Matthew Lee-wing - Academia.edu (original) (raw)

Papers by Matthew Lee-wing

CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne, Jan 25, 2015

Eyelid ptosis can obscure vision and impair activities of daily living Competing interests: None ... more Eyelid ptosis can obscure vision and impair activities of daily living Competing interests: None declared. This article has been peer reviewed. The authors have obtained patient consent.

Canadian Journal of Ophthalmology / Journal Canadien d'Ophtalmologie, 2001

Background: Pyogenic granuloma is a vasoproliferative inflammatory response composed of granulati... more Background: Pyogenic granuloma is a vasoproliferative inflammatory response composed of granulation tissue. The pathogenesis is not entirely clear. We describe a series of patients with pyogenic granulomas occurring following common oculoplastic procedures and propose a common etiology. Methods: Sixteen cases of pyogenic granuloma that occurred after various oculoplastic procedures from 1991 to 2000 were collected from the files of two oculoplastic surgeons. Results: Pyogenic granulomas were found to occur at surgical and nonsurgical sites associated with tissue irritation or inflammation or both. Interpretation: Capillaries are a predominant component of wound healing and pyogenic granulomas. The growth and development of new capillaries follows an orderly sequence of events that is highly regulated by a variety of angiogenic factors. We postulate an imbalance in angiogenesis regulation as the common pathway for pyogenic granuloma development. Contexte : Le granulome pyogeme est une reaction inflammatoire vasoproliferative composee de tissus granuleux, dont Ia pathogenese n'est pas etablie clairement. Nous decrivons une serie de patients dont les granulomes pyogenes surviennent a Ia suite de diverses interventions oculoplastiques et proposons une etiologie commune. Methodes : Nous avons puise, dans les dossiers d'intervention de deux chirurgiens oculoplastiques, 16 cas de granulomes pyogenes survenus entre 1991 et 2000. Resultats : L'on constate que les granulomes pyogenes surviennent sur des sites chirurgicaux et non chirurgicaux associes a !'irritation ou a !'inflammation des tissus ou aux deux. Interpretation : Les capillaires constituent une composante predominante de Ia guerison des blessures et des granulomes pyogenes. La croissance et le developpement de nouveaux capillaires suivent une sequence ordonnee

Ophthalmic Plastic & Reconstructive Surgery, 2003

Exposure of a hydroxyapatite orbital implant measuring 10 x 3 mm developed in a 25-year-old man. ... more Exposure of a hydroxyapatite orbital implant measuring 10 x 3 mm developed in a 25-year-old man. The exposure was repaired with an amniotic membrane graft. Follow-up examinations at 5 days, 2 weeks, 2.5 months, and 5 months after surgery demonstrated closure of the conjunctival defect. The author concludes that amniotic membrane may be useful for the treatment of hydroxyapatite orbital implant exposures.

Cornea, 2008

To report a non-contact lens wearer with persistent Acanthamoeba organisms in the cornea after be... more To report a non-contact lens wearer with persistent Acanthamoeba organisms in the cornea after being treated with medical therapy that included topical chlorhexidine as 1 agent for 1 year. A 53-year-old man with Acanthamoeba keratitis was treated with medical therapy for >1 year, followed by a penetrating keratoplasty. Histopathologic examination of the keratoplasty specimen revealed viable-appearing Acanthamoeba cysts and trophozoites within the deep corneal stroma in a focus of corneal scarring. The use of chlorhexidine as 1 agent in the medical management of Acanthamoeba keratitis may not eradicate the organisms.

