Hong Kong Eye Hospital, located in Kowloon City District, Hong Kong, is a secondary and tertiary eye referral centre, and also the house of the Department of Ophthalmology and Visual Science of the Chinese University of Hong Kong (CUHK). The hospital provides training programmes in ophthalmology for medical students of both the CUHK and the University of Hong Kong.
Complex orbital schwannomas pose a formidable challenge to orbital surgeons due to their deep-seated location which could extend into the cavernous sinus. Surgical approach via conventional orbitotomy is limited by suboptimal exposure and visualization, while frontotemporal craniotomy often entails higher morbidity and prolonged recovery, compromising both function and cosmesis. The minimally invasive endoscopic transorbital approach (ETOA) provides enhanced visualization and surgical precision, facilitating apical tumour removal with fewer complications and excellent cosmetic outcomes. We retrospectively reviewed seven cases of complex orbital schwannoma excised via ETOA. Our results support ETOA as an effective and less morbid alternative with favourable functional and aesthetic results for the management of complex orbital schwannomas.
OBJECTIVE:Topiramate has been linked to increased glaucoma risk, potentially through mechanisms involving ocular fluid shifts. However, comparative risks vs other antiseizure medications (ASMs) and variation by sex or indication remain uncertain. This study evaluates glaucoma incidence in topiramate initiators compared to valproate or lamotrigine users among patients with epilepsy or migraine. METHODS:We conducted a retrospective active-comparator, new-user cohort study using electronic health records from the IQVIA Medical Research Data among patients with epilepsy or migraine initiating topiramate, valproate, or lamotrigine. Patients with prior ASM use, limited washout period and follow-up, or pre-existing glaucoma were excluded. The outcome was incident glaucoma within 1 year, censored at glaucoma occurrence, death, discontinuation, switch, or September 30, 2023. Covariates included age, sex, race, lifestyle factors, comorbidities, and medication history. Propensity score-based inverse probability weighting balanced characteristics, and crude and weighted Cox models estimated hazard ratios (HRs) with 95% confidence intervals (CIs). Subgroup analyses were conducted by sex, age, and indication. RESULTS:The cohort included 688 topiramate, 4490 valproate, and 4179 lamotrigine initiators. After weighting, the 1-year absolute risk increase was approximately 2.4% when comparing topiramate to valproate, and about 2.0% compared to lamotrigine. Topiramate was associated with higher glaucoma risk vs valproate (adjusted HR 2.66, 95% CI 1.12-6.32) and lamotrigine (adjusted HR 3.57, 95% CI 1.76-7.26). Risks were elevated in female (vs valproate: HR 5.31, 95% CI 1.48-19.08; vs lamotrigine: HR 5.73, 95% CI 2.38-13.79) or epilepsy patients (vs valproate: HR 2.23, 95% CI 1.04-4.76; vs lamotrigine: HR 5.08, 95% CI 2.32-11.14), but not in male or migraine patients. SIGNIFICANCE:Topiramate use substantially increases glaucoma risk compared with valproate and lamotrigine, particularly among female or epilepsy patients. No significant association in male or migraine patients was observed. These findings may inform targeted ophthalmologic monitoring in high-risk groups and use of alternative ASMs.
PURPOSE:To report the surgical outcomes of the internal limiting membrane (ILM) flap with no gas tamponade technique in managing high myopia-associated macular hole (MH). DESIGN:Prospective interventional case series. PARTICIPANTS:Patients with high myopia-associated full-thickness MH. METHODS:Consecutive patients with high myopia-associated MH were prospectively recruited. High myopia was defined as refraction of spherical equivalence of ≤-6.0 diopters (in phakic eyes) or axial length (AL) ≥26 mm. The ILM flap without gas tamponade technique was used for MH repair; conversion to conventional surgery with gas tamponade was the contingency surgical plan when necessary. MAIN OUTCOMES MEASURES:Primary outcome was the MH closure rate at week 12. Key secondary outcomes included postoperative best-corrected visual acuity (BCVA) and time to MH closure. RESULTS:Twenty eyes from 20 patients were included. The mean age was 67.2 years, and the median duration of symptoms was 9.5 months. The mean ± standard deviation baseline logarithm of the minimum angle of resolution BCVA was 0.77 ± 0.39, the mean AL was 28.9 ± 2.20 mm, and the mean minimum linear diameter was 424.0 ± 197.7 μm. All participants underwent the planned study intervention and completed the week 12 visit for the assessment of the primary outcome. Macular hole closure was achieved in 20 (100%) eyes at week 12, and the median time to MH closure was 1 week (range, 0-12 weeks). The postoperative mean logarithm of the minimum angle of resolution BCVA was 0.75 ± 0.29 (P = 0.832), 0.50 ± 0.25 (P = 0.013), 0.36 ± 0.21 (P < 0.001), 0.30 ± 0.21 (P < 0.001), and 0.25 ± 0.23 (P < 0.001) at postoperative day 1 and weeks 1, 4, 12, and 24, respectively. The number of eyes with BCVA ≥20/50 increased from 6 (30%) on day 1 to 12 (60%), 17 (85%), 18 (90%), and 18 (94.7%) at weeks 1, 4, 12, and 24, respectively. CONCLUSIONS:The ILM flap with no gas tamponade technique is effective in repairing high myopia-associated MH, achieving a high closure rate and quick postoperative visual recovery. Results from this study support the need for a collaborative multicenter randomized controlled trial. FINANCIAL DISCLOSURE(S):Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
