Hong Kong Eye Hospital

Kowloon, Hong Kong

Hong Kong Eye Hospital

Kowloon, Hong Kong
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Ng A.L.K.,University of Hong Kong | Chan T.C.,University of Hong Kong | Chan T.C.,Hong Kong Eye Hospital | Cheng A.C.,Hong Kong Sanatorium and Hospital
Clinical and Experimental Ophthalmology | Year: 2016

Background: This study aims to compare the effect of conventional corneal collagen cross-linking (CXL) with accelerated corneal collagen cross-linking in treatment of keratoconus. Design: A comparative interventional study was employed. Participants: Participants were consecutive cases of progressive keratoconus receiving either conventional (3mW/cm2 irradiance for 30min) or accelerated CXL (9mW/cm2 irradiance for 10min). Methods: Clinical and topographic parameters were compared between the two groups. Postoperative corneal stromal demarcation line was measured using anterior segment optical coherence tomography. Main Outcome Measures: Clinical and topographic parameters such as corrected distant visual acuity (CDVA), maximum keratometry (Kmax), mean keratometry (Kmean), demarcation line depth were gathered from medical records. Results: There were a total of 26 eyes with an average follow up of 13.9±6.3 months. Fourteen eyes received conventional CXL, and 12 eyes had accelerated CXL. In the conventional CXL group, CDVA improved significantly (P=0.021). There was also a significant reduction in Kmax (P=0.003) and Kmean (P=0.002). In the accelerated CXL group, no significant changes were found in CDVA (P=0.395), Kmax (P=0.388) and Kmean (P=0.952) postoperatively. A significantly greater reduction in Kmax and Kmean were seen in conventional CXL compared to its accelerated counterpart (P=0.001 and 0.015, respectively). The demarcation line was deeper in eyes with conventional CXL (P=0.013), and the depth correlated significantly with the change in Kmean (r=-0.432, P=0.045). Conclusion: Conventional and accelerated CXL are effective in stabilizing keratoconus progression after a mean of 12 months. Patients undergoing conventional CXL showed clinical improvement with greater corneal flattening, which correlated with a deeper corneal stromal demarcation line. This current study is the first to report such correlation. © 2016 Royal Australian and New Zealand College of Ophthalmologists.

Chan T.C.Y.,Hong Kong Eye Hospital | Chan T.C.Y.,Chinese University of Hong Kong | Cheng G.P.M.,Hong Kong Laser Eye Center | Wang Z.,Sun Yat Sen University | And 5 more authors.
American Journal of Ophthalmology | Year: 2015

Purpose To evaluate the outcomes of femtosecond-assisted arcuate keratotomy combined with cataract surgery in eyes with low to moderate corneal astigmatism. Design Retrospective, interventional case series. Methods This study included patients who underwent combined femtosecond-assisted phacoemulsification and arcuate keratotomy between March 2013 and August 2013. Keratometric astigmatism was evaluated before and 2 months after the surgery. Vector analysis of the astigmatic changes was performed using the Alpins method. Results Overall, 54 eyes of 54 patients (18 male and 36 female; mean age, 68.8 ± 11.4 years) were included. The mean preoperative (target-induced astigmatism) and postoperative astigmatism was 1.33 ± 0.57 diopters (D) and 0.87 ± 0.56 D, respectively (P <.001). The magnitude of error (difference between surgically induced and target-induced astigmatism) (-0.13 ± 0.68 D), as well as the correction index (ratio of surgically induced and target-induced astigmatism) (0.86 ± 0.52), demonstrated slight undercorrection. The angle of error was very close to 0, indicating no significant systematic error of misaligned treatment. However, the absolute angle of error showed a less favorable range (17.5 ± 19.2 degrees), suggesting variable factors such as healing or alignment at an individual level. There were no intraoperative or postoperative complications. Conclusions Combined phacoemulsification with arcuate keratotomy using femtosecond laser appears to be a relatively easy and safe means for management of low to moderate corneal astigmatism in cataract surgery candidates. Misalignment at an individual level can reduce its effectiveness. This issue remains to be elucidated in future studies. © 2015 Elsevier Inc. All rights reserved.

