmology Clinic Visits Chen, T., Chen, S., Lee, M., Fisher, A., Lin, C. C., Singh, K., Chang, R. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2018

  View details for Web of Science ID 000442932805281

• Effect of Donor Characteristics on Visual Outcomes and Endothelial Cell Count in the Descemet Endothelial Thickness Comparison Trial Lin, Y., Chamberlain, W., Lin, C. C., Austin, A., Shubach, N., Clover, J., Mcleod, S., Porco, T., Lietman, T., Rose-Nussbaumer, J. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2018

  View details for Web of Science ID 000442912508207

• Outcomes of Wound Dehiscence After Penetrating Keratoplasty. Cornea Wang, K., Singh, K., Silva, R. A., Lin, C. C. 2016: -?

  View details for PubMedID 27755192

• Successful DMEK After Intraoperative Graft Inversion CORNEA Yu, C. Q., Ta, C. N., Terry, M. A., Lin, C. C. 2015; 34 (1): 97-98

  Abstract

  Hardiness of a Descemet membrane endothelial keratoplasty (DMEK) graft is not well established. The aim of this study was to report a case of graft survival after intraoperative inversion.We describe a case of a 76-year-old man with Fuchs corneal dystrophy who underwent DMEK in the left eye. After deployment of the graft and a 15-minute sulfur hexafluoride gas fill, the graft was noted to be inverted. The graft was then reoriented and properly positioned.Because of progressive graft detachment, rebubble was required at 2 weeks after surgery. At 2 months after surgery, the graft was clear and fully adherent. Specular microscopy revealed 27.9% endothelial cell loss of the donor cornea.Despite intraoperative inversion, this DMEK graft remained viable without excessive endothelial cell loss.

  View details for PubMedID 25411936

• Scleral intraocular pressure measurement in cadaver eyes pre- and postkeratoprosthesis implantation. Investigative ophthalmology & visual science Lin, C. C., Chen, A., Jeng, B. H., Porco, T. C., Ou, Y., Han, Y. 2014; 55 (4): 2244-2250

  Abstract

  Purpose: To correlate scleral intraocular pressure (IOP) to assigned IOP using pneumatonometry in cadaver eyes before and after Boston type I keratoprosthesis (KPro) implantation. Methods: Corneal IOP and scleral IOP at the superonasal, superotemporal, inferotemporal, and inferonasal quadrants were measured using pneumatonometry in six cadaver eyes cannulated with an infusion line with assigned IOP held at 20, 30, 40, and 50 mmHg. Measurements of scleral IOP at the same location were repeated after a KPro was implanted. Correlations between scleral IOP and assigned IOP were analyzed for the entire group of eyes and for each individual eye before and after KPro. One eye was tested by another masked grader for inter-observer variability. Results: Scleral IOP measured higher than corneal IOP by a mean of 13.2 mmHg. For group analysis, pre-KPro scleral IOP had a positive and linear correlation with assigned IOP in all quadrants (P<0.00001), and this correlation was preserved after KPro implantation (P<0.00001). There was strong inter-observer agreement in all measurement sites (P< 0.001). In analyses of individual eyes, scleral IOP measured at the inferotemporal quadrant confirmed the strong linear association between scleral IOP and assigned IOP before and after KPro for all study eyes. A Bland-Altman plot showed that the difference in scleral IOP between pre-KPro and post-KPro eyes fell mostly within ±5mmHg. Conclusions: Scleral IOP measured by pneumatonometry may be used to estimate IOP in cadaver eyes with and without keratoprosthesis. This may be a potential modality for assessing IOP for patients with corneal pathology or keratoprosthesis.

