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Tsai A.S.H.,Singapore National Eye Center | Loon S.C.,National University of Singapore
Clinical and Experimental Ophthalmology | Year: 2012

This paper aims to review the current methods available for the measurement of intraocular pressure after myopic laser in situ keratomileusis for the correction of myopia. Searches were performed for studies that assessed or compared various methods of intraocular pressure assessment. There were 20 eligible studies that explored the use of pneumotonometry, pressure phosphene tonometry, rebound tonometry, dynamic contour tonometry, statistical modeling, mathematical formulae, ocular response analyzer and even measuring intraocular pressure on the nasal cornea. Our review shows that an ideal method would be one that is independent of corneal factors. Dynamic contour tonometry and pressure phosphene tonometry held promise in research settings. More studies need to be done to validate the new methods of intraocular pressure assessment, especially in glaucoma patients. It is important to empower laser in situ keratomileusis patients with knowledge of these difficulties and potential implications for the future. © 2011 Royal Australian and New Zealand College of Ophthalmologists.

Yang M.,Singapore National Eye Center | Perros P.,Royal Infirmary
Best Practice and Research: Clinical Endocrinology and Metabolism | Year: 2012

Most patients with Graves' orbitopathy have mild disease that requires no or minimal intervention. For the minority of patients with moderate or severe disease, multiple medical and surgical treatments may be required at different stages. It is crucial that such patients are monitored closely and treatments applied with care in the right sequence. Medical treatments should be used as early as possible and only during the active phase of the disease. Rehabilitative surgery is indicated in the inactive phase of the disease and should follow the sequence: surgical decompression followed by eye muscle surgery, followed by lid surgery. Delivery of care in a coordinated fashion that makes use of best available expertise is important and best implemented through a Combined Thyroid Eye clinic. © 2011 Elsevier Ltd. All rights reserved.

Lim Z.,Singapore National Eye Center
Journal of AAPOS : the official publication of the American Association for Pediatric Ophthalmology and Strabismus / American Association for Pediatric Ophthalmology and Strabismus | Year: 2012

To review the management and outcomes of pediatric patients with cataract who were managed by one of two surgeons at a single institution. An observational series of consecutive cases identified from the hospital's outpatient billing records and surgical data program were used. Visual acuity was measured with the Snellen or Allen charts. Glaucoma was defined as IOP >20 mm Hg with clinical signs of glaucoma or visual field loss. Procedures for aphakic/pseudophakic glaucoma were excluded from analysis of additional surgeries performed subsequent to cataract extraction. The search identified 778 patients (1,122 eyes) diagnosed with cataract over 10 years. Of these, 74% of eyes were treated surgically. Those patients with total, nuclear, and lamellar cataracts were significantly more likely than the overall population to undergo surgery. Additional surgeries were required in 12% of surgically treated eyes, with pseudophakic eyes representing more than one-half. Aphakic and pseudophakic glaucoma prevalence were 12% and 1%, respectively. Cataract morphology was not found to be a predisposing factor in the development of glaucoma. Visual outcomes were significantly better for posterior subcapsular (P = 0.0001), nuclear (P = 0.025), lamellar (P = 0.03), and traumatic cataracts (P = 0.005) than for other morphological types at all ages. Visual acuity was 20/30 or better in 63% of children with unilateral pseudophakia, 45% of children with unilateral aphakia, and approximately 75% of children with bilateral aphakia and pseudophakia. Patients with total, nuclear, and lamellar cataracts were more likely to undergo surgery. Approximately 10% of patients required additional surgeries. No cataract morphology predisposed patients to developing glaucoma. Good visual outcomes were attained in bilaterally pseudophakic/aphakic and unilaterally pseudophakic children. Copyright © 2012 American Association for Pediatric Ophthalmology and Strabismus. Published by Mosby, Inc. All rights reserved.

Teo L.,Singapore National Eye Center
Orbit (Amsterdam, Netherlands) | Year: 2013

To describe the histopathological distribution of biopsied lacrimal gland lesions in a tertiary referral centre in Singapore. This was a retrospective chart review. Clinical records of patients who underwent lacrimal gland biopsy at a tertiary referral centre in Singapore between 2000 to 2010, were reviewed. Data collated included patient demographics, clinical presentation, association with systemic disease and histopathological diagnosis. Sixty-nine patients were studied. Median age of presentation was 50 years. Forty patients (58%) were female and the majority (84%, n = 29) were Chinese. The mean follow-up duration was 35.0 ± 34.5 months. 30.4% (n = 21) of the patients had bilateral disease. Chronic dacryoadenitis (46%, n = 32) was the most common histopathological diagnosis, followed by lymphoproliferative disorders (38%, n = 26) and pleomorphic adenoma (10%, n = 7). The diagnoses in four other patients included adenoid cystic carcinoma, lacrimal gland hypertrophy, lacrimal duct cyst and orbital vascular malformation. Chronic dacryoadenitis and lymphoproliferative disorders are the two commonest causes of lacrimal gland lesions in our series. Although many cases remain non-specific, about 60% have a specific inflammation that may be associated with a systemic disease. As one third of our patients with lymphoproliferative disease of the lacrimal gland had an associated systemic lymphoma, patients with such lesions should be referred for investigation of possible systemic lymphoma. The results of our study can aid in providing a more targeted approach to patient management.

Chng C.-L.,Singapore General Hospital | Seah L.L.,Singapore National Eye Center | Khoo D.H.C.,Singapore General Hospital
Best Practice and Research: Clinical Endocrinology and Metabolism | Year: 2012

Ethnic differences in a number of eye conditions have been described. The literature on ethnic differences in Graves' ophthalmopathy (GO) is limited. There is some evidence to suggest Asian patients with GO may manifest milder phenotypic features of GO, with less proptosis and evidence of extraocular muscle involvement and restriction. The reasons for these differences are likely to be multifactorial and include orbital and lid anatomy, genetic background and autoimmune responses including TSH -receptor antibodies. These differences should be kept in mind when evaluating and managing patients with GO. © 2011 Elsevier Ltd. All rights reserved.

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