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1.  Optical coherence tomography of the anterior segment in secondary glaucoma with corneal opacity after penetrating keratoplasty 
To evaluate secondary glaucoma after penetrating keratoplasty with anterior‐segment optical coherence tomography (OCT).
Case series.
Four eyes of four patients with corneal opacity and increased intraocular pressure (IOP) were evaluated using high‐speed (2000 axial scans/s) OCT at 1.3 μm wavelength. Cross‐sectional images of the anterior segment were analysed to assess the cause of increase in pressure.
Slit‐lamp evaluation of the anterior chamber in all cases was limited by corneal opacity. The OCT imaging allowed visualisation of anterior‐segment structures behind the opaque corneas. Using OCT, iris–intraocular lens adhesion and pupillary block were identified as the probable reasons for the increased IOP in one case. Peripheral anterior synechiae and angle closure were identified in the three remaining cases. In two cases, we found that the tip of the aqueous drainage tube was blocked by peripheral anterior synechiae.
OCT is similar to ultrasound in that it allows visualisation through opaque corneas. However, OCT has an advantage in that it requires neither contact nor immersion. It is a valuable tool for evaluating the depth of the anterior chamber angle and the causes of secondary angle closure.
PMCID: PMC1857632  PMID: 16973665
2.  Internet-Based Approaches to Collaborative Therapeutic Assessment: New Opportunities for Professional Psychologists 
Collaborative (or therapeutic) assessment is an empirically supported procedure that involves the client as an active participant in the assessment process. Clients discuss data they provide with the assessor in a collaborative manner designed to provide insights and assist in setting mutually agreeable treatment goals. Internet-based procedures allow for ongoing (including daily) tracking of psychological variables and provision of immediate graphic feedback to therapists, clients, and clinical supervisors. As an example, we describe one such system: Evidence-Based Assessment System for Clinicians (EAS-C) that contains more than 30 brief and empirically validated assessment instruments that can be completed via the internet or smartphone. We also provide examples from a stress management intervention demonstrating how single-client data from a web-based daily stress and coping diary tied to the EAS-C were utilized to provide clients with individualized feedback, assess progress, identify idiographic patterns of cognitions, affect, and coping strategies, and test clinical hypotheses. Internet- and computer-based technological advances can improve service delivery and help bridge the gap that currently exists between science and practice.
PMCID: PMC3723146  PMID: 23894220
psychological assessment; internet-based assessment; collaborative assessment; evidence-based assessment; stress and coping
4.  Human Corneal Endothelial Cells Employ Phosphorylation of p27Kip1 at Both Ser10 and Thr187 Sites for FGF-2-Mediated Cell Proliferation via PI 3-Kinase 
FGF-2 stimulates proliferation of human CECs through PI 3-kinase and its downstream target ERK1/2 pathways. This signal transduction downregulates p27 through its phosphorylation at both Ser10 and Thr187 sites mediated by KIS and Cdc25A, respectively.
FGF-2 stimulates cell proliferation of rabbit corneal endothelial cells (rCECs) by degrading the cyclin-dependent kinase inhibitor p27Kip1 (p27) through its phosphorylation mechanism. The authors investigated whether the cell proliferation of human CECs (hCECs) is also induced by FGF-2 stimulation through the p27 phosphorylation pathway.
Expression and activation of protein were analyzed by immunoblotting. Cell proliferation was measured by 3-(4,5-dimethylthiazolyl-2)-2,5-diphenyltetrazolium bromide (MTT) assay. Transfection of hCECs with small interference RNA (siRNA) was performed using a transfection reagent.
FGF-2 stimulated cell proliferation in hCECs; the FGF-2 action was completely blocked by pathway-specific inhibitors for PI 3-kinase (LY294002) and MEK1/2 (U0126), respectively. Using immunoblotting, the authors showed that FGF-2 induced phosphorylation of p27 at both serine 10 (Ser10) and threonine 187 (Thr187) sites. These effects were also completely blocked by LY294002 or U0126. The authors then determined cross-talk between PI 3-kinase and extracellular signal-regulated kinase (ERK)1/2; blocking of ERK1/2 activation by LY294002 indicated that in hCECs ERK1/2 works as a downstream effector to PI 3-kinase for cell proliferation induced by FGF-2, whereas the ERK1/2 pathway in rCECs is parallel to the PI 3-kinase pathway. However, the downstream mechanism involved in cell cycle progression in hCECs is identical to that of rCECs: phosphorylation of p27 at Ser10 was mediated by kinase-interacting stathmin (KIS), confirmed with siRNA to KIS, and phosphorylation of p27 at Thr187 was mediated by cell division cycle 25A (Cdc25A), confirmed using Cdc25A inhibitor.
FGF-2 stimulates proliferation of hCECs through PI 3-kinase and its downstream target ERK1/2 pathways. This linear signal transduction significantly downregulates p27 through its phosphorylation at both Ser10 and Thr187 sites mediated by KIS and Cdc25A, respectively.
PMCID: PMC3208027  PMID: 21948550
5.  Early surgical debridement in the management of infectious scleritis after pterygium excision 
The purpose of this study was to report outcomes of infectious scleritis after pterygium surgery, managed with antibiotic therapies and early scleral debridement.
Retrospective chart review of 13 consecutive cases of infectious scleritis after pterygium excision between 1999 and 2009 was conducted. Collected data included prior medical and surgical history, latency period between pterygium surgery and presentation of infectious scleritis, culture and histopathologic findings, antibiotic regimen, length of hospital stay, visual acuity before and after treatment, and complications.