Canadian Journal of Ophthalmology / Journal Canadien d'Ophtalmologie, 2009

A thin 17-year-old male presented with bilateral blurred vision and pressure sensation over the c... more A thin 17-year-old male presented with bilateral blurred vision and pressure sensation over the central forehead. Medical and family histories were unremarkable and he took no medications. His initial visual acuity was 20/20 OU and visual field testing showed enlarged blind spots. Bilateral disc swelling was noted on funduscopy and he was referred to several physicians for workup, including lumbar puncture (opening pressure 280–300 mm H20), normal brain computed tomography, and magnetic resonance imaging. The patient was diagnosed with pseudotumor cerebri. Acetazolamide was prescribed but he was noncompliant and lost to follow-up. Three years later, he presented with severe headaches and reduced visual acuities of 20/100 OD and 20/150 OS. He had bilateral pale, edematous optic discs (in contrast to the hyperemic papilledema usually present in pseudotumor cerebri) and constricted visual fields (Fig. 1). Repeat brain computed tomography and magnetic resonance imaging were normal. A lumbar puncture demonstrated an opening pressure of 460 mm H20 and a venogram showed no venous thrombosis. He was treated with acetazolamide for 3 weeks, with improvement of his visual acuity to 20/30 OD and 20/100 OS. Subsequently, he was referred to one of the authors (Matthew Lee-Wing) for bilateral optic nerve sheath fenestrations. Although his visual acuity remained unchanged immediately after surgery, over the next few weeks his vision deteriorated to 20/100 OD and 20/400 OS. Repeat optic nerve sheath fenestration demonstrated no significant cerebrospinal fluid (CSF) release. A postoperative lumbar puncture revealed an opening pressure of >800 mm H20 with atypical white cells (all lymphocytes, 25% lymphomatous with B cell phenotype) in the CSF (Fig. 2). Primary diffuse large B-cell leptomeningeal lymphoma (PLML) was diagnosed and the patient was treated with a ventriculoperitoneal shunt and high-dose methotrexate. He eventually achieved complete remission; however, his final visual acuity decreased to 20/400 OD and counting fingers OS. Pseudotumor cerebri is a diagnosis of exclusion. The most recent diagnostic recommendations are based on the Modified Dandy Criteria and include signs and symptoms specific to generalized intracranial hypertension, documented elevated intracranial pressure, normal CSF composition, no neuroradiologic abnormalities, and no other causes of intracranial hypertension. PLML is extremely rare and it is not uncommon for initial lumbar punctures to be nondiagnostic. Some patients present with loss of visual acuity and diplopia, but others may have no visual symptoms. Two cases of PLML mistaken for pseudotumor cerebri in young women have been reported in the neurologic literature. The first patient’s primary complaint was headache and she died 1 year after onset of symptoms. The other patient was also misdiagnosed with pseudotumor cerebri for 3 years and did not respond to chemotherapy. There has been little mention of PLML in the ophthalmologic literature and the case reported herein highlights the ophthalmologist’s role in diagnosing the rarer causes of optic neuropathy in patients with normal extensive workup. Specifically, it is important that the ophthalmologist demand repeat, serial lumbar punctures to definitively rule out more ominous diagnoses in patients who present with disc swelling and ongoing vision loss.

American Journal of Ophthalmology, 2001

To report a patient with bilateral lacrimal gland enlargement as the initial manifestation of Ros... more To report a patient with bilateral lacrimal gland enlargement as the initial manifestation of Rosai--Dorfman disease. Case report. A 14-year-old female presented with left lacrimal gland enlargement followed by right lacrimal gland enlargement 11 weeks later. Bilateral lacrimal gland biopsies were performed, and histopathologic examination revealed the diagnosis of Rosai--Dorfman disease. Patients with Rosai--Dorfman disease may present with bilateral lacrimal gland swelling in the absence of lymphadenopathy. Rosai--Dorfman disease should be considered in the differential diagnosis of bilateral lacrimal gland enlargement.

Ophthalmic surgery and lasers

Lung cancer commonly affects middle-aged and elderly smokers. Metastatic disease involving the or... more Lung cancer commonly affects middle-aged and elderly smokers. Metastatic disease involving the orbit is uncommon. We report the unusual occurrence of a 25-year-old male nonsmoker with an aggressive form of lung cancer who developed metastatic orbital disease involving the medial rectus.

