Purpose: To report a case of Epstein-Barr virus (EBV) uveitis after intravitreal triamcinolone injection. Methods: Observational case report. Results: A 66-year-old male presented with bilateral intermediate uveitis, left macular branch retinal vein occlusion, and left macular edema 3 months following acute infectious mononucleosis. He received systemic prednisolone, methotrexate, and intravitreal bevacizumab with partial response. Intravitreal triamcinolone was given for recurrent macular edema, which led to the development of severe panuveitis with positive EBV PCR in aqueous humour. This was successfully treated with high-dose systemic valaciclovir and topical prednisolone. Conclusion: Non-infectious uveitis may become infectious following intravitreal steroid administration triggering intraocular viral replication. Intraocular fluid should be tested in cases which are suspicious for infection and EBV should be considered a differential diagnosis, particularly if PCR is negative for more common viral etiologies.
Purpose: Coronavirus disease 2019 (COVID-19) is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and has been declared as a pandemic by the World Health Organization (WHO). The purpose of the study was to summarize the current recommendations and practice guidelines to be implemented in ophthalmology due to COVID-19. Study design: A systematic review of literature. Methods: A systematic literature search was performed using MEDLINE, EMBASE, CINAHL, Clinical Trials.gov, and ProQuest Dissertations and Theses until May 25, 2020. All conferences held through Association for Research in Vision and Ophthalmology, American Academy of Ophthalmology, and Canadian Society of Ophthalmology were also searched until May 25, 2020. Eligible articles were identified by reviewing the retrieved results. Results: In total, 57 records were retrieved from multiple databases and 0 records were identified through grey literature search. Ten articles were included for analysis. Rigorous hand hygiene, proper screening, and proper use of protective personal equipment by both staff and patients were strongly advised. Careful triage of patients upon arrival to facilities based on screening was advised along with deferral of any non-urgent appointments and implementing measures to limit exposure in waiting rooms. Routine disinfection of equipment, use of shields or barriers on slit lamps, and limiting the use of instruments and tests were strongly recommended and advised. Conclusions: The implementation of guidelines should be in place for ophthalmologic staff, facilities, and visitors to help minimize the spread of COVID-19 and promote a safer environment in ophthalmology.
Introduction: Ologen™ is traditionally placed subconjunctivally during trabeculectomy, which limits its area of action. Subscleral implantation of Ologen has been described involving fashioning a gutter beneath the scleral flap. This, however, would not prevent fibrosis at the margins of the scleral flap. We describe a modified technique of Ologen® placement that has the potential to prevent scarring at the margins of the flap withoutthe need to fashion a gutter. Materials and methods: The study involved a retrospective review of patients who had undergone trabeculectomy with Ologen implantation by the wick technique between January 2015 and August 2016. Patients judged to be at high risk of trabeculectomy failure were operated with this technique. Results: A total of six patients with median age of 38.5 years were included in the study. The mean preoperative intraocular pressure (IOP) was 30.8 ± 7.3 mmHg, which reduced to 10.6 ± 2.2 mmHg 18 months after surgery. By 18 months postoperative, all patients had IOP in the low teens (two patients required additional topical medication). One patient had two episodes of hypotony that responded to steroids and cycloplegics. Another patient required two needlings to bring IOP under control. No other complications were noted. Ultrasound biomicroscopy done 3 months after surgery showed two pieces of Ologen in one patient. Conclusions: The results of our study show that this technique may be used effectively in patients at high risk of trabeculectomy failure. Further studies in a larger number of patients with diverse high-risk conditions are required before this technique is recommended for general use.
