Carl-Joe Mehanna

Road versus roadside particle size distribution in a hot Mediterranean summer--estimation of fleet emission factors.

Particle size distribution at major on-road, roadside, and university-ground sites in Lebanon were studied in summer 2011. In a predominant old traffic fleet, it is shown that calculated PM2.5 mass emission factors (EFs) conform to those of heavy duty vehicles. When compared to roads in California, higher PM2.5 mass but similar particle number EFs are obtained for the average fleet of the on-road sites. This confirms the observed particle size distribution pattern, rich in particles in the accumulation range mainly between 0.425 and 0.675 µm with a prevalent peak at 0.475 µm. Corresponding total particle counts (TC) measured on the roadside are as high as 14,050 particles/cm3 and are up to 67% higher than particle counts measured at the university-ground site. In a hot, dry and humid summer weather with consistent temperature oscillations, particle dispersion is shown to be a function of meteorological factors, mainly the effect of the boundary-layer thickness, with particle counts measured during the morning being around 40% higher than particle counts measured during the afternoon. Implications In a hot and humid Mediterranean summer, high emission factors are associated with an old car fleet. The observed diurnal variation in the particle count is attributed to the change in the thickness boundary layer in summer. In comparison to road sites, the particle size distribution shows the prevalence of larger size particles. Particle counts measured at the roadside sites are at least 20% higher than those of the road sites. The findings call for the reinforcement of local regulations on car age. Furthermore, the high number of particles can cause or aggravate a number of health and ecosystem problems.

Five-Year Incidence and Progression of Diabetic Retinopathy in Patients with Type II Diabetes in a Tertiary Care Center in Lebanon

Objective To estimate the 5-year incidence of progression rate and regression rate and risk factors for diabetic retinopathy (DR) in a cohort of Lebanese patients with type II diabetes. Methods We followed a cohort of 462 Lebanese patients with type II diabetes for over 5 years at the American University of Beirut Medical Center. Patients underwent yearly complete ophthalmic evaluation and fundus photographs and were assessed for the incidence, stage, and evolution of DR using modified Airlie House classification. Results Among the 462 patients, 281 had no DR at baseline. The 5-year cumulative incidence of any DR was 10% (95% CI: 6–13), and only baseline microalbuminuria correlated with the development of DR (OR = 10.53, 95% CI: 4.39–25.23, p < 0.0001). Among the 181 patients with baseline DR, the worsening and regression rates of DR were 31.5% (95% CI: 25–38) and 9% (95% CI: 5–13), respectively. Microalbuminuria also approached statistical significance as a risk factor for DR worsening (OR = 1.89, 95% CI: 0.97–3.70, p = 0.06). Conclusion The 5-year incidence of DR in this hospital-based cohort is relatively low. Microalbuminuria was independently associated with the incidence and progression of the disease. We recommend to screen patients with type II diabetes for microalbuminuria as prognostic for the development and worsening of DR.

Comparison between Nonmydriatic Spectral Domain Optical Coherence Tomography and Conventional Ophthalmologic Examination in Detecting Adult Macular Pathology

Objective: To compare nonmydriatic spectral domain optical coherence tomography (NMOCT) to comprehensive ophthalmologic evaluation (COE) in detecting adult macular abnormalities. Methods: This is a single-reader observational pilot study of adults older than 50 years with no known ophthalmologic problems to assess the correlation between NMOCT and COE in detecting macular abnormalities classified as epiretinal, intraretinal, subretinal, or a combination thereof. Subjects underwent NMOCT of the macula followed by COE which included a dilated fundus examination and ancillary tests as needed. Results: A total of 771 eyes of 406 patients were included. Cohen’s kappa coefficient of agreement between NMOCT and COE for detecting any abnormality was high (0.90, p < 0.0001), with NMOCT having an overall sensitivity of 82.65% and specificity of 98.97%. Sensitivities and specificities of NMOCT in detecting each category of macular abnormalities were as follows: epiretinal (86.36%, 99.73%), intraretinal (80.00%, 99.58%), and subretinal (88.89%, 99.73%), respectively. Conclusion: NMOCT is a promising tool for detecting adult macular abnormalities.