Canadian Journal of Ophthalmology

Clinical Ophthalmology

Purpose: To develop and validate neural network (NN) vs logistic regression (LR) diagnostic predi... more Purpose: To develop and validate neural network (NN) vs logistic regression (LR) diagnostic prediction models in patients with suspected giant cell arteritis (GCA). Design: Multicenter retrospective chart review. Methods: An audit of consecutive patients undergoing temporal artery biopsy (TABx) for suspected GCA was conducted at 14 international medical centers. The outcome variable was biopsy-proven GCA. The predictor variables were age, gender, headache, clinical temporal artery abnormality, jaw claudication, vision loss, diplopia, erythrocyte sedimentation rate, C-reactive protein, and platelet level. The data were divided into three groups to train, validate, and test the models. The NN model with the lowest false-negative rate was chosen. Internal and external validations were performed. Results: Of 1,833 patients who underwent TABx, there was complete information on 1,201 patients, 300 (25%) of whom had a positive TABx. On multivariable LR age, platelets, jaw claudication, vision loss, log C-reactive protein, log erythrocyte sedimentation rate, headache, and clinical temporal artery abnormality were statistically significant predictors of a positive TABx (P#0.05). The area under the receiver operating characteristic curve/Hosmer-Lemeshow P for LR was 0.867 (95% CI, 0.794, 0.917)/0.119 vs NN 0.860 (95% CI, 0.786, 0.911)/0.805, with no statistically significant difference of the area under the curves (P=0.316). The misclassification rate/false-negative rate of LR was 20.6%/47.5% vs 18.1%/30.5% for NN. Missing data analysis did not change the results. Conclusion: Statistical models can aid in the triage of patients with suspected GCA. Misclassification remains a concern, but cutoff values for 95% and 99% sensitivities are provided (https://goo.gl/THCnuU).

OBJECTIVE To evaluate the safety of performing cataract surgery prior to eyelid (entropion/ectrop... more OBJECTIVE To evaluate the safety of performing cataract surgery prior to eyelid (entropion/ectropion) surgery in patients with concurrent cataract and lower eyelid malposition. DESIGN Retrospective case series. PARTICIPANTS AND METHODS Patients with concurrent lower eyelid malposition and cataract undergoing cataract surgery before lower eyelid repair from 2013 to 2020 were identified from two ophthalmologists (M.L.W., G.R.). Both surgeries were performed by the same ophthalmologist, with eyelid repair completed at least 1 month following cataract extraction. Data analysis was performed with two-parameter estimations. The primary outcome was the postoperative endophthalmitis rate in this cohort. RESULTS 129 cases in 90 patients were found (86 involutional entropion and 43 involutional ectropion). No cases of endophthalmitis were encountered. Statistical analysis using the 95% Jeffreys interval for one-sample binomial proportion revealed an upper limit of 1.9%. The Agresti-Caffo inte...

Canadian journal of ophthalmology. Journal canadien d'ophtalmologie, 2001

Pyogenic granuloma is a vasoproliferative inflammatory response composed of granulation tissue. T... more Pyogenic granuloma is a vasoproliferative inflammatory response composed of granulation tissue. The pathogenesis is not entirely clear. We describe a series of patients with pyogenic granulomas occurring following common oculoplastic procedures and propose a common etiology. Sixteen cases of pyogenic granuloma that occurred after various oculoplastic procedures from 1991 to 2000 were collected from the files of two oculoplastic surgeons. Pyogenic granulomas were found to occur at surgical and nonsurgical sites associated with tissue irritation or inflammation or both. Capillaries are a predominant component of wound healing and pyogenic granulomas. The growth and development of new capillaries follows an orderly sequence of events that is highly regulated by a variety of angiogenic factors. We postulate an imbalance in angiogenesis regulation as the common pathway for pyogenic granuloma development.

Ophthalmic surgery and lasers

Lung cancer commonly affects middle-aged and elderly smokers. Metastatic disease involving the or... more Lung cancer commonly affects middle-aged and elderly smokers. Metastatic disease involving the orbit is uncommon. We report the unusual occurrence of a 25-year-old male nonsmoker with an aggressive form of lung cancer who developed metastatic orbital disease involving the medial rectus.

