Cheng-Hsien Chang

Astigmatism in preschool children in Taiwan.

PURPOSE To elucidate the prevalence of astigmatism and its corneal component, the association between the amount of astigmatism and its axis, and the association between the axis of astigmatism and body mass index (BMI) in Taiwanese preschool children. METHODS In this population-based study we analyzed 2 data sets, one obtained by retrospective review of vision-screening data and another obtained in a prospective observational study. Each study collected data for age, sex, and refraction status. Autokeratometry, height, and weight measurements were obtained only in the observational study. Astigmatism was classified as with-the-rule, against-the-rule, or oblique. RESULTS The prevalence of astigmatism was unassociated with age or sex in both data sets. The retrospective study (1,094 subjects; mean age, 5 years; range, 2.19-7.32 years) revealed that 13.3% of the subjects had astigmatism > or = 1.00 D, and most of them had with-the-rule astigmatism; 4.0% had high astigmatism (>1.50 D). Children with with-the-rule astigmatism had greater mean cylinder power than those with against-the-rule or oblique astigmatism. In the prospective study (190 subjects; mean age, 5.65 years; range, 3.79-6.68 years) astigmatism correlated with its corneal component. Preschoolers with with-the-rule astigmatism and with-the-rule corneal astigmatism had greater BMI and heavier weight than those with against-the-rule or oblique type. CONCLUSIONS Astigmatism is common in Taiwanese preschool children. The predominant types are with-the-rule and oblique astigmatism. Most patients with high astigmatism and high corneal astigmatism have with-the-rule type. High BMI or weight is associated with with-the-rule astigmatism and with with-the-rule corneal astigmatism.

Epidemiologic Study on Work-Related Eye Injuries in Kaohsiung, Taiwan

To describe the epidemiologic features of work‐related eye injuries in Kaohsiung, a hospital‐based study was performed. Four hundred and eighty‐six patients who were treated at emergency service or were admitted to the ophthalmology ward over a 4‐year period were reviewed. Among these, 38.9% of eye injuries in the study were work‐related. Male workers had a 3.99 higher odds ratio (OR) than females to suffer from eye injuries (95% confidence interval [CI], 1.99‐8.04). Most of the work‐related eye injuries occurred in subjects who were 30‐49 years old (OR, 3.02, and 95% CI, 1.56‐5.82, when compared with those aged ≤29 years). The most common type of eye injury in the occupational exposure group was foreign body injury (31.2%), followed by blunt injuries (20.6%), chemical burn (19.6%), UV light radiation (12.7%), and corneal abrasions (11.6%). On the other hand, in the non‐occupational exposure group, the most common types of eye injury were blunt injuries (43.4%), corneal abrasions (28.3%), and foreign body injury (20.2%). Our study found that foreign body injury and blunt injuries were the two highest priority injuries for which prevention strategies should be developed in Kaohsiung city. Furthermore, after advanced examination of types of media that caused eye injuries, we found that being hit by wooden objects around the eye, by flying objects in the eye, and by welding flashes are important risk factors for workers to avoid. In conclusion, most of the occupational eye injuries occurred among male workers aged 30‐49 years. Due to the lack of an occupational eye injury surveillance system to monitor the incidence of eye injuries and to undertake risk assessment, preventable occupational eye injuries have not been properly controlled. We hope to provide information for further development of preventive strategies.

Case-control Study on the Prevention of Occupational Eye Injuries

The risk factors for occupational eye injuries have never been published in Taiwan. We conducted a case‐control study to analyze the differences among workers on their knowledge, attitude to and practice (KAP) of occupational accident prevention. In the study a statistical model was also set up for predicting the occupational problem. Subjects, including 31 cases of work‐related eye injuries and 62 controls, completed a structured questionnaire on KAP, which revealed that 80.6% and 62.7% of workers in the case and control groups, respectively, did not wear eye protection during work. Furthermore, we found that temporary employment (OR, 10.7; 95% CI, 3.03‐36.16) and fewer than 10 years of education (OR, 4.44; 95% CI, 1.73‐11.44) were the major risk factors for occupational eye injuries. In addition, we developed a logistic regression model with four predictors (temporary employment, education years less than 10, poor management of industrial health and safety in the workplace, and poor attitude towards accident prevention) for the occurrence of occupational eye injuries. In conclusion, in Taiwan, compulsory regulation of wearing eye protection during work, good education, management of work safety and hygiene and employee (especially temporary worker) commitment to safety and health are strongly recommended prevention strategies.