  View details for DOI 10.1167/iovs.13-13153

  View details for PubMedID 24557348

• Rapid corneal adrenochrome deposition from topical ibopamine in the setting of infectious keratitis EYE Bhosai, S. J., Lin, C. C., Greene, J., BLOOMER, M. M., Jeng, B. H. 2013; 27 (1): 105-106

  View details for DOI 10.1038/eye.2012.217

  View details for Web of Science ID 000313557200018

  View details for PubMedID 23079754

  View details for PubMedCentralID PMC3545386

• Seasonal Trends of Microbial Keratitis in South India CORNEA Lin, C. C., Lalitha, P., Srinivasan, M., Prajna, N. V., McLeod, S. D., Acharya, N. R., Lietman, T. M., Porco, T. C. 2012; 31 (10): 1123-1127

  Abstract

  Previous studies suggest that fungal keratitis is more common in hot humid climates and that bacterial keratitis is independent of seasonal variation. This study analyzes seasonal trends in the incidence of fungal and bacterial keratitis at the Aravind Eye Hospital in southeast India.Using microbiology records from August 2006 to July 2009, retrospective analyses of infectious keratitis were performed. Bacterial and fungal keratitis incidence data were analyzed for seasonal patterns.Among the 6967 infectious keratitis cases, cultures were performed in 5221 (74.9%) cases; among them, 3028 (58%) were positive. Of the culture-positive cases, 1908 (63%) and 1081 (35.7%) were of fungal and bacterial etiology, respectively. The predominant fungal organism was Fusarium spp (42.3%) and the predominant bacterial organisms were Streptococcus pneumoniae (35.1%), Pseudomonas aeruginosa (24.3%), and Nocardia spp (8.1%). Analyses revealed an uneven distribution of fungal keratitis throughout the year (P < 0.001) with peaks in July and January. No significant seasonal trend was observed for the combined bacterial keratitis group.A higher incidence of fungal keratitis occurs during the months corresponding to the windy and harvest seasons, during which time infection from vegetative corneal injury may be more likely. Robust screening efforts during these periods may mitigate visually debilitating sequelae from infectious keratitis.

  View details for DOI 10.1097/ICO.0b013e31825694d3

  View details for Web of Science ID 000308695200007

  View details for PubMedID 22868629

• Acanthamoeba Keratitis in South India: A Longitudinal Analysis of Epidemics OPHTHALMIC EPIDEMIOLOGY Lalitha, P., Lin, C. C., Srinivasan, M., Mascarenhas, J., Prajna, N. V., Keenan, J. D., McLeod, S. D., Acharya, N. R., Lietman, T. M., Porco, T. C. 2012; 19 (2): 111-115

  Abstract

  In light of the increased incidence of contact lens associated Acanthamoeba keratitis in recent years, this study analyzed longitudinal trends of its incidence among predominantly non-contact lens wearers in a high-volume referral center in South India.A retrospective analysis of microbiology laboratory records at the Aravind Eye Hospital from 1988-2009 was performed. The Maximum Excess Events Test (MEET) was used to identify epidemics of Acanthamoeba keratitis.There were a total of 38,529 unique cases of infectious keratitis evaluated over this time period, of which 372 were culture-positive for Acanthamoeba. Only three cases (0.9%) of Acanthamoeba keratitis occurred among contact lens wearers. MEET identified unique Acanthamoeba keratitis epidemics in 1993 and 2002.Discrete epidemics of Acanthamoeba keratitis occurred among a rural, non-contact lens wearing, population in South India in 1993 and 2002.

  View details for DOI 10.3109/09286586.2011.645990

  View details for Web of Science ID 000302067400010

  View details for PubMedID 22364672

  View details for PubMedCentralID PMC3830554

• Trachoma control - Is azithromycin the answer for trichiasis too? ARCHIVES OF OPHTHALMOLOGY Lin, C., Lietman, T. 2007; 125 (6): 819-820

  View details for Web of Science ID 000247143600013

  View details for PubMedID 17562994

• Syphilis in China: results of a national surveillance programme LANCET Chen, Z., Zhang, G., Gong, X., Lin, C., Gao, X., Liang, G., Yue, X., Chen, X., Cohen, M. S. 2007; 369 (9556): 132-138

  Abstract

  After a massive syphilis epidemic in the first half of the 20th century, China was able to eliminate this infection for 20 years (1960-80). However, substantial changes in Chinese society have been followed by a resurgent epidemic of sexually transmitted diseases. Sporadic reports have provided clues to the magnitude of the spread of syphilis, but a national surveillance effort is needed to provide data for planning and intervention.We collected and assessed case report data from China's national sexually transmitted disease surveillance system and sentinel site network.In 1993, the reported total rate of cases of syphilis in China was 0.2 cases per 100,000, whereas primary and secondary syphilis alone represented 5.7 cases per 100,000 persons in 2005. The rate of congenital syphilis increased greatly with an average yearly rise of 71.9%, from 0.01 cases per 100,000 livebirths in 1991 to 19.68 cases per 100 000 livebirths in 2005.The results suggest that a range of unique biological and social forces are driving the spread of syphilis in China. A national campaign for detection and treatment of syphilis, and a credible prevention strategy, are urgently needed.

