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Biomedical subjects

William G Hodge

Publications and source records attributed to William G Hodge.

At least 19 recordsLinked to original sources
PubMed2006

Conjunctival T-cell lymphoma: a clinicopathologic case report.

OBJECTIVE: To report a patient with conjunctival T-cell lymphoma, an extremely rare entity. DESIGN: Single case report. METHODS: Based on clinical examination, an excisional biopsy and immunostaining were performed on the conjunctival lesion. For management, we excised and performed triple freeze-thaw cryotherapy to the involved area, and we consulted the oncology service. MAIN OUTCOME MEASURES: T-cell and B-cell markers, and clinical examination of the lesion. RESULTS: Both examination and laboratory assessment revealed no evidence of systemic involvement. Conjunctival biopsy showed expansion of the substantia propria with an infiltrate of chronic inflammatory cells (including lymphocytes, plasma cells, and eosinophils), and prominent lymphocyte exocytosis with reactive epithelial changes. The CD-45 RO (T-cell marker) was strongly positive, whereas the CD-20 (B-cell marker) was negative. The T-cell receptor gene rearrangement was positive with beta clonality, confirming the diagnosis of T-cell lymphoma. CONCLUSIONS: T-cell lymphoma is a rare but possible diagnosis of gelatinous conjunctival lesions. The oncology consultants were reluctant to treat the patient with systemic chemotherapy or radiation because extraconjunctival extension could never be documented. The answer to the question of what is the most appropriate treatment for conjunctival T-cell lymphoma remains unknown.

Antigens, CD20↗
PubMed2006

Efficacy of omega-3 fatty acids in preventing age-related macular degeneration: a systematic review.

TOPIC: What is the evidence for efficacy of dietary and/or supplemental omega-3 fatty acids in preventing age-related macular degeneration (AMD)? CLINICAL RELEVANCE: Age-related macular degeneraion is the leading cause of blindness and vision impairment in persons older than 50 years living in North America. There is no cure for AMD, and treatment does not usually restore vision but only prevents disease progression to a modest degree. omega-3 fatty acids are considered potentially important antioxidants and are being considered as an arm of the Age-Related Eye Disease Study II clinical trial. METHODS/LITERATURE REVIEWED: Keywords were searched in Medline, Pre-Medline, Embase, and the Cochrane Library on Ovid. There was no restriction on the year or language of publication. RESULTS: There were 6 observational studies found, but the specific outcomes, exposures, and covariates studied all varied greatly. CONCLUSION: There is some clinical evidence for protection of AMD from omega-3 fatty acids. However, the results are not consistent. Hence, our conclusion is that this issue is neither clearly supported nor refuted by the present world literature. This is an intriguing and extremely important question but needs further study first with prospective cohort designs and, if positive, randomized clinical trials.

Antioxidants↗
PubMed2006

The evidence for efficacy of omega-3 fatty acids in preventing or slowing the progression of retinitis pigmentosa: a systematic review.

BACKGROUND: Studies in preterm and term human infants have suggested that a dietary supply of omega-3 fatty acids is essential for optimal visual development. Several basic science studies support the hypothesis that omega-3 fatty acids may be useful therapeutic agents for pathologies of the retina and lens. As part of a systematic review of the effect of omega-3 fatty acids on eye health, the purpose of this study was to conduct a systematic review of the scientific-medical literature to appraise and synthesize the evidence for the effects of omega-3 fatty acids in preventing the development or progression of retinitis pigmentosa. METHODS: A comprehensive search was undertaken in MEDLINE, PREMEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Global Health, and Dissertation Abstracts. Unpublished literature was sought through manual searches of reference lists of included studies and key review articles and from the files of content experts. Searches were not restricted by language of publication, publication type, or study design. Eligibility criteria were applied to screen eligible studies on two levels. Data extraction and quality assessment were performed. RESULTS: Six studies published between 1995 and 2004 met eligibility criteria in investigating the question of the possible value of omega-3 fatty acids in slowing the progression of retinitis pigmentosa. Meta-analysis was not performed because there was not enough available information for formal quantitative analysis. INTERPRETATION: There are trends in improvement of some retinitis pigmentosa outcomes with omega-3 fatty acids in the higher quality studies. Clinical research is preliminary in this field, however. Accordingly, definitive answers will require significantly more observational and interventional clinical research.

Databases, Factual↗
PubMed2006

Trabeculectomy and phacotrabeculectomy, with mitomycin-C, show similar two-year target IOP outcomes.