Eyelid Tumors in Southern Taiwan: A 5-Year Survey from a Medical University

This retrospective case analysis investigated the epidemiology of eyelid tumors in a subtropical area. The study assessed the proportion of all eyelid tumors that were malignancies, the accuracy of diagnosis, and surgical results. We retrospectively collected all cases of eyelid tumors in the Department of Ophthalmology, Kaohsiung Medical University, Taiwan, between January 1994 and December 1998. Among the 144 cases collected, about half of the tumors were located in the upper eyelids and the other half in the lower eyelids. Nearly 50% of cases underwent tumor resection with eyelid reconstruction. When followed up to April 1999, 97% of patients were satisfied with the surgical results. There were 18 cases (12.5%) of malignant tumors, including 14 basal cell carcinomas, three sebaceous carcinomas, and one squamous cell carcinoma. Before surgery, two malignancies were presumed to be benign tumors while another two were thought to be different malignant tumors. The benign tumors included 38 nevi, 15 squamous papillomas, 13 cysts, 11 verrucae, 10 seborrheic keratoses, four hemangiomas, and others. All tumors that were thought to be malignancies were treated using complete resection with margin monitoring by frozen section. At the end of follow‐up, no recurrence was noted. More than 10% of cases of eyelid tumors in this subtropical teaching hospital were malignant. All surgeons should be alert to this phenomenon when they operate on an eyelid tumor. The best policy is to send all specimens for pathologic examination.

Proteomic analysis of the differences in orbital protein expression in thyroid orbitopathy

BackgroundThyroid orbitopathy (TO) is a multi-system inflammatory disease characterized by orbital congestion, ocular surface disorders, restrictive myopathy, and skin lesions. The molecular and cellular processes of pathogenic formation of TO orbital fat tissues are not fully understood. In this study, a comparative proteomic analysis was conducted to investigate the importance of some differential proteins of orbital fat tissues in TO.MethodsThe differential proteins were analyzed by comparing the two-dimensional gel electrophoresis (2-DE) maps of the orbital fat tissues of TO with those of normal orbital fat tissues. The 2-DE results were further verified by Western blot and immunohistochemistry.ResultsFifteen up-regulated and two down-regulated proteins in TO orbital fat tissues in comparison with the control were exhibited by 2-DE maps. The over-expressed proteins including guanine nucleotide-binding protein, isocitrate dehydrogenase (IDH), annexin A2, heat shock protein 60 (HSP 60), calreticulin (CALR), protein disulfide-isomerase A3 (PDIA3), spectrin, superoxide dismutase (SOD), and transitional endoplasmic reticulum ATPase (TER ATPase) may contribute to increased thyroid-stimulating hormone receptor (TSHR) expression and cell proliferation. The proteomic data of specific proteins are consistent with those determined by Western blot and immunohistochemistry.ConclusionsComparison of orbital fat proteins from thyroid orbitopathy with age-matched controls shows significant differences in the proteome, and up-regulations of the specific proteins in orbital fat tissues from TO are associated with biochemical mechanisms or capacities against endoplasmic reticulum stress, mitochondria dysfunction, and cell proliferation as well as apoptosis in TO orbital fat tissues.

Refractive Status of Mountain Aborigine Schoolchildren in Southern Taiwan

Myopia is an epidemic health problem in Taiwans schoolchildren. The prevalence of myopia has been increasing yearly, and the average age at which myopia develops has also become younger. Due to insufficient eye care in remote areas, the refractive status of aboriginal schoolchildren has not been well established. In 2005 and 2006, under the sponsorship of the Bureau of Health Promotion, we surveyed the ocular refraction of aboriginal schoolchildren in southern Taiwan mountain townships. From five primary schools in two townships, 371 children aged from 7 to 13 years of age were enrolled in our study. Refractive status under cycloplegia and subjective visual acuity were obtained. The crude prevalence of myopia (<−0.25 diopter [D]) was 25.6%. Although the prevalence increased with age, the annual change in mean refractive status was slower in the schoolchildren of mountain aborigines. The spherical equivalents of 93% of children were within ±1 D. The highest myopia was only −2.50 D. Seven children (1.82%) were refractive amblyopic, for which high hyperopia, astigmatism or anisometropia were the main causes. As aboriginal children were noted to be more myopic in this study than in the past, better eye care should be implemented in these remote areas.

Malignant melanoma of the choroid in the eye with oculodermal melanocytosis of a Chinese woman.

In this study, we report a rare case of choroidal melanoma in an eye with oculodermal melanocytosis (Nevus of Ota). A 56‐year‐old Taiwanese woman with oculodermal melanocytosis in the right eye was found to have an ipsilateral uveal melanoma. Histopathology of the enucleated eye confirmed the diagnosis of malignant choroidal melanoma of mixed cell type. A search of the literature revealed strong evidence that oculodermal melanocytosis can predispose to the development of uveal melanoma in Caucasians. Only seven such cases have been reported in the East Asian population. This is believed to be the first such reported case in a patient of Chinese descent.

