Purpose We aimed to investigate the longitudinal change in the number of surgically operated myopic traction maculopathies (MTM) cases at a tertiary eye centre. Methods A retrospective study of all consecutive cases of surgically operated MTM over 12 years (2009-2020) was conducted in a myopia prevalent region. We compared outcomes among three groups: (1) myopic macular hole (MH), (2) myopic macular hole with retinal detachment (MHRD), and (3) myopic foveoschisis with retinal detachment (MFRD). Results Fifty-one cases were included in the study (8 cases of MH, 33 cases of MHRD and 10 cases of MFRD). The overall mean age was 63.8 +/- 8.7 with a female preponderance (2:1). The mean age of the MH group (58.6) was significantly younger than the MHRD group (64.2) and MFRD group (66.6) ( p = 0.02). Subgroup analysis using ATN classification did not show its correlation with both visual improvement and anatomical success. When comparing the first 6-year period (2009-2014) with the second 6-year period (2015-2020), there was a significant increase in the number of cases ( p = 0.01). Conclusion We observe an increase in the number of surgically operated MTM. This follows the trend of the global rise in the prevalence of myopia and baby boomers entering retirement.

PURPOSE:The aim of this study is to investigate the efficacy of a mobile platform that combines smartphone-based retinal imaging with automated grading for determining the presence of referral-warranted diabetic retinopathy (RWDR).METHODS:A smartphone-based camera (RetinaScope) was used by non-ophthalmic personnel to image the retina of patients with diabetes. Images were analyzed with the Eyenuk EyeArt® system, which generated referral recommendations based on presence of diabetic retinopathy (DR) and/or markers for clinically significant macular oedema. Images were independently evaluated by two masked readers and categorized as refer/no refer. The accuracies of the graders and automated interpretation were determined by comparing results to gold standard clinical diagnoses.RESULTS:A total of 119 eyes from 69 patients were included. RWDR was present in 88 eyes (73.9%) and in 54 patients (78.3%). At the patient-level, automated interpretation had a sensitivity of 87.0% and specificity of 78.6%; grader 1 had a sensitivity of 96.3% and specificity of 42.9%; grader 2 had a sensitivity of 92.5% and specificity of 50.0%. At the eye-level, automated interpretation had a sensitivity of 77.8% and specificity of 71.5%; grader 1 had a sensitivity of 94.0% and specificity of 52.2%; grader 2 had a sensitivity of 89.5% and specificity of 66.9%.DISCUSSION:Retinal photography with RetinaScope combined with automated interpretation by EyeArt achieved a lower sensitivity but higher specificity than trained expert graders. Feasibility testing was performed using non-ophthalmic personnel in a retina clinic with high disease burden. Additional studies are needed to assess efficacy of screening diabetic patients from general population.

Purpose High-quality, wide-field retinal imaging is a valuable method to screen preventable, vision-threatening diseases of the retina. Smartphone-based retinal cameras hold promise for increasing access to retinal imaging, but variable image quality and restricted field of view can limit their utility. We developed and clinically tested a smartphone-based system that addresses these challenges with automation-assisted imaging. Methods The system was designed to improve smartphone retinal imaging by combining automated fixation guidance, photomontage, and multi-colored illumination with optimized optics, user-tested ergonomics, and touch-screen interface. System performance was evaluated from images of ophthalmic patients taken by non-ophthalmic personnel. Two masked ophthalmologists evaluated images for abnormalities and disease severity. Results The system automatically generated 100-degree retinal photomontages from five overlapping images in under 1 minute at full resolution (52.3 pixels per retinal degree) fully on-phone, revealing numerous retinal abnormalities. Feasibility of the system for DR screening using the retinal photomontages was performed in 71 diabetics by masked graders. DR grade matched perfectly with dilated clinical examination in 55.1% of eyes and within 1 severity level for 85.2% of eyes. For referral-warranted DR, average sensitivity was 93.3% and specificity 56.8%. Conclusions Automation-assisted imaging produced high-quality, wide-field retinal images that demonstrate the potential of smartphone-based retinal cameras to be used for retinal disease screening. Translational Relevance Enhancement of smartphone-based retinal imaging through automation and software intelligence holds great promise for increasing the accessibility of retinal screening.