Aim: To assess the prevalence of severe visual impairment (SVI) and reasons for not accessing eye care services in a field practice area of a tertiary care hospital. Study design: Cross-sectional observational study. Materials and methods: Through a cross-sectional study using simple random sampling, a total of 1510, individuals above 18 years of age, from six rural and maternity welfare centers (RMCW) within a distance of 20 km from a tertiary hospital were approached. All participants underwent basic assessment of visual acuity, anterior segment evaluation using torch light, and answered a structured questionnaire on eye care. Results: Of 1510 subjects, 267 had SVI (defined as visual acuity < 6/60 either in one or both eyes) with a prevalence of 17.7%. SVI was higher among men and those above 60 years of age (52.8%). Significant association was found between barriers to accessing eye care facilities and lack of knowledge to access health care (p = 0.004), lack of financial support (95% CI, p = 0.006), and social reasons (95% CI, p = 0.028). Prevalence of SVI among diabetics was 32.7% as compared to non-diabetics (OR: 2.630; 95% confidence interval: 1.864–3.712), and among hypertensives was 34.61% as compared to non-hypertensives (OR: 2.836; 95% confidence interval: 1.977–4.068). Conclusion: In spite of being close to a tertiary care center, a prevalence of SVI in 17.7% of this population indicates a lack of knowledge regarding the importance of self-health care in subjects. This emphasizes the need to increase the awareness among the general public to access the ophthalmic health care facilities in order to improve the ocular health of the patients.
Purpose: To compare safety, efficacy, stability, and predictability of implantable collamer lens (ICL) with femtosecond-laser in situ keratomileusis (FS-LASIK) or small incision lenticule extraction (SMILE) for the correction of moderate-to-high myopia/myopic astigmatism. Study design: We retrospectively collected data from patients with moderate-to-high myopia/myopic astigmatism (spherical equivalent [SE] ≥ −3.00 diopters [D]) who underwent ICL (48 eyes), FS-LASIK (36 eyes), or SMILE (86 eyes) at Hai Yen Eye Center from October 2016 to February 2018. Materials and methods: The Wilcoxon Mann-Whitney U test was used to compare pre- and postoperative patients’ characteristics of ICL with SMILE or FS-LASIK. Generalized linear models with unstructured correlation matrix and robust standard errors were used to analyze efficacy and safety indices; logistic regression was used for cylinder predictability. Results: After controlling for age, preoperative SE, and preoperative corrected distance visual acuity (pCDVA), SMILE had significantly lower safety indices (Coefficient = −0.04, 95% CI = −0.07–−0.01) and efficacy indices (Coefficient = −0.10, 95% CI = −0.20–−0.01) than did ICL, while FS-LASIK was not significantly different from ICL (Coefficient = −0.02, 95% CI = −0.06–0.02 and Coefficient = −0.01, 95% CI= −0.10–0.09, respectively). ICL SEswere stable over 12 months after surgery. However, in FS-LASIK and SMILE, SEs significantly decreased at 12 months compared with 6 months after surgery. The percentage of eyes that underwent FS-LASIK and had target SEs within ±0.5 D at 12 months was significantly lower than those that underwent ICL (OR = 0.14, 95% CI = 0.02–0.85), after controlling for age, preoperative SE, and pCDVA. Conclusion: For the correction of moderate-to-high myopia/myopic astigmatism, ICL seems to perform better than SMILE and FS-LASIK.
Aim: To study the microbiological and epidemiological profile of patients with suppurative corneal ulcer presenting in a rural referral center situated in a Sub-Himalayan territory of north India. The study was conducted to evaluate the epidemiology and frequency of mycotic keratitis among the patients of suppurative corneal ulcer and to identify various fungal species as etiological agents. Methods: Corneal scrapings from 56 patients of suppurative corneal ulcers were subjected to direct microscopy and culture. Results: Of the 56 cases of suppurative corneal ulcer investigated, fungal etiology was identified in 18 (32%) cases. Most of the patients (82.1%) worked in agriculture. Trivial trauma with vegetative matter was the most common predisposing factor. Fusarium and Acremonium species were the most common fungi isolated, followed by Aspergillus. Four cases of rare mycotic keratitis caused by Paecilomyces lilacinus, Scedosporium apiospermum, Monilia sitophila, and Ulocladium species were detected. Four cases were smear positive (10% KOH wet mount) but culture negative. Analysis of KOH wet mount was done using culture as gold standard. The sensitivity and specificity of KOH wet mount was 71.43% and 90.48%, respectively. Conclusion: Direct microscopy and culture has a greater diagnostic value in the management of suppurative corneal ulcer. The authors have observed changes in the pattern of organisms identified as cause of fungal keratitis in the region. Rare species of fungi may also be detected if corneal scrapings are collected for direct microscopy and culture from all the cases of suppurative corneal ulcers greater than 2 mm.