BACKGROUND: To determine the efficacy and safety of trabeculectomy with mitomycin-C (trabMMC) compared with that of single-site phacotrabeculectomy with mitomycin-C (phacotrabMMC) in glaucoma patients at increased risk for filtering surgery failure. METHODS: Eighty-five consecutive eyes that underwent trabMMC and 105 consecutive eyes that underwent phacotrabMMC were retrospectively compared up to 2 years postoperatively with respect to intraocular pressure (IOP), number of glaucoma medications, and surgical complication rates. The primary outcome was the difference in the cumulative proportion of patients meeting the target IOP range at 2 years. Secondary outcomes included mean postoperative IOP, mean IOP drop from baseline, mean number of glaucoma medications, and surgical complication rates. RESULTS: Baseline characteristics were similar in the 2 groups and most patients had advanced glaucoma with a similar upper limit of the target IOP range (15.5 +/- 2.6 mm Hg for trabMMC vs. 15.3 +/- 2.1 mm Hg for phacotrabMMC, p = 0.56). Loss to follow-up was significant in both groups (almost 50% over 2 years). A statistically similar proportion of patients achieved their target IOP range at 1 and 2 years in both groups: the cumulative success rate at 2 years was 29.04% and 22.91% (p = 0.44) without add-on glaucoma therapy, 25.38% and 25.22% (p = 0.60) with the use of up to 2 glaucoma medications, and 30.01% and 25.17% (p = 0.81) with the use of any number of glaucoma medications, in the trabMMC and phacotrabMMC groups, respectively. Mean postoperative IOP was also similar between the 2 groups at almost all follow-up times up to 2 years (13.56 +/- 4.92 mm Hg in trabMMC vs. 13.98 +/- 4.74 mm Hg in phacotrabMMC at 2 years, p = 0.67). The mean IOP drop from baseline was significantly greater in the trabMMC group throughout the study period (-10.87 +/- 8.33 mm Hg in trabMMC vs. -6.15 +/- 7.01 mm Hg in phacotrabMMC at 2 years, p = 0.003); however, baseline IOP was also higher in the trabMMC group (26.1 mm Hg vs. 20.3 mm Hg, p < 0.0001). Serious postoperative complication rates were similarly low between the 2 groups. INTERPRETATION: TrabMMC and phacotrabMMC may be equally safe and effective in bringing IOP to within an acceptable target range over 2 years in advanced glaucoma patients at increased risk for filtering surgery failure, although trabMMC appears to be associated with greater IOP lowering from baseline.

Adult↗
PubMed2006

Bilateral acanthamoeba keratitis and treatment strategy based on lesion depth.

CASE REPORT: This report summarizes a case of bilateral acanthamoeba keratitis in an 18-year-old male contact-lens wearer. Early diagnosis is important and combination treatment is recommended, tailored to the depth of the lesions. COMMENTS: Treatment can be difficult, particularly since amoebic cysts are especially resistant. Surgery may be required for advanced cases. Suggestions for reducing corneal toxicity to antiamoebic therapy are included.

Acanthamoeba Keratitis↗
PubMed2006

Perspectives on low vision service in Canada: a pilot study.

BACKGROUND: A review of the literature and current practice patterns for vision rehabilitation care in Canada provide a basis for this pilot study, which was undertaken to explore related issues from the perspectives of older adults and low vision service providers. The pilot study was overseen by a number of collaborators whose names are listed at the end of this paper. METHODS: Thirty people aged 60 years or older who had vision impairments and were clients of the Canadian National Institute for the Blind were surveyed by telephone. Ophthalmologists, optometrists, and opticians completed a mail questionnaire. Vision rehabilitation practitioners and nurses, ophthalmic technicians, and service providers for low vision technical aids were surveyed by e-mail. RESULTS: Ophthalmologists are a primary source of referrals to low vision services, but low functional vision does not always trigger such referrals, nor are referrals always timely. Optometrists are primary providers of low vision services, including dispensing of low vision aids, but such aids are expensive, and inadequate training in their use may contribute to noncompliance. Costs associated with providing low vision assessments and services are higher than compensation to vision service providers, whose capacity to meet increasing demand is limited. In addition, there are disparities between rural and urban areas and among provinces in the availability of, and funding for, services and aids. INTERPRETATION: On the basis of the findings, an emergent theory is proposed on the consequences resulting from lack of planning and standards for vision rehabilitation care. The implications of this study form the basis for further research.

Aged↗
PubMed2006

A simple, cross-linked collagen tissue substitute for corneal implantation.