Smartphone-based retinal photography is a promising method for increasing accessibility of retinal screening in the primary care and community settings. Recent work has focused on validating its use in detection of diabetic retinopathy. However, retinal imaging can be technically challenging and additional work is needed to improve ease of retinal imaging in the primary care setting. We, therefore, performed usability testing of a smartphone-based retinal camera, RetinaScope, among medical assistants in primary care who had never performed retinal imaging. A total of 24 medical assistants performed first-time imaging in a total of five rounds of testing, and iterative improvements to the device were made between test rounds based on the results. The time to acquire a single ~50° image of the posterior pole of a model eye decreased from 283±60 s to 34±17 s (p<0.01) for first-time users. The time to acquire five overlapping images of the retina decreased from 325±60 s to 118±26 s (p=0.02) for first-time users. Testing in the human eye demonstrated that a single wide-view retinal image could be captured in 65±7 s and five overlapping images in 229±114 s. Users reported high Systems Usability Scores of 86±13 throughout the rounds, reflecting a high level of comfort in first-time operation of the device. Our study demonstrates that smartphone-based retinal photography has the potential to be quickly adopted among medical assistants in the primary care setting.

The purpose of this study was to describe the epidemiology, visual outcome and prognostic factors of intraocular foreign body (IOFB) injuries in a tertiary centre in Hong Kong. A retrospective review of 21 eyes in 21 patients with IOFB that presented to United Christian Hospital from January 2001 to July 2014 was performed. IOFB represented 16 % of all open-globe traumas. There was a high male predominance (90 %). The mean age was 42. Work-related injuries (86 %) were the main cause, where only 10.5 % had eye protection. Hammering was the commonest mechanism of injury (43 %). Most IOFBs were metallic (67 %). The IOFB was found in the anterior segment in 31 % and posterior segment in 69 %. 57 % presented with an initial visual acuity of ≥0.1, and up to 24 % of patients had an initial visual acuity of better than or equal to 0.5. Most cases (76 %) received prompt surgical intervention within 24 h, and there was a low (0 %) endophthalmitis rate. Forty-eight percent had an improvement in visual acuity, defined as final visual acuity more than or equal to 2 lines of improvement from initial visual acuity, and 48 % attained a final visual acuity of better than or equal to 0.5. One case underwent evisceration. A smaller IOFB size (<5 mm) was associated with a good final visual acuity of better than or equal to 0.5 (p = 0.048). It was also found that a posterior segment IOFB was more likely to give a final VA of less than 0.5 (p = 0.035). IOFB remains a significant complication of work-related injuries in Hong Kong. This is the first local study that explores the epidemiology of IOFB injuries in Hong Kong. The favourable visual outcome and low endophthalmitis rate may be related to early removal of IOFB. Despite legal ordinances for mandatory eye protection, the uptake of eye protection was low.

We report a case of peripheral pigmentary retinopathy and visual field loss following topiramate use for uncontrolled seizures. Such side effects have not been well documented despite the increasing use of topiramate in the past 10 years. A thorough search of available English literature revealed only a small number of reports of topiramate-induced retinopathy or visual field defects in humans. One similar case has been described. We are concerned about the possible rare instances of this occurrence in future patients and hence would like to propose a presumed correlation.