Median follow-up was at 14 months. Twelve patients underwent prompt surgical debridement after infectious scleritis diagnosis (median, 2.5 days). Debridement was delayed in one patient. Median hospital stay was 3 days. Best-corrected visual acuity improved in ten patients, remained stable in one patient, and decreased in two patients following treatment. Complications included scleral thinning requiring scleral patch graft (1/13), glaucoma (3/13), and progression to phthisis bulbi (1/13). No patients required enucleation.
In contrast to the generally poor outcomes in the literature, early surgical debridement of pterygium-associated infectious scleritis appears to offer improved prognosis.
PMCID: PMC3345049  PMID: 22354483
Infectious scleritis; Pterygium excision; Surgical debridement; Biofilm; Medicine & Public Health; Ophthalmology
6.  A Person-Focused Analysis of Resilience Resources and Coping in Diabetes Patients 
This study investigated the resilience resources and coping profiles of diabetes patients. A total of 145 patients with diabetes completed a questionnaire packet including two measurements of coping (COPE and Coping Styles questionnaires), and personal resources. Glycosylated hemoglobin (HbA1c) was also assessed. Resilience was defined by a factor score derived from measures of self-esteem, self-efficacy, self-mastery, and optimism. All of the maladaptive coping subscales were negatively associated with resilience (r's range from −.34 to −.56, all p's <.001). Of the adaptive coping subscales, only acceptance, emotional support, and pragmatism were positively associated with resilience. The upper, middle, and lower tertiles of the resilience factor were identified and the coping profiles of these groups differed significantly, with low resilience patients favoring maladaptive strategies much more than those with high or moderate resilience resources. Resilience groups did not differ in HbA1c levels; correlation coefficients of the coping subscales with HbA1c were explored. This study demonstrates a link between maladaptive coping and low resilience, suggesting that resilience impacts one's ability to manage the difficult treatment and lifestyle requirements of diabetes.
PMCID: PMC2880488  PMID: 20526415
Diabetes; Resilience; Coping; HbA1c
7.  The role of resilience on psychological adjustment and physical health in patients with diabetes 
British journal of health psychology  2007;13(Pt 2):311-325.
This study used a longitudinal design to investigate the buffering role of resilience on worsening HbA1c and self-care behaviours in the face of rising diabetes-related distress.
A total of 111 patients with diabetes completed surveys and had their glycosylated hemoglobin (HbA1c) assessed at baseline and 1-year follow-up. Resilience was defined by a factor score of self-esteem, self-efficacy, self-mastery, and optimism. Diabetes-related distress and self-care behaviours were also assessed.
Baseline resilience, diabetes-related distress, and their interaction predicted physical health (HbA1c) at 1-year. Patients with low, moderate, and high resilience were identified. Those with low or moderate resilience levels showed a strong association between rising distress and worsening HbA1c across time (r=.57, .56, respectively). However, those with high resilience scores did not show the same associations (r=.08). Low resilience was also associated with fewer self-care behaviours when faced with increasing distress (r= −.55). These correlation coefficients remained significant after controlling for starting points.
In patients with diabetes, resilience resources predicted future HbA1c and buffered worsening HbA1c and self-care behaviours in the face of rising distress levels.
PMCID: PMC2899486  PMID: 17535497
8.  Identification of Notch-1 expression in the limbal basal epithelium 
Molecular Vision  2007;13:337-344.
To determine whether Notch-1, a ligand-activated transmembrane receptor known to maintain cells in an undifferentiated state, primarily progenitor cells in other systems, could be used as a stem cell marker in human limbal epithelium.
Human corneoscleral tissues obtained from the Doheny Eye & Tissue Transplant Bank were prepared for cross section and whole mount analysis. Tissue for whole mount was incubated in dispase; the epithelial sheet was removed and fixed in 4% paraformaldehyde. Sections and whole mount were stained with antibodies against Notch-1, Notch-2, β-1 integrin, α-6, and the G2 subtype member of the ATP binding cassette transporter (ABCG2). Specificity of the Notch-1 antibody was determined by western blot analysis with Cos-7 cells transfected with Notch-1. Explant culture was performed and only primary cultures were used in this experiment.
Notch-1 was found to be expressed in the limbal basal region where stem cells reside. Notch-1 antigenicity was more pronounced in cell clusters, mainly in the palisades of Vogt. The central cornea was almost devoid of Notch-1. The intensity of Notch-1 staining in cultured cells from the limbal explants was high in only a few cells. The Notch-1 signal was diminished in dividing cells. Expression in cultured cells was more cytoplasmic; few cells showed additional nuclear staining. The Notch-1-stained whole mount showed only a few cells in the limbal region. A 300 kDa and a 110 kDa band confirmed the specificity of the antibody in Cos-7 cells transfected with Notch-1. Double staining for ABCG2 and Notch-1 showed some ABCG2-positive cells co-expressing Notch-1 in the limbal basal epithelium, indicating that Notch-1-expressing cells might be a unique subpopulation of cells with stem cell properties.
Immunofluorescence data shows that Notch-1 could be a possible marker for the stem cells in the limbal basal epithelium. Further studies and characterization of the Notch pathway in corneal development will provide valuable clues for the identification of stem cells.
PMCID: PMC2633467  PMID: 17392684

Results 1-8 (8)