PURPOSE:: To characterize epidemiological data on methicillin-resistant Staphylococcus aureus (MRSA) ocular infections over a 10-year period in Hong Kong; to compare the characteristics between hospital-associated methicillin-resistant Staphylococcus aureus (h-MRSA) and community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) ocular infections; and to review the treatment regimen and outcome of identified cases. METHODS:: A retrospective case review of ocular samples testing positive for MRSA at a tertiary eye center from July 2005 to June 2015 was performed. RESULTS:: Ninety nonduplicative samples from 75 patients with ocular MRSA infection were included during the study period. The average annual rate of ocular MRSA infection among all ocular S. aureus infections was 12.9%. Ten patients had CA-MRSA (13.3%). The most common clinical manifestation was preseptal cellulitis in the CA-MRSA group and blepharoconjunctivitis in the h-MRSA group. Vision-threatening conditions occurred only in the h-MRSA group. Besides vancomycin, other antibiotics to which both MRSA groups were highly sensitive included chloramphenicol, fusidic acid, cotrimoxazole, and gentamicin. Significantly more CA-MRSA was sensitive to levofloxacin and clindamycin (P < 0.01). The h-MRSA group required a significantly longer duration of treatment to eradicate infection (mean 79 vs. 28 days, P < 0.01). CONCLUSIONS:: CA-MRSA presents as a genetically different organism with distinctive clinical presentation and antibiotic sensitivity from its h-MRSA counterpart. Despite increasing resistance patterns, we demonstrate that MRSA ocular infections can be effectively treated without the use of vancomycin, limiting its use to refractory or vision-threatening conditions. Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.

Chan T.C.Y.,Hong Kong Eye Hospital | Li E.Y.M.,Hong Kong Eye Hospital | Yau J.C.Y.,Hong Kong Eye Hospital
Journal of Cataract and Refractive Surgery | Year: 2014

Purpose To use anterior segment optical coherence tomography (AS-OCT) to identify eyes with posterior polar cataract at high risk for posterior capsule rupture (PCR) during cataract extraction. Setting Hong Kong Eye Hospital, Hong Kong, China. Design Retrospective case series. Methods Eyes with clinically diagnosed posterior polar cataract that had AS-OCT imaging and phacoemulsification were included. Each eye was graded according to the features of the posterior lens opacity and the underlying capsule. Eyes were categorized as having grade 1 or grade 2 cataract depending on the amount of clearance between the posterior opacity and the capsule (≤50% clearance and <50% clearance, respectively). Grade 3 represented the absence of an intact posterior capsule. The incidence of intraoperative PCR was compared with the AS-OCT grading to identify eyes at high risk for PCR. Results The study assessed 37 eyes, 19 with grade 1 cataract, 13 with grade 2, and 5 with grade 3. Posterior capsule rupture occurred in 8 eyes (21.6%), 1 (5.3%) with grade 1 cataract, 4 (30.8%) with grade 2, and 3 (60.0%) with grade 3. The PCR rate was statistically significantly different between the groups (P =.018). When grade 2 cases and grade 3 cases were combined, AS-OCT had a sensitivity of 87.5% and specificity of 62.1%. Conclusions Anterior segment OCT can be used to grade posterior polar cataracts and identify eyes at high risk for PCR, allowing better surgical planning and preoperative counseling. Financial Disclosure No author has a financial or proprietary interest in any material or method mentioned. © 2014 ASCRS and ESCRS.

Chan T.C.Y.,Hong Kong Eye Hospital | Chan T.C.Y.,Chinese University of Hong Kong | Lam J.K.M.,Hong Kong Eye Hospital | Lam J.K.M.,Chinese University of Hong Kong | And 3 more authors.
American Journal of Ophthalmology | Year: 2015

Purpose To compare the outcome of primary anterior chamber vs secondary scleral-fixated intraocular lens (IOL) implantation in complicated cataract surgeries. Design Retrospective, comparative study. Methods A consecutive series of complicated cataract surgeries with primary anterior chamber (ACIOL) or secondary scleral-fixated IOL implantation from January 1, 2004 to December 31, 2009 was analyzed. Main outcome measures included the postoperative best-corrected visual acuity (BCVA) and postoperative complications. Results There were 89 eyes in the primary ACIOL group and 74 eyes in the secondary scleral-fixated IOL group. The mean follow-up duration was 64.1 ± 36.7 months. The mean postoperative logarithm of minimal angle of resolution (logMAR) BCVA at 1 year was 0.32 ± 0.54 and 0.34 ± 0.21 in the primary ACIOL group and the secondary scleral-fixated IOL group, respectively (P =.734). The mean latest logMAR BCVA was 0.68 ± 0.54 and 0.61 ± 0.47 in the primary ACIOL group and the secondary scleral-fixated IOL group, respectively (P =.336). The primary ACIOL group had more early postoperative complications (P <.001). No difference in late postoperative complications was observed between the 2 groups (P =.100). Regression analysis showed that primary ACIOL and secondary scleral-fixated IOL implantation had similar latest postoperative logMAR BCVA (P =.927), while the presence of late complications was associated with a worse final visual outcome (P =.000). Conclusions This study shows that there are no long-term differences in the visual outcomes and complication profiles after primary ACIOL or secondary scleral-fixated IOL implantation in a complicated cataract operation when capsular support is inadequate. © 2015 Elsevier Inc.