Ophthalmology, 1999

To help understand the pathogenesis of herpes family virus ocular infection among patients positi... more To help understand the pathogenesis of herpes family virus ocular infection among patients positive for HIV, the authors compared the rates of detection of herpes family virus DNA from the conjunctiva of patients who are positive and negative for human immunodeficiency virus (HIV) using the polymerase chain reaction (PCR). Cross-sectional study. The conjunctival scrapings of 30 patients positive for HIV and 30 patients negative for HIV were examined. PCR was used to assay for the presence of herpes simplex virus type 1 (HSV), varicella-zoster virus (VZV), cytomegalovirus (CMV), and Epstein-Barr virus (EBV) DNA (n = 240 samples). The rate of detection of virus DNA in the two groups, controlling for age, gender, and race, was measured. HSV and VZV DNA were not detected in any of the HIV-positive or HIV-negative samples. CMV DNA was detected in 20% (6 of 30) of patients positive for HIV and was undetected in control subjects negative for HIV (P = 0.01). EBV DNA was detected in 40% (12 of 30) of patients positive for HIV and in 47% (14 of 30) of control subjects negative for HIV (P = 0.58). There was no difference in the frequency of detection of HSV, VZV, or EBV DNA from the conjunctiva of patients positive or negative for HIV. Only CMV DNA was detected at a significantly higher rate in the conjunctiva of patients positive for HIV compared with control subjects negative for HIV. These different rates of peripheral virus shedding may be one possible explanation for the different rates of clinical infection among the herpes family viruses among patients positive for HIV.

Ophthalmology, 2001

To determine the prevalence of lacrimal sac pathology in patients undergoing dacryocystorhinostom... more To determine the prevalence of lacrimal sac pathology in patients undergoing dacryocystorhinostomy (DCR) for primary acquired nasolacrimal duct obstruction (PANDO). Observational case series. One hundred sixty-six patients with symptoms of PANDO. A total of 202 lacrimal sac biopsies were obtained from 166 patients undergoing external DCR procedures for symptoms of PANDO. Patient demographics, presenting symptoms and signs, relevant history, and assessment of the nasolacrimal system were recorded. All lacrimal biopsy specimens were examined histopathologically. A total of 118 patients (71%) were female and 48 patients (29%) were male. The mean age was 60.7 years (range, 21-93 years). All patients demonstrated epiphora, and 32 patients had dacryocystitis. Duration of symptoms ranged from 6 weeks to 50 years. No lacrimal sac tumors were detected. Sixty-five percent of specimens demonstrated chronic inflammation. No neoplasms were detected among 202 lacrimal sac specimens from 166 patients with symptoms of PANDO. Most lacrimal sac specimens demonstrated chronic inflammatory changes. We conclude that a lacrimal sac biopsy should be performed when there is suspicion of a neoplasm based on the clinical, historical, or intraoperative findings, rather than routine biopsy of all patients with PANDO.

Cornea, 1999

Herpesvirus infection of the lacrimal gland was investigated as an etiologic factor for keratocon... more Herpesvirus infection of the lacrimal gland was investigated as an etiologic factor for keratoconjunctivitis sicca in patients who were positive for human immunodeficiency virus (HIV). In this cross-sectional study, we recorded the Schirmer tests and tear break-up times (TBUTs) among 30 patients who were positive for HIV. Dry-eye state was defined as a Schirmer test of <10 mm of wetting at 5 min or a TBUT of <10 s. The polymerase chain reaction assay (PCR) for herpes family viruses [Epstein-Barr virus (EBV), cytomegalovirus (CMV), herpes simplex virus (HSV), and varicella-zoster virus (VZV)] was performed on the conjunctival and tear specimens of the 30 HIV-positive patients by using virus-specific single primers. We compared the rates of virus DNA detection among dry-eye and non-dry-eye patients by calculating the odds ratio of detection for each virus. The odds ratio of viral DNA detection was adjusted for age, gender, race, CD4 count, and duration of HIV positivity. The adjusted odds ratios of EBV DNA detection among dry-eye to non-dry-eye patients were 1.30 (p = 0.79) and 0.97 (p = 0.98) by using Schirmer tests and TBUTs, respectively. For CMV, the adjusted odds ratios among dry-eye to non-dry-eye patients were 1.94 (p = 0.58) with Schirmer tests and 1.02 (p = 0.99) with TBUTs. HSV and VZV DNA were not detected in any samples. Our study does not support the role of herpesvirus infection of the lacrimal gland as a causative factor in the pathogenesis of dry eyes in patients positive for HIV.

Cancer research, 1987

We have previously reported the identification and characterization of a prolactin-inducible prot... more We have previously reported the identification and characterization of a prolactin-inducible protein (PIP) as well as the cloning of the gene encoding PIP in cultured human breast cancer cells. We now present three lines of evidence that the gene encoding PIP is ...

CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne, Jan 25, 2015

Eyelid ptosis can obscure vision and impair activities of daily living Competing interests: None ... more Eyelid ptosis can obscure vision and impair activities of daily living Competing interests: None declared. This article has been peer reviewed. The authors have obtained patient consent.

Canadian Journal of Ophthalmology / Journal Canadien d'Ophtalmologie, 2001

Background: Pyogenic granuloma is a vasoproliferative inflammatory response composed of granulati... more Background: Pyogenic granuloma is a vasoproliferative inflammatory response composed of granulation tissue. The pathogenesis is not entirely clear. We describe a series of patients with pyogenic granulomas occurring following common oculoplastic procedures and propose a common etiology. Methods: Sixteen cases of pyogenic granuloma that occurred after various oculoplastic procedures from 1991 to 2000 were collected from the files of two oculoplastic surgeons. Results: Pyogenic granulomas were found to occur at surgical and nonsurgical sites associated with tissue irritation or inflammation or both. Interpretation: Capillaries are a predominant component of wound healing and pyogenic granulomas. The growth and development of new capillaries follows an orderly sequence of events that is highly regulated by a variety of angiogenic factors. We postulate an imbalance in angiogenesis regulation as the common pathway for pyogenic granuloma development. Contexte : Le granulome pyogeme est une reaction inflammatoire vasoproliferative composee de tissus granuleux, dont Ia pathogenese n'est pas etablie clairement. Nous decrivons une serie de patients dont les granulomes pyogenes surviennent a Ia suite de diverses interventions oculoplastiques et proposons une etiologie commune. Methodes : Nous avons puise, dans les dossiers d'intervention de deux chirurgiens oculoplastiques, 16 cas de granulomes pyogenes survenus entre 1991 et 2000. Resultats : L'on constate que les granulomes pyogenes surviennent sur des sites chirurgicaux et non chirurgicaux associes a !'irritation ou a !'inflammation des tissus ou aux deux. Interpretation : Les capillaires constituent une composante predominante de Ia guerison des blessures et des granulomes pyogenes. La croissance et le developpement de nouveaux capillaires suivent une sequence ordonnee

Ophthalmic Plastic & Reconstructive Surgery, 2003

Exposure of a hydroxyapatite orbital implant measuring 10 x 3 mm developed in a 25-year-old man. ... more Exposure of a hydroxyapatite orbital implant measuring 10 x 3 mm developed in a 25-year-old man. The exposure was repaired with an amniotic membrane graft. Follow-up examinations at 5 days, 2 weeks, 2.5 months, and 5 months after surgery demonstrated closure of the conjunctival defect. The author concludes that amniotic membrane may be useful for the treatment of hydroxyapatite orbital implant exposures.

Cornea, 2008

To report a non-contact lens wearer with persistent Acanthamoeba organisms in the cornea after be... more To report a non-contact lens wearer with persistent Acanthamoeba organisms in the cornea after being treated with medical therapy that included topical chlorhexidine as 1 agent for 1 year. A 53-year-old man with Acanthamoeba keratitis was treated with medical therapy for >1 year, followed by a penetrating keratoplasty. Histopathologic examination of the keratoplasty specimen revealed viable-appearing Acanthamoeba cysts and trophozoites within the deep corneal stroma in a focus of corneal scarring. The use of chlorhexidine as 1 agent in the medical management of Acanthamoeba keratitis may not eradicate the organisms.