Purpose: For over 10 years, there have been zero cases of postoperative endophthalmitis (POE) after cataract surgery at Chatswood Private Hospital (CPH), Sydney, Australia. Study design: We conducted a retrospective audit study to evaluate the reasons for this, as well as the different preferences for route of antibiotic prophylaxis used. Methods: Deidentified data on cataract surgery cases for 2010–2020 were extracted and analyzed descriptively. Results: A total of 28,937 cataract surgery cases were performed at CPH from 2010-2020, for which no cases of POE were identified. The intracameral route for antibiotic prophylaxis was more commonly used compared to subconjunctival or both. Conclusion: Administration of prophylactic antibiotics, regardless of the route of administration, is beneficial and equally effective in preventing POE. Having operating theatres dedicated to ophthalmology helps maintain high standards of sterility of instrumentation and operating environments.
We report a rare case of idiopathic intracranial hypertension following oral minocycline therapy for the treatment of acne. A 29-year-old, non-obese female, with a history of minocycline use for 1 month for treatment of acne presented with headache and transient blurred vision for 3 weeks. She was found to have bilateral disc edema with normal visual acuity and color vision. Magnetic resonance imaging of the brain was normal with partially empty sella features and enlarged tortuous optic nerve in both eyes. Cerebrospinal fluid opening pressure was high. Ultrasound B-scan was done to serially monitor the optic nerve sheath diameter. She improved significantly after stopping the minocycline and following intracranial pressure lowering measures. Idiosyncratic reaction of intracranial hypertension with minocycline can be symptomatic as early as 1 week. Consultants should be aware of this as early consult with ophthalmologists/neurologists can prevent visual loss. A simple ultrasound B-scan can prove to be a vital non-invasive tool in monitoring these patients.
Human research involves research conducted on human subjects, their personal data, or tissue.This includes clinical trials involving testing and treatment, surveys which involve personal data, interviews, or observation, and blood or tissue specimens.Looking through the history of research in medicine and science, we find that some experiments compromised the well-being of human research subjects.In World War II concentration camps, experiments were conducted without the consent of the subjects and involved extreme pain and suffering, many times ending in major disability and death of the research subjects.The Nuremberg Code and the related Declaration of Helsinki arose from the need for guidelines to protect the well-being of research subjects.The World Medical Association (WMA) Declaration of Helsinki on Ethical Principles for Medical Research Involving Human Subjects was initially adopted by the 18th WMA General Assembly in Helsinki, Finland in June 1964. 1It outlines the guidelines for physicians engaged in clinical research focusing on the responsibilities of researchers for the protection of research subjects.The role of Human Research Ethics Committees (HREC) mainly involves protecting the welfare of human research subjects.This concern also extends to animals, included in item 21 of the Declaration of Helsinki: "Medical research involving human subjects must conform to generally accepted scientific principles, be based on a thorough knowledge of the scientific literature, other relevant sources of information, and adequate laboratory and, as appropriate, animal experimentation.The welfare of animals used for research must be respected." 1 The same principles apply to animals as they do to human subjects, that is, the benefits should outweigh the harm.Over the years, the Declaration of Helsinki has been further elaborated; it was last updated by the 64th WMA General Assembly in Fortaleza, Brazil in October 2013.While becoming more comprehensive, it has also become more difficult for researchers to understand.It may basically be summarized as follows: "To avoid or minimize harm to research subjects; where there is potential harm, it should