High-Definition Optical Coherence Tomography of the Macula in Deprivational Amblyopia

BACKGROUND AND OBJECTIVE This study evaluated macular thickness in deprivational amblyopia and compared it to matched controls. PATIENTS AND METHODS The authors present a cross-sectional study of patients with amblyopia from pediatric cataract and matched controls. Macular high-definition optical coherence tomography scans of each eye were acquired. Central macular thickness (CMT) and parafoveal thicknesses at 500 μm, 1,000 μm, and 1,500 μm in the nasal, temporal, inferior, and superior locations were measured. RESULTS Thirty-four eyes were included: 14 eyes with deprivational amblyopia and 20 controls. In amblyopes, the mean age was 10.06 years ± 3.89 years and logMAR visual acuity (VA) was 0.41 ± 0.53, whereas in the control group, mean age was 8.96 years ± 1.89 years and mean logMAR VA was 0.03 ± 0.05. The macula in deprivational amblyopia was significantly thicker centrally compared to controls (P = .0013), but only tended to be thicker at 500 μm and thinner at 1,000 μm and 1,500 μm. Male gender, poorer VA, and hyperopic refraction positively correlated with CMT (P = .011, P = .018, and P = .038, respectively). CONCLUSION Eyes with deprivational amblyopia had increased CMT compared to controls, and this correlated with the severity of amblyopia. [Ophthalmic Surg Lasers Imaging Retina. 2018;49:198-204.].

Macular Changes on Optical Coherence Tomography Before, During, and After Silicone Oil Tamponade for Macula-On Retinal Detachment: A Case Series

Purpose: Assess changes on spectral domain optical coherence tomography (OCT) before, during, and after removal of silicone oil (SO). Methods: Retrospective series of patients who underwent SO tamponade for macula-on rhegmatogenous retinal detachment. OCT scans of the affected eye were taken before, during, and 3 months after SO tamponade. Qualitative assessment of foveal contour and quantitative comparison of OCT parameters (central macular, cube, ganglion cell layer [GCL], and outer retinal thicknesses) were done between 3 time points. Results: Ten eyes of 9 patients were included. Flattening of the foveal contour during SO tamponade was completely reversed after SO removal. Average cube and GCL thicknesses decreased with SO tamponade and increased after SO removal (P = .01 and P = .02, respectively). Outer retinal thicknesses did not vary among 3 time points (P = .09). Conclusions: SO tamponade causes foveal flattening and thinning of the inner retinal layers, which is reversible on removal.

Corrigendum to “Five-Year Incidence and Progression of Diabetic Retinopathy in Patients with Type II Diabetes in a Tertiary Care Center in Lebanon”

[This corrects the article DOI: 10.1155/2017/9805145.].

Changing Trends in Eye-Related Complaints Presenting to the Emergency Department in Beirut, Lebanon, over 15 Years

Objective To report the 15-year trend in ophthalmic presentations to the emergency department (ED) at the only medical center in Lebanon that provides 24-hour ophthalmologic care. Methods Retrospective review of 1967 patients presenting to the ED with eye-related complaints between September 1997 and August 1998 and between September 2012 and August 2013. Diagnoses were classified into 4 categories according to the International Society of Ocular Trauma and include penetrating eye injuries, nonpenetrating eye trauma, nontraumatic ophthalmic emergencies, and nontraumatic, nonurgent ophthalmic conditions. Results One thousand sixty eye-related presentations out of 39,158 total ED visits (2.71%) presented in 1997 compared to 907 out of 46,363 in 2012 (1.96%). Penetrating and nonpenetrating eye emergencies decreased between 1997 and 2012 (7.17% to 4.19%, p = 0.003 and 52.64% to 29.00%, p < 0.001, resp.) while nonurgent cases increased from 30.19% to 53.47% (p < 0.001). 57% of patients were covered by third-party guarantors in 1997 versus 73% in 2012. Conclusion Our results demonstrate a significant increase in nonurgent cases in parallel with the proportion of third-party payers, an issue to be addressed by public health policies and proper resource allocation. A detailed nationwide review is needed to make solid recommendations for the management of ophthalmologic presentations in the ED.