Leung D.Y.L.,Chinese University of Hong Kong | Leung D.Y.L.,Hong Kong Sanatorium and Hospital | Tham C.C.Y.,Chinese University of Hong Kong | Tham C.C.Y.,Hong Kong Eye Hospital
Seminars in Ophthalmology | Year: 2013

Trabeculectomy remains a mainstay surgery for glaucoma. The necessity to raise a bleb and use of chemoadjuvants may result in bleb-related complications, such as bleb-fibrosis, bleb-leaks, bleb-related infections, overfiltration, or hypotony. This review highlights some of the latest developments in preventing and managing these complications, including anti-vascular endothelial growth factors, monoclonal antibodies for moderate reduction of fibrosis, newer surgical strategies for bleb leaks, an update from a randomized clinical trial highlighting the incidence and management of bleb-related infections, and various treatment strategies for an overfiltering bleb. In addition, other surgical interventions with less or no bleb-related complications will be discussed, including non-penetrating glaucoma surgeries, glaucoma drainage devices, or phacoemulsification. © 2013 Informa Healthcare USA, Inc.

Wong A.L.,Caritas Medical Center | Chan T.C.Y.,Hong Kong Eye Hospital | Fong A.H.C.,Hong Kong Eye Hospital | Lam B.N.M.,Hong Kong Eye Hospital | Yuen H.K.L.,Hong Kong Eye Hospital
Journal of Cataract and Refractive Surgery | Year: 2014

Purpose To review the clinical characteristics and surgical outcomes of patients with true exfoliation syndrome of the lens capsule having phacoemulsification cataract surgery. Setting Hong Kong Eye Hospital, Kowloon, Hong Kong. Design Case series. Methods Eyes of patients with true exfoliation syndrome diagnosed clinically or intraoperatively had standard phacoemulsification and intraocular lens (IOL) implantation. The anterior capsules removed during capsulorhexis were sent for histological confirmation. Results Twenty-four eyes of 18 patients were included. All eyes were confirmed to have true exfoliation syndrome by histological examination of the anterior lens capsule. Seven eyes (29.2%) had preexisting chronic glaucoma; 5 (20.8%) had laser iridotomy before the diagnosis. During phacoemulsification, all eyes had a continuous curvilinear capsulorhexis without complications. Trypan blue staining was used during capsulorhexis in 11 eyes (45.8%). Posterior capsule rupture occurred during lens chopping in 1 eye (4.2%). No loose zonular fibers or radial extension of capsulorhexis occurred. Capsular bag IOL implantation was successfully performed in all cases except the 1 with a posterior capsule rupture, in which an anterior chamber IOL was implanted. Conclusions Phacoemulsification was safely performed in eyes with true exfoliation syndrome. Trypan blue staining can be used to facilitate capsulorhexis creation. Ultrasound biomicroscopy or anterior segment optical coherence tomography may be useful in preoperative assessment of such cases. The disease may be associated with glaucoma and laser iridotomy. Financial Disclosure No author has a financial or proprietary interest in any material or method mentioned. © 2013 ASCRS and ESCRS.

Chan T.C.Y.,Chinese University of Hong Kong | Chan T.C.Y.,Hong Kong Eye Hospital | Liu D.,Chinese University of Hong Kong | Yu M.,Hang Seng Management College | And 3 more authors.
Ophthalmology | Year: 2015