PURPOSE: To develop a simple corneal substitute from cross-linked collagen. METHODS: Porcine type I collagen (10%; pH 5), was mixed with 1-ethyl-3-(3-dimethylaminopropyl)carbodiimide (EDC) and N-hydroxysuccinimide (NHS). The final homogenous solution was molded to corneal dimensions, cured, and then implanted into rabbits and minipigs by lamellar keratoplasty. The implants were followed for up to 6 months after surgery. Clinical examinations of the cornea included detailed slit lamp biomicroscopy, in vivo confocal microscopy, topography and esthesiometry for nerve function. Histopathologic examinations were also performed on rabbit corneas harvested after 6 months. RESULTS: Cross-linked collagen (refractive index, 1.35) had optical clarity superior to human corneas. Implanted into rabbit and porcine corneas, only 1 of 24 of the surgical corneas showed a slight haze at 6 months after surgery. All other implants showed no adverse reactions and remained optically clear. Topography showed a smooth surface and a profile similar to that of the contralateral nonsurgical eye. The implanted matrices promoted regeneration of corneal cells, tear film, and nerves. Touch sensitivity was restored, indicating some restoration of function. The corneas with implants showed no significant loss of thickness and demonstrated stable host-graft integration. CONCLUSIONS: Collagen can be adequately stabilized, using water soluble carbodiimides as protein cross-linking reagents, in the fabrication of corneal matrix substitutes for implantation. The simple cross-linking methodology would allow for easy fabrication of matrices for transplantation in centers where there is a shortage of corneas, or where there is need for temporary patches to repair perforations in emergency situations.

Animals↗
PubMed2006

Characterization of lymphoproliferative lesions of the conjunctiva: immunohistochemical and molecular genetic studies.

BACKGROUND: Conjunctival lymphoproliferative lesions have not been selected for independent analysis with newer immunohistochemical and molecular genetic techniques to highlight their unique profile. METHODS: Retrospective case series examined biopsies from 16 consecutive patients with conjunctival lymphoproliferative lesions. The histopathologic, immunohistochemical, and molecular genetic features were characterized, as well as the frequency of tumour type, prognostic implications, clinical features, and treatments offered. RESULTS: The diagnosis was lymphoma in 12 cases, atypical lymphoid hyperplasia (ALH) in 1 case, and reactive lymphoid hyperplasia (RLH) in 3 cases. The primary lymphomas consisted of 4 mucosa-associated lymphoid tissue lymphomas (MALTL), 1 follicular lymphoma (FL), 2 diffuse large B-cell lymphomas (DLBCLs), 1 lymphoplasmacytic lymphoma, and 1 T-cell lymphoma. Primary lymphomas were treated with radiation (n = 7), surgery (n = 1), and topical chemotherapy (n = 1). Complete remission was achieved in 8 of 9 primary lymphomas. Two cases of recurrence to the other conjunctiva were treated with radiation and both remained disease free. Secondary lymphomas included 2 DLBCL and 1 MALTL. Complete remission was seen in 2 patients after radiation plus chemotherapy, while the patient treated with chemotherapy alone was lost to follow-up. The 1 case of ALH presented bilaterally and achieved complete remission after topical chemotherapy treatments. The 3 RLH cases were surgically managed and 2 of the 3 recurred and were subsequently excised. Eleven lymphomas were of B-cell lineage by immunophenotyping. Molecular genetic studies of immunoglobulin heavy chain (IgH) gene rearrangement by polymerase chain reaction (PCR) showed clonal bands in 6 of 12 lymphomas, 1 of 3 RLH (polyclonal by immunophenotyping) and 1 ALH. BCL2-IgH [t(14;18)] rearrangement was seen in 8 of 12 cases (1 FL, 3 DLBCLs, 4 MALTLs) by real-time quantitative PCR. INTERPRETATION: Conjunctival lymphomas are predominantly B-cell type with a high prevalence of MALTL. An unexpected finding was the BCL2-IgH rearrangement seen in 4 of 5 MALTL cases in our series. The significance of this remains unclear.

Adult↗
PubMed2005

Donor age as a predictor of cornea transplant success.

BACKGROUND: The purpose of this study was to examine the association between donor age and cornea transplant success. METHODS: This retrospective cohort study comprised 116 patients who had cornea transplants performed for the first time. The primary analysis was performed to evaluate the time to graft failure as a function of donor age. Donor age was divided into 3 categories: (1) continuous, (2) younger than 65 versus 65 years and older, and (3) younger than 60 versus older than 70 years. We controlled for other variables that may affect graft outcome by multivariate modeling. The primary outcome was graft failure. RESULTS: No statistically significant association was found between time to failure and donor age [adjusted hazard ratio: 1.004 (p = 0.68) for continuous age, 1.18 (p = 0.68) for age < 65 vs. > or = 65 years, and 2.10 (p = 0.089) for age < 60 vs. > 70 years]. However, with all model-building strategies, our results demonstrated that all hazard ratios calculated were greater than 1.00 for the older versus the younger aged groups. INTERPRETATION: The influence of donor age on success of cornea transplants remains unresolved. Large, multicentre prospective cohort studies and randomized trials are needed to decisively determine the impact of donor age on cornea transplant success.