Canadian Journal of Ophthalmology / Journal Canadien d'Ophtalmologie, 2009

A thin 17-year-old male presented with bilateral blurred vision and pressure sensation over the c... more A thin 17-year-old male presented with bilateral blurred vision and pressure sensation over the central forehead. Medical and family histories were unremarkable and he took no medications. His initial visual acuity was 20/20 OU and visual field testing showed enlarged blind spots. Bilateral disc swelling was noted on funduscopy and he was referred to several physicians for workup, including lumbar puncture (opening pressure 280–300 mm H20), normal brain computed tomography, and magnetic resonance imaging. The patient was diagnosed with pseudotumor cerebri. Acetazolamide was prescribed but he was noncompliant and lost to follow-up. Three years later, he presented with severe headaches and reduced visual acuities of 20/100 OD and 20/150 OS. He had bilateral pale, edematous optic discs (in contrast to the hyperemic papilledema usually present in pseudotumor cerebri) and constricted visual fields (Fig. 1). Repeat brain computed tomography and magnetic resonance imaging were normal. A lumbar puncture demonstrated an opening pressure of 460 mm H20 and a venogram showed no venous thrombosis. He was treated with acetazolamide for 3 weeks, with improvement of his visual acuity to 20/30 OD and 20/100 OS. Subsequently, he was referred to one of the authors (Matthew Lee-Wing) for bilateral optic nerve sheath fenestrations. Although his visual acuity remained unchanged immediately after surgery, over the next few weeks his vision deteriorated to 20/100 OD and 20/400 OS. Repeat optic nerve sheath fenestration demonstrated no significant cerebrospinal fluid (CSF) release. A postoperative lumbar puncture revealed an opening pressure of >800 mm H20 with atypical white cells (all lymphocytes, 25% lymphomatous with B cell phenotype) in the CSF (Fig. 2). Primary diffuse large B-cell leptomeningeal lymphoma (PLML) was diagnosed and the patient was treated with a ventriculoperitoneal shunt and high-dose methotrexate. He eventually achieved complete remission; however, his final visual acuity decreased to 20/400 OD and counting fingers OS. Pseudotumor cerebri is a diagnosis of exclusion. The most recent diagnostic recommendations are based on the Modified Dandy Criteria and include signs and symptoms specific to generalized intracranial hypertension, documented elevated intracranial pressure, normal CSF composition, no neuroradiologic abnormalities, and no other causes of intracranial hypertension. PLML is extremely rare and it is not uncommon for initial lumbar punctures to be nondiagnostic. Some patients present with loss of visual acuity and diplopia, but others may have no visual symptoms. Two cases of PLML mistaken for pseudotumor cerebri in young women have been reported in the neurologic literature. The first patient’s primary complaint was headache and she died 1 year after onset of symptoms. The other patient was also misdiagnosed with pseudotumor cerebri for 3 years and did not respond to chemotherapy. There has been little mention of PLML in the ophthalmologic literature and the case reported herein highlights the ophthalmologist’s role in diagnosing the rarer causes of optic neuropathy in patients with normal extensive workup. Specifically, it is important that the ophthalmologist demand repeat, serial lumbar punctures to definitively rule out more ominous diagnoses in patients who present with disc swelling and ongoing vision loss.

American Journal of Ophthalmology, 2001

To report a patient with bilateral lacrimal gland enlargement as the initial manifestation of Ros... more To report a patient with bilateral lacrimal gland enlargement as the initial manifestation of Rosai--Dorfman disease. Case report. A 14-year-old female presented with left lacrimal gland enlargement followed by right lacrimal gland enlargement 11 weeks later. Bilateral lacrimal gland biopsies were performed, and histopathologic examination revealed the diagnosis of Rosai--Dorfman disease. Patients with Rosai--Dorfman disease may present with bilateral lacrimal gland swelling in the absence of lymphadenopathy. Rosai--Dorfman disease should be considered in the differential diagnosis of bilateral lacrimal gland enlargement.

Ophthalmic surgery and lasers

Lung cancer commonly affects middle-aged and elderly smokers. Metastatic disease involving the or... more Lung cancer commonly affects middle-aged and elderly smokers. Metastatic disease involving the orbit is uncommon. We report the unusual occurrence of a 25-year-old male nonsmoker with an aggressive form of lung cancer who developed metastatic orbital disease involving the medial rectus.