Purpose To investigate the change in posterior corneal elevation up to 1 year after myopic femtosecond-assisted LASIK and photorefractive keratectomy (PRK). Design Prospective, longitudinal, comparative study. Participants Patients undergoing femtosecond-assisted LASIK or PRK. Methods Corneal imaging was performed using swept-source optical coherence tomography at baseline and at each postoperative follow-up. A 2-way analysis of variance model with repeated measures and a linear mixed effect model were used to compare the differences in posterior corneal elevation between LASIK and PRK at different points after adjusting for the preoperative spherical equivalent (SEQ), central corneal thickness (CCT), thinnest corneal thickness (TCT), residual bed thickness (RST), and ablation depth (AD). Main Outcome Measures The changes in posterior corneal elevation 1 month, 3 months, 6 months, and 12 months after surgery. Results Ninety-eight eyes of 49 patients (mean age 35.2 ± 8.5 years) (62 LASIK, 36 PRK) were included. The mean change in posterior corneal elevation values after LASIK and PRK were 4.88±0.47 μm versus 3.67±0.48 μm (B-1), 2.42±0.56 μm versus 3.00±0.47 μm (B-3), 3.76±0.46 μm versus 2.76±0.46 μm (B-6), and 2.92±0.46 μm versus 2.72±0.46 μm (B-12), respectively. Significant differences in posterior corneal elevation after LASIK were found from month 1, to month 3, to month 6, to month 12 (P ≤ 0.001), whereas posterior corneal elevation did not change significantly from month 3, to month 6, to month 12 (P ≥ 0.373) after PRK. LASIK and PRK eyes showed significant differences at months 3 and 12 (P ≤ 0.023). A similar pattern was observed for the changes in posterior corneal elevation after LASIK and PRK after adjusting for the effect of SEQ, CCT, TCT, RST, and AD. The adjusted forward displacements of the posterior corneal surface were statistically significant throughout the study period after both refractive surgeries (P < 0.05). Conclusions The findings of our study suggested that there was a mild but significant forward protrusion of the posterior cornea after femtosecond laser-assisted LASIK and PRK. The posterior cornea fluctuated during the first postoperative year after LASIK, whereas it stabilized as early as 3 months after PRK. © 2015 American Academy of Ophthalmology.

Chan T.C.Y.,Hong Kong Eye Hospital | Li E.Y.M.,Hong Kong Eye Hospital | Wong V.W.Y.,Hong Kong Eye Hospital | Jhanji V.,Chinese University of Hong Kong
American Journal of Ophthalmology | Year: 2014

PURPOSE: To analyze cases of orthokeratology-associated infectious keratitis managed in a tertiary care eye hospital in Hong Kong between 2003 and 2013.DESIGN: Retrospective study.METHODS: Case records of patients with infectious keratitis attributable to orthokeratology contact lenses were analyzed. Data analyzed included clinical features, microbiological evaluation, and treatment outcomes.RESULTS: A total of 23 patients were included (16 female, 7 male, mean age: 15.0 ± 4.2 years; range: 9-23 years). All patients were using overnight orthokeratology for an average of 2.7 ± 2.8 years (range: 3 months - 10 years) before the onset of infection. Clinical features included corneal infiltrate (n = 14, 60.9%) and corneal perineuritis (n = 12, 52.2%). Fifteen eyes (65.2%) had a positive microbiological culture obtained from corneal scrapings. The most commonly isolated organism was Pseudomonas aeruginosa (n = 6), followed by coagulase-negative Staphylococcus (n = 5) and Acanthamoeba (n = 3). Five cases of Pseudomonas aeruginosa and 5 cases of Acanthamoeba were identified from contact lenses or contact lens solution. The mean duration from disease onset to remission was 31.9 ± 34.9 days (range: 6-131 days). All patients responded to medical treatment, and no emergency surgical intervention was needed. The best-corrected logMAR visual acuity improved significantly from 0.62 ± 0.51 (20/83 Snellen) to 0.15 ± 0.20 (20/28 Snellen) (Wilcoxon signed rank test, P <.001).CONCLUSIONS: Orthokeratology-associated infectious keratitis continues to be a serious problem, especially in regions with high prevalence of myopia. Early clinical and microbiological diagnosis and intensive treatment can improve final visual outcomes. © 2014 Elsevier Inc. All rights reserved.

Wong M.O.M.,Queen Mary Hospital | Wong M.O.M.,Hong Kong Eye Hospital | Lee J.W.Y.,Caritas Medical Center | Choy B.N.K.,University of Hong Kong | And 2 more authors.
Survey of Ophthalmology | Year: 2015

Selective laser trabeculoplasty (SLT) is a relatively new type of laser used in treating open-angle glaucoma (OAG) and is reported to be equally efficacious to a first-line medication and argon laser trabeculoplasty (ALT). We summarize available evidence for considering SLT as an alternative treatment in OAG through systematic review and meta-analysis. Among OAG patients who range from newly diagnosed to those on maximally tolerated medical therapy, SLT results in a 6.9-35.9% intraocular pressure (IOP) reduction. Complications are rare and include an IOP spike requiring surgery, persistent macular edema, and corneal haze and thinning. Meta-analysis of randomized, controlled trials shows that SLT is non-inferior to ALT and medication in IOP reduction and also in achieving treatment success. Number of medications reduction is similar between SLT and ALT. More robust evidence is needed to determine its efficacy as a repeated procedure. © 2015 Elsevier Inc.

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