Age Factors↗
PubMed2005

Iatrogenic risk factors for cytomegalovirus retinitis.

BACKGROUND: To determine the iatrogenic risk factors for cytomegalovirus (CMV) retinitis in patients with the acquired immunodeficiency syndrome (AIDS). METHODS: The case-control study included 120 patients with CMV retinitis and 159 patients without CMV retinitis, all of whom had AIDS and CD4 counts less than 50 cells/microL at the time of diagnosis of retinitis or at the defined corresponding date in the controls. Iatrogenic risk factors studied were corticosteroid use, treatment with chemotherapy, treatment with radiotherapy, and blood transfusions. RESULTS: Among the risk factors studied, only steroid use was predictive of CMV retinitis (odds ratio 6.41, 95% confidence interval 2.35-17.51). Based on this study, the use of steroids systemically elevated the risk of CMV retinitis.

AIDS-Related Opportunistic Infections↗
PubMed2004

Clinical risk factors for cytomegalovirus retinitis in patients with AIDS.

PURPOSE: To determine the clinical risk factors for cytomegalovirus (CMV) retinitis in patients with AIDS. DESIGN: A case-control study. PARTICIPANTS: The study included 120 patients in whom CMV retinitis had been diagnosed from 1990 through 1999 (cases) and 159 patients without CMV retinitis from the same period (controls). All individuals had AIDS and CD4 counts less than 50 cells/microl at the time of diagnosis of retinitis in the cases or on the corresponding date for the controls. METHODS: Clinical risk factors were determined by history or physical examination. Confounders controlled for included CD4 count, hospital center, and a series of variables to control for confounding by drug treatment. Statistical analysis was performed by multivariate logistic regression. A systematic model-building strategy was developed from assumption testing to model building to model checking. MAIN VARIABLES MEASURED: Presence of visual symptoms, retinal microinfarctions (cotton-wool spots), history of opportunistic infections, and risk factors for human immunodeficiency virus acquisition were determined and compared in both groups. RESULTS: The following clinical risk factors were significant predictors of CMV retinitis: flashing lights or floaters (odds ratio [OR], 11.42; 95% confidence interval [CI], 3.43 to 38.01), cotton-wool spots (OR, 2.90; 95% CI, 1.01 to 8.29), number of previous opportunistic infections (OR, 1.81; 95% CI, 1.24 to 2.64), previous nonocular CMV infection (OR, 82.99; 95% CI, 6.86 to 1004.58), previous Mycobacterium infection (OR, 3.41; 95% CI, 0.99 to 11.85), and homosexuality (OR, 2.83; 95% CI, 1.13 to 7.12). CONCLUSIONS: Based on this study, clinical variables have been identified that elevate the risk of CMV retinitis. These findings may be useful to clinicians and health policy experts in developing rational guidelines for screening, examination frequency, and targeted prophylaxis for CMV retinitis in patients with AIDS.

AIDS-Related Opportunistic Infections↗
PubMed2004

Laboratory-based risk factors for cytomegalovirus retinitis.