Canadian Journal of Ophthalmology

Clinical Ophthalmology

Purpose: To develop and validate neural network (NN) vs logistic regression (LR) diagnostic predi... more Purpose: To develop and validate neural network (NN) vs logistic regression (LR) diagnostic prediction models in patients with suspected giant cell arteritis (GCA). Design: Multicenter retrospective chart review. Methods: An audit of consecutive patients undergoing temporal artery biopsy (TABx) for suspected GCA was conducted at 14 international medical centers. The outcome variable was biopsy-proven GCA. The predictor variables were age, gender, headache, clinical temporal artery abnormality, jaw claudication, vision loss, diplopia, erythrocyte sedimentation rate, C-reactive protein, and platelet level. The data were divided into three groups to train, validate, and test the models. The NN model with the lowest false-negative rate was chosen. Internal and external validations were performed. Results: Of 1,833 patients who underwent TABx, there was complete information on 1,201 patients, 300 (25%) of whom had a positive TABx. On multivariable LR age, platelets, jaw claudication, vision loss, log C-reactive protein, log erythrocyte sedimentation rate, headache, and clinical temporal artery abnormality were statistically significant predictors of a positive TABx (P#0.05). The area under the receiver operating characteristic curve/Hosmer-Lemeshow P for LR was 0.867 (95% CI, 0.794, 0.917)/0.119 vs NN 0.860 (95% CI, 0.786, 0.911)/0.805, with no statistically significant difference of the area under the curves (P=0.316). The misclassification rate/false-negative rate of LR was 20.6%/47.5% vs 18.1%/30.5% for NN. Missing data analysis did not change the results. Conclusion: Statistical models can aid in the triage of patients with suspected GCA. Misclassification remains a concern, but cutoff values for 95% and 99% sensitivities are provided (https://goo.gl/THCnuU).

OBJECTIVE To evaluate the safety of performing cataract surgery prior to eyelid (entropion/ectrop... more OBJECTIVE To evaluate the safety of performing cataract surgery prior to eyelid (entropion/ectropion) surgery in patients with concurrent cataract and lower eyelid malposition. DESIGN Retrospective case series. PARTICIPANTS AND METHODS Patients with concurrent lower eyelid malposition and cataract undergoing cataract surgery before lower eyelid repair from 2013 to 2020 were identified from two ophthalmologists (M.L.W., G.R.). Both surgeries were performed by the same ophthalmologist, with eyelid repair completed at least 1 month following cataract extraction. Data analysis was performed with two-parameter estimations. The primary outcome was the postoperative endophthalmitis rate in this cohort. RESULTS 129 cases in 90 patients were found (86 involutional entropion and 43 involutional ectropion). No cases of endophthalmitis were encountered. Statistical analysis using the 95% Jeffreys interval for one-sample binomial proportion revealed an upper limit of 1.9%. The Agresti-Caffo inte...

Canadian journal of ophthalmology. Journal canadien d'ophtalmologie, 2001

Pyogenic granuloma is a vasoproliferative inflammatory response composed of granulation tissue. T... more Pyogenic granuloma is a vasoproliferative inflammatory response composed of granulation tissue. The pathogenesis is not entirely clear. We describe a series of patients with pyogenic granulomas occurring following common oculoplastic procedures and propose a common etiology. Sixteen cases of pyogenic granuloma that occurred after various oculoplastic procedures from 1991 to 2000 were collected from the files of two oculoplastic surgeons. Pyogenic granulomas were found to occur at surgical and nonsurgical sites associated with tissue irritation or inflammation or both. Capillaries are a predominant component of wound healing and pyogenic granulomas. The growth and development of new capillaries follows an orderly sequence of events that is highly regulated by a variety of angiogenic factors. We postulate an imbalance in angiogenesis regulation as the common pathway for pyogenic granuloma development.

Ophthalmic surgery and lasers

Lung cancer commonly affects middle-aged and elderly smokers. Metastatic disease involving the or... more Lung cancer commonly affects middle-aged and elderly smokers. Metastatic disease involving the orbit is uncommon. We report the unusual occurrence of a 25-year-old male nonsmoker with an aggressive form of lung cancer who developed metastatic orbital disease involving the medial rectus.