Purpose: To determine the efficacy of various concentrations of atropine eyedrops on retarding myopia progression and axial elongation in Asian children. Study design: Meta-analysis. Methods: Randomized clinical trials and prospective interventional non-randomized studies which enrolled children aged 4 to 14 years old who received atropine treatment for myopia were included in the study. The Cochrane Collaboration 6 aspects of bias was used to assess the risk of bias for all included studies. Outcome measures were myopia progression and axial elongation. Meta-analysis was conducted using the random-effects model. Results: Eight randomized clinical trials and two prospective interventional non-randomized studies which included a total of 1,229 Asian children were included in the analysis. The pooled mean difference between control and atropine for myopia progression was 0.77 diopters (D) per year [CI 0.64, 0.89]. Subgroup analysis by concentration showed a decreasing trend with decreasing concentration. The pooled mean difference of myopia progression for 1%, 0.5%, 0.25%, and 0.1–0.125% atropine was 0.97 D/year [CI 0.72, 1.21], 0.88 D/year [CI 0.74, 1.02], 0.79 D/year [CI 0.37, 1.21], and 0.80 D/year [CI 0.62, 0.97], respectively; whereas that for 0.01% atropine was 0.46 D/year [CI -0.02, 0.94] indicating that this intervention may or may not be favorable for slowing myopia progression. The pooled mean difference between control and atropine for axial elongation was -0.22 mm [CI -0.29, -0.14] favoring atropine. Subgroup analysis by concentration also showed decreasing trend with decreasing concentration. The pooled mean difference of axial elongation for 1%, 0.5%, 0.1%, 0.05%, and 0.025% atropine was -0.44 mm [CI -0.57, -0.32], -0.19 mm [CI -0.35, -0.04], -0.10 mm [CI -0.17, -0.03], -0.21 mm [CI -0.28, -0.14], and -0.12 mm [CI -0.16, -0.08], respectively; whereas that for 0.01% atropine was -0.01 mm [CI -0.09, 0.06] indicating that this intervention may or may not be favorable in reducing axial elongation. Conclusion: This meta-analysis shows that the effects of atropine for both myopia progression and axial elongation are dose-dependent for the concentration 0.025% to 1%. Results for 0.01% atropine are still equivocal.
Background: There has been an increase in the use of routine intracameral antibiotics for endophthalmitis prophylaxis in cataract surgery. However, this can be associated with serious adverse events. Previously, subconjunctival antibiotics were the preferred route but there is minimal literature directly comparing the two. Hence, the safest and most efficacious route of prophylactic antibiotic administration remains controversial. Purpose: To evaluate the efficacy and safety of subconjunctival with intracameral antibiotics for postoperative endophthalmitis (POE) prophylaxis in patients undergoing uncomplicated cataract surgery. Methods: A literature review was conducted in Cochrane and PubMed for studies that compared the efficacy of prophylactic subconjunctival and intracameral antibiotics for post-cataract endophthalmitis. Searches were not limited to English or study design. Results: Three observational studies showed that subconjunctival and intracameral antibiotics both reduced POE rates. Intracameral antibiotics demonstrated a high efficacy (OR = 0.25, 95% CI 0.13-0.46, p < 0.0001) but was also associated with increased potential complications. All studies were conducted in a sequential nature during which cataract surgery techniques and instrumentation have improved in recent years. Conclusion: In institutions with a high incidence of endophthalmitis, routine intracameral antibiotic use would be more appropriate. However, in facilities with lower rates of POE, the subconjunctival route of delivery can be an alternative due to its better safety profile.