  View details for Web of Science ID 000243538200032

  View details for PubMedID 17223476

• China's syphilis epidemic: A systematic review of seroprevalence studies SEXUALLY TRANSMITTED DISEASES Lin, C. C., Gao, X., Chen, X., Chen, Q., Cohen, M. S. 2006; 33 (12): 726-736

  Abstract

  The objective of this study was to investigate syphilis prevalence among low- and high-risk groups in China.The goal of this study was to explore the magnitude of China's syphilis epidemic.A systematic literature review of syphilis seroprevalence studies in China was performed searching PubMed and the Chinese Periodicals Database (CPD).Five and 169 studies were retrieved from PubMed and the CPD, respectively. From 2000 to 2005, select low-risk groups had the following median syphilis prevalence: antenatal women (0.45%), premarital individuals (0.66%), and food and service employees (0.3%). Select high-risk groups had the following median prevalence: incarcerated female sex workers (12.49%), drug users (6.81%), and men who have sex with men (14.56%). In the last decade, prevalence has increased in all groups with the steepest rises seen among high-risk groups.Syphilis infection is increasing among low- and high-risk groups in China, suggesting unsafe sexual behavior that may accelerate HIV transmission and challenge current syphilis prevention and control efforts.

  View details for DOI 10.1097/01.olq.0000222703.12018.58

  View details for Web of Science ID 000242285500007

  View details for PubMedID 16755273

• Poverty and the spread of bloodborne disease in central China JOURNAL OF INFECTIOUS DISEASES Tucker, J. D., Lin, C. C. 2006; 193 (6): 902-903

  View details for Web of Science ID 000235536200027

  View details for PubMedID 16479531

• Determinants of bone and blood lead levels among minorities living in the Boston area ENVIRONMENTAL HEALTH PERSPECTIVES Lin, C., Kim, R., Tsaih, S. W., Sparrow, D., Hu, H. 2004; 112 (11): 1147-1151

  Abstract

  We measured blood and bone lead levels among minority individuals who live in some of Boston's neighborhoods with high minority representation. Compared with samples of predominantly white subjects we had studied before, the 84 volunteers in this study (33:67 male:female ratio; 31-72 years of age) had similar educational, occupational, and smoking profiles and mean blood, tibia, and patella lead levels (3 microg/dL, 11.9 microg/g, and 14.2 microg/g, respectively) that were also similar. The slopes of the univariate regressions of blood, tibia, and patella lead versus age were 0.10 microg/dL/year (p < 0.001), 0.45 microg/g/year (p < 0.001), and 0.73 microg/g/year (p < 0.001), respectively. Analyses of smoothing curves and regression lines for tibia and patella lead suggested an inflection point at 55 years of age, with slopes for subjects greater than or equal to 55 years of age that were not only steeper than those of younger subjects but also substantially steeper than those observed for individuals > 55 years of age in studies of predominantly white participants. This apparent racial disparity at older ages may be related to differences in historic occupational and/or environmental exposures, or possibly the lower rates of bone turnover that are known to occur in postmenopausal black women. The higher levels of lead accumulation seen in this age group are of concern because such levels have been shown in other studies to predict elevated risks of chronic disease such as hypertension and cognitive dysfunction. Additional research on bone lead levels in minorities and their socioeconomic and racial determinants is needed.

  View details for DOI 10.1289/ehp.6705

  View details for Web of Science ID 000223743700032

  View details for PubMedID 15289158

  View details for PubMedCentralID PMC1247473

• Rapid photochemical generation of ubiquinol through a radical pathway: An avenue for probing submillisecond enzyme kinetics JOURNAL OF ORGANIC CHEMISTRY Schultz, B. E., Hansen, K. C., Lin, C. C., Chan, S. I. 2000; 65 (10): 3244-3247

  View details for Web of Science ID 000087262500059

  View details for PubMedID 10814227