Clinical & Experimental OphthalmologyVolume 39, Issue 7 p. 717-717 Myopic macular hole: response Kenneth KW Li FRCS, Kenneth KW Li FRCS Department of Ophthalmology, United Christian Hospital, Kowloon Eye Institute, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, ChinaSearch for more papers by this authorEmily WH Tang FRCS, Emily WH Tang FRCS Department of Ophthalmology, United Christian Hospital, Kowloon Eye Institute, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, ChinaSearch for more papers by this authorPatrick SH Li FRCS, Patrick SH Li FRCS Department of Ophthalmology, United Christian Hospital, Kowloon Eye Institute, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, ChinaSearch for more papers by this authorDavid Wong FRCOphth, David Wong FRCOphth Department of Ophthalmology, United Christian Hospital, Kowloon Eye Institute, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, ChinaSearch for more papers by this author Kenneth KW Li FRCS, Kenneth KW Li FRCS Department of Ophthalmology, United Christian Hospital, Kowloon Eye Institute, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, ChinaSearch for more papers by this authorEmily WH Tang FRCS, Emily WH Tang FRCS Department of Ophthalmology, United Christian Hospital, Kowloon Eye Institute, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, ChinaSearch for more papers by this authorPatrick SH Li FRCS, Patrick SH Li FRCS Department of Ophthalmology, United Christian Hospital, Kowloon Eye Institute, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, ChinaSearch for more papers by this authorDavid Wong FRCOphth, David Wong FRCOphth Department of Ophthalmology, United Christian Hospital, Kowloon Eye Institute, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, ChinaSearch for more papers by this author First published: 15 March 2011 https://doi.org/10.1111/j.1442-9071.2011.02567.xRead the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinkedInRedditWechat No abstract is available for this article. References 1 Essex RW. Myopic macular hole. Clin Experiment Ophthalmol 2011; [Epub ahead of print] doi: 10.1111/j.1442-9071.2011.02536.x. 2 Li KK, Tang EW, Li PS, Wong D. Double peel using triamcinolone acetonide and trypan blue in the management of myopic macular hole with retinal detachment: a case-control study. Clin Experiment Ophthalmol 2010; 38: 664–8. Volume39, Issue7September/October 2011Pages 717-717 ReferencesRelatedInformation

A bstract Purpose: To evaluate the safety and efficacy of double peel using triamcinolone acetonide (TA) and trypan blue (TB) in removing epiretinal tissues in vitrectomy for myopic macular hole with retinal detachment (MHRD). Methods: Prospective interventional case control study. Patients with myopic MHRD underwent vitrectomy with TA‐assisted adherent cortical vitreous (ACV) removal followed by TB‐assisted internal‐limiting membrane (ILM) peeling and gas tamponade. The results were compared with historical control group without the use of any vital dye or TA. Results: Ten eyes of 10 study cases were compared with nine eyes of nine control cases. Mean axial length was 28.3 ± 1.4 mm and 29.6 ± 2.4 mm and mean follow‐up period was 15 months and 42 months for the study group and the control group, respectively. Reattachment rate was 70% in the study group and 44% in the control group. Mean logMAR visual acuity improvement was 0.02 at 6 months and 0.01 at 12 months for the study group ( P < 0.05). Transient intraocular pressure rise was observed in seven eyes in the study group and five eyes in the control group. No other complication was noted. Conclusion: Double peel using TA and TB appeared safe and effective in facilitating removal of ACV and ILM in MHRD. It has higher surgical success rate compared with conventional vitrectomy with epiretinal membrane peeling and gas tamponade.

A bstract Purpose: To identify factors associated with variability in anatomical and functional response of diabetic macular oedema (DMO) after 4 mg of intravitreal triamcinolone acetonide (ivTA), and for recurrence of macular oedema. Design: Pooled analysis of individual data from two randomized controlled trials. Methods: This was a multicentre study involving 107 eyes with DMO administered 4 mg ivTA. Predictive factors for response to treatment were evaluated with linear regression analysis. Factors associated with time to recurrence of oedema were studied with Cox proportional hazards modelling. Main outcome measures were maximum improvement in optical coherence tomography (OCT)‐measured central foveal thickness (CFT) and best‐corrected visual acuity (BCVA), final CFT and BCVA at 12 months and time to oedema recurrence. Results: Greater reduction of retinal thickening occurred in eyes with worse baseline thickening ( P < 0.001). There was also greater improvement of visual acuity in eyes with poorer preoperative BCVA levels ( P < 0.001). Age, duration of oedema and previous macular laser treatment had no significant effect on maximal BCVA or CFT improvement. Eyes given 4 mg triamcinolone alone were more likely to develop recurrence of oedema at 12 months than those given a combination of 4 mg triamcinolone plus sequential laser (hazard ratio 2.60 [95% confidence interval: 1.45–4.67]). Conclusion: Baseline OCT‐measured retinal thickening and BCVA are important predictors of maximal anatomical and functional response of DMO to ivTA, respectively. Combination treatment strategy using sequential laser therapy may have a role in delaying recurrence of oedema after triamcinolone.