Introduction:To investigate the difference in longitudinal change of beta-zone parapapillary atrophy (ß-zone PPA) between primary open-angle glaucoma (POAG) and normal eyes. MethodsA total of 153 eyes with POAG and 105 normal eyes were followed for 10 years or longer, with disc photography performed every year.The topographic parameters of ß-zone PPA (area, maximal radial extent, angular extent around disc) were measured.The factors associated with the enlargement of ß-zone PPA parameters were assessed by odds ratio (OR) using multivariable logistic regression. ResultsOver the course of the average 11.6 ± 1.3-year follow-up period, enlargement of βzone PPA was detected in 66.7% of POAG eyes and in 26.7% of normal eyes.Increment of all PPA parameters was significantly more common in cases of POAG than in normal eyes (all P < 0.001).The spatial distribution of maximal radial extent at baseline and final was significantly different between the two groups: POAG eyes; inferotemporal vs. normal eyes; temporal (Chi-square = 26.549,P < 0.001, Chisquare = 19.320,P = 0.004, respectively).The widening of radial extent was significantly associated with older age (OR: 1.036, P = 0.010) and the presence of glaucoma (OR: 2.599, P = 0.002).The increment of angular extent was associated with the presence of glaucoma (OR:12.167,P = 0.017) and optic disc hemorrhage (OR: 3.266, P = 0.019). ConclusionThe pattern of ß-zone PPA change differed between POAG and normal eyes during a follow-up period of 10 years or more.The enlargement of PPA occurred more frequently in POAG than in normal eyes.The widening of radial extent was associated with older age and glaucoma, while the increment of angular extent was associated with glaucomatous damage.
Purpose: This review aimed to investigate the global incidence of postoperative endophthalmitis (POE) after cataract surgery over the last three decades, with a particular focus on the use of prophylactic intracameral antibiotics. Study design: Literature review. Methods: A literature search was performed in PubMed and Scopus. Data was collected from included studies and analyzed in IBM SPSS v27. Results: A total of 63 studies from 20 regions were included. The use of prophylactic intracameral antibiotics significantly reduced POE incidence. The baseline POE incidence in studies that involved intracameral prophylaxis tended to be high. A downward linear trend in POE incidence was observed in studies that did not involve intracameral antibiotic prophylaxis. Interestingly, a study in Japan reported the use of intracameral antibiotic prophylaxis in only 10.4% of cataract surgeries with an overall POE incidence of 0.025%, which is comparable to countries that use intracameral prophylaxis routinely. Within studies from Australia, China, Europe, India, Singapore and United States, Australia had the highest POE incidence with and without intracameral prophylaxis, while China had the lowest POE incidences. Conclusion: Intracameral antibiotics are an effective prophylaxis against POE. However, the incidence of POE is decreasing worldwide even without intracameral prophylaxis. The benefits of intracameral antibiotics should be weighed against its risks prior to its implementation as routine prophylaxis protocol for cataract surgery.
XEN gel stent implantation (XEN) surgery is becoming more popular due to its safety profile and efficacy, with conjunctival lymphatics thought to be critical in maintaining bleb drainage. We are reporting the case of a 75-year-old man with right eye pseudoexfoliative glaucoma who had two previous episodes of failed XEN surgery despite given needling and antimetabolite. He had a repeat XEN surgery in our center and his intraocular pressure was under control at the time of writing without any topical glaucoma medication, needling, nor antimetabolite. On examination, there was presence of prominent, dilated, and irregular lymphatic vessel originating from the distal end of the bleb. Anterior segment optical coherence tomography identified the lymphatic vessel located in the superficial Tenon’s layer, which is most likely an initial lymphatic but larger in diameter. This dilated lymphatic vessel may be an important factor for his currently successful filtration surgery.
Aim: To identify the effects of tocotrienol-rich vitamin E from palm oil (Tocovid) on diabetic retinopathy (DR) in patients with type 2 diabetes. Materials and methods: The intervention group (n = 21) received 200 mg Tocovid twice daily while the control group (n = 22) received placebo twice daily for 8 weeks. Changes in retinal photography by conventional grading and novel quantification of retinal hemorrhage were assessed. Changes in serum biomarkers advanced glycation end products (AGE) general, sRAGE (soluble receptor of AGE), Nε-CML (specific type of AGE), and cystatin C were evaluated. Results: A novel technique to quantify retinal hemorrhage had a strong positive correlation with conventional grading of DR in both eyes at baseline and at the end of the study. Eight-week supplementation of Tocovid resulted in significant reduction in retinal hemorrhage in the right eye. Liver enzymes and ALT significantly reduced. No significant changes in grade of DR, serum biomarkers, HbA1c, blood pressure, renal profile, and lipid profile were observed. Conclusions: Tocovid is a potential adjunct to current treatment of DR and fatty liver disease. A novel method of quantifying retinal hemorrhage is a potential technique for assessing disease severity of DR, particularly the early changes.