Neutrophils contribute to vasculitis by increased release of neutrophil extracellular traps in BEHÇET’S disease

BACKGROUND AND OBJECTIVES Behçets disease (BD) is a multi-system inflammatory disorder that can cause vasculitis. Here we questioned whether Neutrophils in BD cause vasculitis via releasing Neutrophil Extracellular Traps (NETs), a process called NETosis. METHODS Circulating neutrophils were isolated from a cohort of Middle Eastern BD patients with an active disease and healthy volunteers. The percentage of NETs release was monitored in neutrophils stimulated or not with BD serum, and treated or not with Colchicine, Dexamethasone, Cl-amidine or N-Acetyl Cysteine (NAC). The mRNA expression levels of PAD4 (a key enzyme in NETosis) was also assessed. The effect of NETs on the proliferation and cell death of endothelial cells was investigated using an in vitro co-culture model. The presence of NETs in skin tissues of BD patients was examined using immunolabeling of NETs associated proteins. RESULTS Circulating Neutrophils from BD patients were more prone to release NETs in vitro and expressed higher levels of PAD4 compared to healthy volunteers. Spontaneous NETs formation in BD neutrophils was inhibited by Colchicine and Dexamethasone, two drugs used to treat BD. NETs formation was also inhibited by Cl-amidine, a specific PAD4 inhibitor, and by NAC, a ROS inhibitor. Interestingly, serum from BD patients stimulated circulating neutrophils from healthy volunteers to release more NETs and increased their mRNA PAD4 expression. Moreover, endothelial cells cultured in the presence of NETs from BD patients showed a decrease in proliferation and an increase in apoptosis and cell death. Finally, NETosis was predominantly identified around affected blood vessels in biopsies of vasculitis from BD patients. CONCLUSION Our results provide evidence on the implication of NETosis in the pathophysiology of BD especially in inducing vasculitis.

Unmeasurable small size superficial and deep foveal avascular zone in nanophthalmos: the Collaborative Nanophthalmos OCTA Study

Aim To study the macular structure and vasculature in consecutive nanophthalmic eyes using optical coherence tomography angiography. Methods This is a prospective, multicentre, cross-sectional study of patients with nanophthalmos (one or both eyes). The superficial and deep foveal avascular zones (FAZ) were measured both manually and with the machine’s built-in automated measurement tool. Correlations between best corrected visual acuity (BCVA), central macular thickness (CMT) and subfoveolar choroidal thickness (SFCT) were calculated. Results Sixty-five eyes of 35 subjects (16 men and 19 women) with a mean age of 37.4 years were analysed. The mean±SD of refractive error was 14.3±3.2 dioptres, axial length was 16.4±1.6 mm, CMT was 410.2±128.3 µm and SFCT was 450.1±108.3 µm. FAZ was unmeasurable small size in both the superficial and deep capillary plexus in all eyes, along with tortuosity of the superficial foveal capillaries and large vessels. Foveal folds were present in 29 eyes. Disc drusen was detected in 27 eyes and was absent in 31 eyes, while fundus autofluorescence was positive in 17 and negative in 24 eyes. BCVA varied from 20/20 to 20/800, with a mean of 20/76. Using Spearman’s correlation, logarithm of the minimum angle of resolution BCVA correlated negatively with axial length (r=−0.30; p=0.015). Conclusions FAZ attenuation, capillary tortuosity, foveal folds and thickened subfoveal choroid characterise the nanophthalmic macula. These findings may result from a redundant retina and the absence of apoptotic foveolar retraction because of developmental arrest of the optic vesicle after closure of the embryonic fissure.

Intravitreal Adalimumab for the Control of Breakthrough Intraocular Inflammation

ABSTRACT Purpose: Investigate the efficacy of intravitreal adalimumab in breakthrough panuveitis in patients on systemic adalimumab for more than 3 months. Methods: Retrospective study of patients on systemic adalimumab with breakthrough panuveitis requiring intravitreal adalimumab therapy. Results: Seven eyes of four patients with Adamantiades–Behçet disease panuveitis were included and all were maintained on systemic adalimumab for 7.3 months (range 3–11) with inflammation controlled for 4.1 months (range 2–10) before breakthrough uveitis. The total number of attacks was 13 over 24.5 months (range 12–30). Resolution of attack was defined as return to baseline visual acuity with resolution of inflammatory markers. Three attacks resolved after only one injection and 10 attacks required an average of 2.4 injections (range 2–3). No systemic or ocular complications were noted. Conclusions: Intravitreal adalimumab warrants further investigation as a potentially effective, practical and safe adjunctive therapy for the control of breakthrough inflammation in select patients maintained on systemic adalimumab.