BACKGROUND: Very few studies have investigated risk factors for cytomegalovirus (CMV) retinitis. Identifying these risk factors will have many benefits, including helping establish screening regimens, examination frequency regimens, and targeted prophylaxis with oral therapy with valganciclovir or other anti-CMV agents. The purpose of this study was to determine the laboratory-based risk factors for CMV retinitis in patients with AIDS. METHODS: We conducted a case-control study involving 120 patients in whom CMV retinitis had been diagnosed in 1990-99 and 159 patients without CMV retinitis from the same period. The sampling was from a primary study base in eastern Ontario and western Quebec of patients with AIDS and CD4 counts less than 50 cells/microL at the time of diagnosis of retinitis in the case subjects or an analogous date for the control subjects. There were two components to the study. In the first component (n = 279) we examined standard-of-care laboratory tests (hematologic and nutrition variables) done during the study period. In the second component (n = 57), which was a subset of the first, we examined laboratory tests (HLA type, qualitative and quantitative CMV polymerase chain reaction [PCR] and HIV load) on stored blood samples from the eastern Ontario site. Multivariate logistic regression was used to model the data and control for confounding. We developed a systematic model-building strategy, from assumption testing to model building to model checking. RESULTS: A low hemoglobin concentration was a statistically significant predictor of CMV retinitis (odds ratio [OR] 0.96, 95% confidence interval [CI] 0.94-0.98). Both qualitative CMV PCR (OR 21.71, 95% CI 1.80-261.67) and quantitative CMV PCR (OR 33.03,95% CI 2.32-469.39) were strong predictors of CMV retinitis. Among the 80 HLA types tested, HLA-Bw4 (OR 11.68, 95% CI 1.29-105.82) and HLA-DRB115 (OR 9.34, 95% CI 1.14-76.41) were significant predictors of CMV retinitis, whereas HLA-Cw7 was protective against CMV retinitis (OR 0.09, 95% CI 0.01-0.67). INTERPRETATION: We have identified laboratory variables that elevate (or decrease) the risk of CMV retinitis. These findings may be useful to clinicians and health policy experts in developing rational guidelines for screening, examination frequency and targeted prophylaxis for patients with AIDS.

AIDS-Related Opportunistic Infections↗
PubMed2004

Myopia and astigmatism in retinopathy of prematurity after treatment with cryotherapy or laser photocoagulation.

BACKGROUND: Visual outcome studies have shown that laser photocoagulation may result in more favourable clinical outcomes than cryotherapy in threshold retinopathy of prematurity (ROP). Comparative refractive outcome studies have shown that patients treated with laser photocoagulation have less myopia than those treated with cryotherapy. We carried out a study to determine whether a difference in visual outcome or refraction exists in patients with threshold ROP who have been treated with cryotherapy vs. laser photocoagulation. METHODS: A retrospective cohort study was conducted comparing treatment results after at least 3 years of follow-up in patients with threshold ROP treated with cryotherapy or laser photocoagulation at a tertiary care children's hospital. Visual acuity and refraction were the outcomes studied. Covariates measured were sex, gestational age and birth weight. Analysis was performed with both bivariate analysis and multivariate models. RESULTS: Seventy-one eyes of 37 patients with threshold ROP were included in the study. Thirty-seven eyes received cryotherapy, and 34 eyes received laser photocoagulation. The mean spherical equivalent refraction was significantly lower in the cryotherapy group than in the laser photocoagulation group (-9.21 dioptres vs. -1.80 dioptres, p = 0.001). Patients in the cryotherapy group were more likely than those in the laser photocoagulation group to have against-the-rule astigmatism (odds ratio 6.86, p = 0.004). Laser photocoagulation did not significantly lower the frequency of an unfavourable visual outcome (visual acuity worse than 20/200) (p = 0.09). INTERPRETATION: Eyes with threshold ROP treated with laser photocoagulation were significantly less myopic and less likely to have against-the-rule astigmatism than those treated with cryotherapy.

Astigmatism↗
PubMed2003

One-minute schirmer test with anesthesia.

PURPOSE: The 5-minute Schirmer test is a commonly described test for dry eye syndrome but is impractical for most ophthalmologists to perform routinely because of the 5-minute time frame. Hence, we decided to evaluate the intraindividual reliability of different wetting times of the Schirmer basal tear secretion test correlated to that of the standard 5-minute Schirmer test. METHODS: A prospective study was performed using 60 eyes of 30 patients. All patients had symptoms of dry eye syndrome. Patients were excluded if they had anatomic lid abnormalities that could interfere with the conduct of the test. The reliability of the Schirmer test at 30 seconds and 1, 2, 3, and 4 minutes was compared with that of the standard 5-minute test using the intraclass correlation coefficient (ICC). RESULTS: The ICC for each eye was only moderate at 30 seconds but was high to extremely high thereafter. Specifically, at 1 minute, the ICC for right eyes was 0.938 and for left eyes was 0.817. Furthermore, 100% of patients with severe dry eye (defined as a 5-minute Schirmer test of 5.5 mm or less) had a 1-minute Schirmer test less than or equal to 2 mm. Also, 80% of patients with a moderate dry eye (defined as a 5-minute Schirmer test between 5.5 to 10 mm) had a 1-minute test between 3 to 6 mm. CONCLUSION: Our results support the hypothesis that shorter durations of the 5-minute Schirmer test correlate highly with those of the 5-minute test. Specifically, the 1-minute test correlates highly with the 5-minute test and will make this test much more practical for ophthalmologists.

Anesthetics, Local↗