Blowout fracture with entrapped orbital contents within the maxillary sinus is common due to the fragility of the inferior wall, but complete herniation of the eye globe is extremely rare and emergent. Dealing with such a case appears to be a real challenge for any ophthalmologist. We herein present a case of a 31-year-old woman with the entire eyeball missing from the orbit following a road traffic accident. Imaging revealed a complete herniation of the globe into the maxillary sinus. The patient underwent surgery for repositioning the herniated orbital contents and reconstructing the orbital walls. The outcome was satisfactory in terms of aesthetic effect, although the patient’s vision could not be restored as it still depends on various factors, especially the survival of ganglion cells after trauma.
Dear Readers, We would like to announce that Asian Journal of Ophthalmology (Asian JO) is now a fully online, open-access journal, without the registration requirements for readers. Although Asian JO is not listed on MEDLINE’S PubMed yet, it is indexed in Scopus and Google Scholar. Articles can be found either through those services or through our extensive archive. Asian JO was the official journal of the Southeast Asian Glaucoma Interest Group (SEAGIG). It was initially published in 1998 and, at that time, was one of the few journals in Asia for authors to publish in. Asian JO is now an international journal serving authors and readers around the world with a publishing team in three continents. The first publisher of Asian JO was Scientific Communications, based in Hong Kong, which later relocated to New Zealand. When the publisher retired, it became inactive. Fortunately, Professor Paul Chew along with his team at National University of Singapore managed to keep it afloat until Kugler Publications of the Netherlands became its official publisher. Paul asked me to join him in the role as Chief Editor as he needed to devote more time to develop his inventions, which include the micropulse transcleral laser therapy for glaucoma and the Paul Glaucoma Implant shunt. I was introduced to Asian JO when I asked Paul for advice on which journal to publish an article on the Ong Eye Speculum for glaucoma surgery. Asian JO promotes the publication of novel ideas and surgical techniques. Brief reports and case reports can convey clinical gems that will improve the management of ophthalmology patients. Some journals reject papers describing innovative ideas because they may not conform to the standard research presentation format, but we believe this is a crucial part of the process of scientific discovery. We have also re-established our role as the official journal of Asia-Pacific Glaucoma Society. For this reason, the next issue of Asian JO will be dedicated to abstracts for the Asia-Pacific Glaucoma Congress (APGC), to be held in Kuala Lumpur on August 14-16, 2020. Hence, Kugler Publications and Asian JO will be present at this conference, and we hope to meet readers and authors to discuss how we can improve the journal. With kind regards,Dr. Keith OngChief Editor
We propose a method to estimate “fudge factor” in the selection of IOL power for post-myopic LASIK patients undergoing cataract surgery by considering the difference between subjective refraction (SR) and autorefraction (AR) and to also compare the predictability of two popular regression formulae: SRK-T and Haigis.
Vortex keratopathy is a common side effect of amiodarone, which is a class III antiarrhythmic agent. We describe a 50-year-old man who developed vortex keratopahy with amiodarone 200 mg BD for atrial fibrillation since two years. The daily (400 mg/day) and cumulative dose (100 g) combined with the length of therapy is associated with the toxicity. Toxic effects may also be observed at lower maintenance doses, as observed in this patient. This case indicates that multi-organ toxicity due to amiodarone may develop even with short-term use and a low maintenance dose. Having been off the medication for two months, it is expected that the deposition pattern will diminish, as is the case for the vast majority of patients.