Importance:The incidence and determinants of progression across the pachychoroid subtype remain incompletely characterized, limiting risk stratification and follow-up strategies. Objective:To evaluate progression, diagnostic transitions, and associated risk factors in eyes with pachychoroid subtype. Design, Setting, and Participants:This prospective, multicenter, observational cohort study included participants with pachychoroid subtype, defined by subfoveal choroidal thickness (SFCT) of 300 µm or greater measured beneath the foveal center point, recruited at centers in Asia. Participants underwent standardized clinical assessment and multimodal imaging and were followed up for 2 years. The study was conducted between July 2020 and November 2023, and data analysis was performed from November 2023 to February 2026. Exposures:Baseline pachychoroid subtype phenotype and imaging characteristics. Main Outcomes and Measures:The primary outcome was diagnostic progression within the pachychoroid subtype spectrum over 2 years. Secondary outcomes included incident neovascularization, treatment initiations, and changes in best-corrected visual acuity (BCVA) and SFCT. Results:A total of 205 eyes from 125 participants (mean [SD] age, 59.0 [8.8] years; 32 female participants [25.6%]) completed 2-year follow-up. At baseline, 39 eyes had uncomplicated pachychoroid (UP), 102 had pachychoroid pigment epitheliopathy (PPE), 47 had central serous chorioretinopathy (CSCR), and 17 had pachychoroid neovasculopathy (PNV). Mean (SD) changes from baseline in BCVA and SFCT were 0.13 (0.18) logMAR (approximate Snellen equivalent, 20/25) to 0.11 (0.24) (20/25; difference, -0.02 logMAR [approximately 1 letter]; 95% CI, -0.05 to 0.02; P = .33) and from 419 (83) µm to 424 (90) µm (difference, 6 µm; 95% CI, -5 to 16; P = .32), respectively. Eyes with CSCR and PNV had worse baseline BCVA compared to eyes with UP and PPE. Progression occurred in 15 eyes (7.3%; 95% CI, 4.5%-11.6%), including 7 eyes with neovascularization, all of which had shallow, irregular retinal pigment epithelium elevation at baseline, among 116 eyes at baseline with such elevation. Conclusions and Relevance:In this study among a relatively small cohort of 4 different levels of pachychoroid subtype, progression to a worse level was infrequent, as was worsening of visual acuity or choroidal thickening. Neovascularization was unusual and occurred exclusively in eyes with shallow, irregular retinal pigment epithelium elevation, suggesting the importance of this imaging feature if confirmed in subsequent studies.
Purpose To evaluate the longitudinal changes in the parapapillary gamma zone in children receiving 0.05%, 0.025%, 0.01% atropine eyedrops and placebo/switchover over 3 years based on the Low-Concentration Atropine for Myopia Progression (LAMP1) study. Design Secondary analysis from a randomized controlled trial. Participants 280 children underwent spectral domain optical coherence tomography (SD-OCT) at baseline, which involved 24 equally spaced radial OCT B-scans of the optic nerve head, taken at one-year intervals. Methods Children in the LAMP1 study were randomized to receive 0.05%, 0.025%, 0.01% atropine, or placebo eyedrops. In the second year, placebo participants switched to 0.05% atropine. At the beginning of the third year, each group was re-randomized to continued treatment or cessation (washout). The Bruch’s membrane opening (BMO) was identified in 48 meridians in each eye. Gamma zone was defined as the parapapillary region without Bruch’s membrane. Main Outcome Measures Differences between treatment groups in gamma zone area changes from baseline to the 3-year follow-up visits. Results Out of 238 children included at baseline, the study included 192 (80.7%) children completing the follow-up of 3 years. The cumulative mean gamma zone area changes differed significantly between the initial 0.05%, 0.025%, and 0.01% atropine subgroups (0.09±0.09mm2, 0.19±0.12mm2, and 0.22±0.17mm2; P for trend<0.001) over 3 years. In multivariable analysis, gamma zone area enlargement was associated with 0.05% atropine (β=-0.07, P=0.005), female sex (β=0.05, P=0.006), larger baseline gamma zone area (β=0.23, P<0.001), and larger axial elongation (β=0.14, P<0.001). Conclusion Low-concentration atropine reduced parapapillary gamma zone enlargement in a concentration-dependent manner over a 3-year treatment period. Continued 0.05% atropine treatment showed efficacy in controlling gamma zone development.