Objective: To evaluate the efficacy of sequential intravitreal triamcinolone acetonide (TA) injection followed by grid laser photocoagulation for treating diabetic macular edema (DME).Design: Prospective, 3-armed, randomized clinical trial.Participants: One hundred eleven eyes of 111 patients with DME involving the fovea.Intervention: Patients were randomized to grid laser photocoagulation (37 eyes), 4 mg of intravitreal TA (38 eyes), or 4 mg of intravitreal TA combined with sequential grid laser about 1 month later (36 eyes).Main Outcome Measures: Central foveal thickness (CFT) as measured by optical coherence tomography, logarithm of the minimum angle of resolution (logMAR) best-corrected visual acuity (BCVA), and side effect profiles. The 6-month results are reported.Results: All patients completed 6 months' follow-up. Baseline mean (+/- standard deviation) CFTs were 385 +/- 100 mu m, 396 +/- 91 mu m, and 424 +/- 108 mu m for the laser, intravitreal TA, and combined groups, respectively (P = 0.24). After treatment, significant CFT reductions were noted in both the intravitreal TA and combined groups at all follow-up visits (P<0.01) but not in the laser group. Mean CFT improved significantly to minimums of 267 +/- 75 mu m and 256 +/- 73 for the intravitreal TA and combined groups, respectively, but the difference between the 3 groups was not significant at 6 months. The standardized change in macular thickening at 17 weeks was significantly greater in the combined group versus the intravitreal TA group (P = 0.007), suggesting that combined treatment might prolong the effects of intravitreal TA. Mean baseline logMAR BCVAs were 0.64 +/- 0.37, 0.72 +/- 0.34, and 0.69 +/- 0.34 in the laser, intravitreal TA, and combined groups, respectively (P = 0.67). Best-corrected visual acuity improved significantly at 4 and 9 weeks for the intravitreal TA group but did not change significantly in the other 2 groups. No significant difference in BCVA was observed between the 3 groups at any time point.Conclusions: Contrary to the results of a recent study, combined treatment of intravitreal TA plus grid laser did not yield better CFT reduction or BCVA improvement at 6 months than intravitreal TA alone. Grid laser alone was significantly worse than the 2 other treatment modalities.

In their article, Mandell and associates (Am J Ophthalmol 136:900–903, 2003) described using ultrasound biomicroscopy to measure anterior chamber depth (ACD) in plateau iris syndrome and pupillary block. We agree that ultrasound biomicroscopy is a good method for measuring ACD. There are, however, issues related to the study that merit further discussion. Anterior chamber depth in plateau iris syndrome and pupillary block as measured by ultrasound biomicroscopy: Author's replyAmerican Journal of OphthalmologyVol. 137Issue 6Preview Full-Text PDF

Aim: To evaluate the changes in ocular and surgical parameters during the waiting period for cataract extraction. Patients and methods: The records of all patients who had cataract extraction between January and March 2001 at the United Christian Hospital were reviewed. The initial visual acuity when the operation was scheduled was compared with that at the preoperation visit, approximately 3 weeks before the operation. The patients were divided into 2 groups based on their initial visual acuities. Patients in group 1 were those with initial visual acuities = 0.1. The mean waiting time for cataract operation was calculated and compared between the 2 groups. The operation cancellation rate and change in the method of cataract extraction were also studied. Cataract-related complications occurring during the waiting period were documented. Results: The records of 107 consecutive patients under- going 107 cataract operations were reviewed. The mean age was 73.7 ± 8.1 years. Fifty one patients (47.7%) with initial best corrected visual acuity = 0.1 (group 2) had a mean waiting time of 35.1 ± 6.7 weeks. Forty seven patients (43.9%) had a further decrease in visual acuity while waiting for cataract operation. There were no lens- induced complications such as phacomorphic glaucoma for any patients waiting for cataract surgery. Three patients required a change of the cataract extraction method from phacoemulsification to planned extra- capsular extraction due to increased cataract density. Eight patients (7.5%) had the cataract operation cancelled. Five of the 8 patients had their operations cancelled due to changes in comorbidities. Conclusion: In a local hospital, where general health is poor, a 20- to 35-week waiting time for cataract extraction, based on the initial visual acuity, may be acceptable for patients with uncomplicated cataract. Patients with previous cataract operation cancelled due to poorly controlled systemic diseases should be re-scheduled for early surgery.