Charles C. Lin, MD

All Publications

• 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

• 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

• 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

• 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

• 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

• 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

• 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