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Lee J.W.Y.,Caritas Medical Center | Lee J.W.Y.,University of Hong Kong | Liu C.C.L.,Hong Kong Polytechnic University | Chan J.C.H.,Queen Mary Hospital | And 3 more authors.
Clinical Ophthalmology | Year: 2014

Purpose: To determine the predictors of success for adjuvant selective laser trabeculoplasty (SLT) in Chinese primary open angle glaucoma (POAG) patients.Methods: This prospective study recruited Chinese subjects with unilateral or bilateral POAG currently taking medication to reduce intraocular pressure (IOP). All subjects received a single session of 360° SLT treatment and continued their medications for 1 month. SLT success was defined as IOP reduction ≥ 20% at 1 month. The following covariates were analyzed in both groups via univariate and multivariate analyses: age, sex, lens status, initial IOPs, post-SLT IOPs, number and type of medications, SLT shots and energy, and pre-SLT investigations.Results: In 51 eyes of 33 POAG subjects, the success rate of SLT was 47.1%. Certain groups of patients were associated with greater success using univariate analysis. These groups included the following: older age (coefficient =0.1; OR: 1.1; P=0.0003), a higher pre-SLT IOP (coefficient =0.3; OR: 1.3; P=0.0005), using four types of antiglaucoma medication (coefficient =2.1; OR: 8.4; P=0.005), a greater degree of spherical equivalent (coefficient =2.1; OR: 8.4; P=0.005), and the use of a topical carbonic anhydrase inhibitor (coefficient =1.7; OR: 6.0; P=0.003). None of the covariates were significant using multivariate analysis.Conclusion: Older age, a higher pretreatment IOP, using multiple antiglaucoma medications especially topical carbonic anhydrase inhibitor, and higher refractive errors were associated with greater SLT success. © 2014 Lee et al. Source


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. Source


Chow V.W.S.,Hong Kong Eye Hospital | Agarwal T.,All India Institute of Medical Sciences | Vajpayee R.B.,All India Institute of Medical Sciences | Vajpayee R.B.,University of Melbourne | And 3 more authors.
Current Opinion in Ophthalmology | Year: 2013

PURPOSE OF REVIEW: Descemet's membrane detachment (DMD) is commonly encountered after intraocular surgery and ocular trauma. Although its occurrence has been known for a long time, the disease course and its optimal management is not yet fully understood. This review aims to present an update on current trends in diagnosis and management of DMD. RECENT FINDINGS: Different causes as well as a variable course of disease exist for DMD. Although some DMDs reattach spontaneously with a good visual outcome, some corneas clear without the need for an attached membrane and a few corneas do not clear in spite of an attached Descemet's membrane. DMDs may be treated either conservatively or surgically, with many surgeons favouring an early surgical intervention especially for scrolled, extensive and sight-disabling DMDs. However, due to an unknown course of the disease, exact timing and nature of surgical intervention could not yet been fully defined. SUMMARY: Most DMDs can now be recognized and managed successfully with good visual outcome. However, optimal timing and treatment strategy for different DMDs remain an area to be explored for the best visual recovery for patients. Copyright © Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited. Source


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. Source


Lam D.K.T.,Hong Kong Eye Hospital | Chow V.W.S.,Hong Kong Eye Hospital | Ye C.,Chinese University of Hong Kong | Ng P.K.-F.,Chinese University of Hong Kong | And 4 more authors.
British Journal of Ophthalmology | Year: 2016

Purpose To compare the visual outcomes of aspheric toric intraocular lens (IOL) implantation and limbal relaxing incisions (LRI) for management of coexisting age-related cataracts and astigmatism. Methods In this prospective study, sixty eyes of 60 patients with visually significant cataract and coexisting corneal astigmatism ≤3 dioptres (D) were randomised to undergo phacoemulsification with either aspheric toric IOL or aspheric monofocal IOL with LRI. The main outcome measures were postoperative 3-month uncorrected visual acuity (UCVA), contrast sensitivity, rotational stability of the toric IOL and spectacle independence. Results The postoperative UCVA, contrast sensitivity and refractive astigmatism were significantly better than the baseline measurements for both groups (p≤0.001). There was no significant difference detected for these parameters between LRI and toric IOL groups postoperatively (p≥0.119). At both postoperative month 1 and 3, the percentages of eyes in need of spectacles were lower in toric group than LRI group (p≤0.030). IOL misalignment was noted in three eyes in the toric IOL group (mean misalignment 7.67±4.04°). On vector analysis, magnitude of error (ME) was negative in the LRI group indicating undercorrection, whereas the ME was close to zero for toric group. Conclusions Both toric IOL implantation and LRI were effective in correcting corneal astigmatism ≤3 D during phacoemulsification, while LRI tended to undercorrect astigmatism. Source

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