Ophthalmology, 1999

To help understand the pathogenesis of herpes family virus ocular infection among patients positi... more To help understand the pathogenesis of herpes family virus ocular infection among patients positive for HIV, the authors compared the rates of detection of herpes family virus DNA from the conjunctiva of patients who are positive and negative for human immunodeficiency virus (HIV) using the polymerase chain reaction (PCR). Cross-sectional study. The conjunctival scrapings of 30 patients positive for HIV and 30 patients negative for HIV were examined. PCR was used to assay for the presence of herpes simplex virus type 1 (HSV), varicella-zoster virus (VZV), cytomegalovirus (CMV), and Epstein-Barr virus (EBV) DNA (n = 240 samples). The rate of detection of virus DNA in the two groups, controlling for age, gender, and race, was measured. HSV and VZV DNA were not detected in any of the HIV-positive or HIV-negative samples. CMV DNA was detected in 20% (6 of 30) of patients positive for HIV and was undetected in control subjects negative for HIV (P = 0.01). EBV DNA was detected in 40% (12 of 30) of patients positive for HIV and in 47% (14 of 30) of control subjects negative for HIV (P = 0.58). There was no difference in the frequency of detection of HSV, VZV, or EBV DNA from the conjunctiva of patients positive or negative for HIV. Only CMV DNA was detected at a significantly higher rate in the conjunctiva of patients positive for HIV compared with control subjects negative for HIV. These different rates of peripheral virus shedding may be one possible explanation for the different rates of clinical infection among the herpes family viruses among patients positive for HIV.

Ophthalmology, 2001

To determine the prevalence of lacrimal sac pathology in patients undergoing dacryocystorhinostom... more To determine the prevalence of lacrimal sac pathology in patients undergoing dacryocystorhinostomy (DCR) for primary acquired nasolacrimal duct obstruction (PANDO). Observational case series. One hundred sixty-six patients with symptoms of PANDO. A total of 202 lacrimal sac biopsies were obtained from 166 patients undergoing external DCR procedures for symptoms of PANDO. Patient demographics, presenting symptoms and signs, relevant history, and assessment of the nasolacrimal system were recorded. All lacrimal biopsy specimens were examined histopathologically. A total of 118 patients (71%) were female and 48 patients (29%) were male. The mean age was 60.7 years (range, 21-93 years). All patients demonstrated epiphora, and 32 patients had dacryocystitis. Duration of symptoms ranged from 6 weeks to 50 years. No lacrimal sac tumors were detected. Sixty-five percent of specimens demonstrated chronic inflammation. No neoplasms were detected among 202 lacrimal sac specimens from 166 patients with symptoms of PANDO. Most lacrimal sac specimens demonstrated chronic inflammatory changes. We conclude that a lacrimal sac biopsy should be performed when there is suspicion of a neoplasm based on the clinical, historical, or intraoperative findings, rather than routine biopsy of all patients with PANDO.

Cornea, 1999

Herpesvirus infection of the lacrimal gland was investigated as an etiologic factor for keratocon... more Herpesvirus infection of the lacrimal gland was investigated as an etiologic factor for keratoconjunctivitis sicca in patients who were positive for human immunodeficiency virus (HIV). In this cross-sectional study, we recorded the Schirmer tests and tear break-up times (TBUTs) among 30 patients who were positive for HIV. Dry-eye state was defined as a Schirmer test of <10 mm of wetting at 5 min or a TBUT of <10 s. The polymerase chain reaction assay (PCR) for herpes family viruses [Epstein-Barr virus (EBV), cytomegalovirus (CMV), herpes simplex virus (HSV), and varicella-zoster virus (VZV)] was performed on the conjunctival and tear specimens of the 30 HIV-positive patients by using virus-specific single primers. We compared the rates of virus DNA detection among dry-eye and non-dry-eye patients by calculating the odds ratio of detection for each virus. The odds ratio of viral DNA detection was adjusted for age, gender, race, CD4 count, and duration of HIV positivity. The adjusted odds ratios of EBV DNA detection among dry-eye to non-dry-eye patients were 1.30 (p = 0.79) and 0.97 (p = 0.98) by using Schirmer tests and TBUTs, respectively. For CMV, the adjusted odds ratios among dry-eye to non-dry-eye patients were 1.94 (p = 0.58) with Schirmer tests and 1.02 (p = 0.99) with TBUTs. HSV and VZV DNA were not detected in any samples. Our study does not support the role of herpesvirus infection of the lacrimal gland as a causative factor in the pathogenesis of dry eyes in patients positive for HIV.

Cancer research, 1987

We have previously reported the identification and characterization of a prolactin-inducible prot... more We have previously reported the identification and characterization of a prolactin-inducible protein (PIP) as well as the cloning of the gene encoding PIP in cultured human breast cancer cells. We now present three lines of evidence that the gene encoding PIP is ...