Primary ocular caruncular basal cell carcinoma in a Chinese patient.

Although basal cell carcinoma (BCC) is the most common eyelid neoplasm, BCC that originates from the lacrimal caruncle is extremely rare. To the best of our knowledge, only seven cases have been reported and here we report the first documented primary caruncular BCC in an Oriental patient. A 73‐year‐old Chinese man presented with a telangiectatic, multilobulated, pigmented tumor that measured 5×5 mm, which had arisen from the lacrimal caruncle of the left eye 3 months previously. The patient underwent tumor excision, and histopathological examination revealed BCC. He received adjuvant chemotherapy with intra‐arterial methotrexate (30 mg/m2). A nodular pigmented BCC recurred in the bulbar conjunctiva close to the original tumor 3 months later, and he underwent a second excision. Bleomycin (8.5 mg/m2 monthly) was added to the chemotherapy regimen, which was changed to fluorouracil (300 mg/m2 monthly) 2 months later. The tumor did not recur during follow‐up of 22 months. Malignant tumors of the caruncle are infrequent. BCC should be considered in the differential diagnosis of a pigmented caruncular lesion.

Quinoline-Based Compound BPIQ Exerts Anti-Proliferative Effects on Human Retinoblastoma Cells via Modulating Intracellular Reactive Oxygen Species

Retinoblastoma (Rb) is the most common primary intraocular malignant tumor of childhood. It is important to develop the strategy for Rb treatment. We have tested a quinolone derivative 2,9-bis[2-(pyrrolidin-1-yl)ethoxy]-6-{4-[2-(pyrrolidin-1-yl)ethoxy]phenyl}-11H-indeno[1,2-c]quinolin-11-one (BPIQ) for its anti-cancer effects against Rb via cultured human Rb cell line Y79. Our results showed that BPIQ significantly inhibits cell growth of Y79. Furthermore, the flow cytometer-based assays and Western blotting showed that BPIQ induces the apoptosis of Y79 via increasing the level of reactive oxygen species (ROS). Besides, the activation of γH2AX, a DNA damage sensor in human Y79 cells was also observed, indicating the potential of BPIQ for causing DNA damage of Rb cells. On the contrary, BPIQ-induced apoptosis of Y79 cells was attenuated significantly by N-acetyl-l-cysteine (NAC), an ROS scavenger. The results of Western blot showed that BPIQ down-regulates the levels of anti-apoptotic proteins Bcl-2, survivin and XIAP while up-regulates the pro-apoptotic proteins Bad, Bax and Bid. Our present study demonstrated the anti-proliferative effect of BPIQ in human Y79 cells. The inhibitory effect of BPIQ on the proliferation of Y79 cells is, at least, partly mediated by the regulation of ROS and DNA damage pathway. In conclusion, BPIQ may provide an alternative option in the chemotherapeutics or chemoprevention on the Rb therapy in the future.

Proteomic surveillance of putative new autoantigens in thyroid orbitopathy.

Aims Thyroid orbitopathy (TO) is an autoimmune inflammatory disorder characterised by several ocular manifestations. Several autoantigens have been proposed to be involved in the pathogenesis of TO, but the autoantigen system and the mechanism of TO would be rather complex. In this study, an immunoproteomic method was used to survey novel autoantigens expressed in the orbital fat tissue of patients with TO. Methods We used immunoproteomic, ELISA and immunohistochemical staining methods to survey novel autoantigens expressed in the orbital fat tissue of patients with TO. Results Six protein spots showing high reactivity with the serum from the patients with TO were detected as candidate orbital autoantigens, and two of them (carbonic anhydrase 1 (CA1) and alcohol dehydrogenase 1B (ADH1B)) were further verified by ELISA and immunohistochemical staining. We found that CA1 and ADH1B could attribute target autoantigens in this autoimmune disease. We discovered anti-CA1 and anti-ADH1B antibody prevalence to be higher in patients with TO (68.57%/51.43%) or Graves’ disease (GD) (72%/48%) than in healthy controls respectively. Immunohistochemical staining study revealed the significantly enhanced expressions of CA1 and ADH1B in orbital fat of TO compared with that in healthy controls. Conclusions We found that CA1 and ADH1B could attribute target autoantigens in this autoimmune disease. The high prevalence of these autoantibodies against CA1 and ADH1B in patients with TO and GD clarifies the potential clinical role for anti-CA1 and anti-ADH1B antibodies as biomarkers for GD and TO.