Argon laser peripheral iridoplasty (ALPI) versus systemic intraocular pressure lowering medications as the immediate management for phacomorphic angle closure

Poster Session: Glaucoma PhenotypesPurpose: To compare the efficacy and safety of argon laser peripheral iridoplasty (ALPI) to systemic intraocular pressure (IOP) lowering medications in the immediate management of phacomorphic angle closure. Patients and methods: This was a prospective randomized controlled study conducted at a district hospital in Hong Kong, China. Consecutive cases of phacomorphic angle closure were recruited from December 2009 to December 2010. Patients received intravenous (IV) and oral carbonic anhydrase inhibitor or ALPI as the initial treatment. IV mannitol was administered in both groups for presenting IOP > 60 mmHg or IOP > 40 mmHg 2 hours post treatment. The following perimeters were compared between the 2 arms: Snellen best correct visual acuity (BCVA); duration of symptoms; presenting IOP; IOP at 15 minutes, 30minutes and hourly after treatment until IOP < 25 mmHg; post-op angle, retinal nerve fibre layer (RNFL), endothelial count, BCVA and IOP. Results: Ten consecutive cases were included in the study. Six cases received medication therapy and 4 received ALPI. The mean age was 79.7 ± 7.2 in the medical therapy group and 78.3 ± 11.0 in the ALPI group. The presenting IOP was 50.7 ± 8.4 mmHg and 50.25 ± 6.9 mmHg in the medical therapy and ALPI group respectively. The duration of phacomorphic glaucoma in the medical group was 2.8 ± 3.5 days and 0.9 ± 0.25 days in the ALPI group. In the medical therapy group, 50% (3/6) required IV mannitol and none in the ALPI group. The time taken to reduce the presenting IOP to < 25 mmHg was 115.0 ± 97.0 minutes in the medical therapy group and 18.8 ± 7.5 minutes in the ALPI group. Within the first 30minutes, the drop in IOP was 20.8 ± 13.5mmHg in the medical group and 34.8 ± 3.2mmHg in the ALPI group, representing a 41.0% and 69.3% drop in IOP respectively. The degree of peripheral anterior synechiae (PAS) formation at 3 months was 45 ± 45.3° and 22.5 ± 5° in the medical and ALPI group respectively. The RNFL, angle, endothelial count, post-op VA and IOP were comparable in both groups. Conclusion: ALPI is an effective and safe IOP lowering modality in acute phacomorphic angle closure, offering a more rapid reduction of IOP, avoiding the use of systemic carbonic anhydrase inhibitor and hyperosmotic agents, and with seemingly less PAS formation and comparable post-op results as compared to medical therapy. ALPI should replace medical therapy as first line treatment in phacomorphic angle closure especially in elderly patients cannot tolerable the side effects of systemic IOP-lowering medication.published_or_final_versio

Intraperitoneal drain placement and outcomes after elective colorectal surgery: international matched, prospective, cohort study

Despite current guidelines, intraperitoneal drain placement after elective colorectal surgery remains widespread. Drains were not associated with earlier detection of intraperitoneal collections, but were associated with prolonged hospital stay and increased risk of surgical-site infections.Background Many surgeons routinely place intraperitoneal drains after elective colorectal surgery. However, enhanced recovery after surgery guidelines recommend against their routine use owing to a lack of clear clinical benefit. This study aimed to describe international variation in intraperitoneal drain placement and the safety of this practice. Methods COMPASS (COMPlicAted intra-abdominal collectionS after colorectal Surgery) was a prospective, international, cohort study which enrolled consecutive adults undergoing elective colorectal surgery (February to March 2020). The primary outcome was the rate of intraperitoneal drain placement. Secondary outcomes included: rate and time to diagnosis of postoperative intraperitoneal collections; rate of surgical site infections (SSIs); time to discharge; and 30-day major postoperative complications (Clavien-Dindo grade at least III). After propensity score matching, multivariable logistic regression and Cox proportional hazards regression were used to estimate the independent association of the secondary outcomes with drain placement. Results Overall, 1805 patients from 22 countries were included (798 women, 44.2 per cent; median age 67.0 years). The drain insertion rate was 51.9 per cent (937 patients). After matching, drains were not associated with reduced rates (odds ratio (OR) 1.33, 95 per cent c.i. 0.79 to 2.23; P = 0.287) or earlier detection (hazard ratio (HR) 0.87, 0.33 to 2.31; P = 0.780) of collections. Although not associated with worse major postoperative complications (OR 1.09, 0.68 to 1.75; P = 0.709), drains were associated with delayed hospital discharge (HR 0.58, 0.52 to 0.66; P &lt; 0.001) and an increased risk of SSIs (OR 2.47, 1.50 to 4.05; P &lt; 0.001). Conclusion Intraperitoneal drain placement after elective colorectal surgery is not associated with earlier detection of postoperative collections, but prolongs hospital stay and increases SSI risk

To compare the efficacy and safety of argon laser peripheral iridoplasty (ALPI) to systemic intraocular pressure (IOP) lowering medications in the immediate management of acute phacomorphic angle closure

Glaucoma free paper session 3BACKGROUND: The purpose of this study was to compare the efficacy and safety of argon laser peripheral iridoplasty (ALPI) and systemic intraocular pressure (IOP)-lowering medications in the immediate management of acute phacomorphic angle closure. METHODS: Consecutive cases of acute phacomorphic angle closure were randomized to receive ALPI and an intravenous or oral carbonic anhydrase inhibitor as initial treatment. Intravenous mannitol was administered for presenting IOP > 60 mmHg or IOP > 40 mmHg 2 hours posttreatment in both arms. RESULTS: Of 10 consecutive cases, six received medical therapy and four received ALPI. Fifty percent in the medical group and none in the ALPI group required intravenous mannitol. The ALPI group took less time to achieve IOP < 25 mmHg (18.8 ± 7.5 minutes versus 115.0 ± 97.0 minutes, P = 0.001, F test); had a greater IOP reduction within 30 minutes (69.8% ± 7.7% versus 40.9 ± 23.9%, P = 0.03, t-test); and had a consistently smaller post-attack cup to disc ratio (0.50 ± 0.02 versus 0.60 ± 0.20, P = 0.002, F test). CONCLUSION: ALPI offers greater safety, consistency, and efficacy than systemic IOP-lowering medications as initial treatment for phacomorphic angle closure

Argon laser peripheral iridoplasty versus systemic intraocular pressure-lowering medications as immediate management for acute phacomorphic angle closure

Jacky WY Lee,1 Jimmy SM Lai,1 Doris WF Yick,2 Can YF Yuen21Department of Ophthalmology, University of Hong Kong, 2Department of Ophthalmology, The Caritas Medical Centre, Kowloon West Cluster, Hong Kong, People&amp;rsquo;s Republic of ChinaBackground: The purpose of this study was to compare the efficacy and safety of argon laser peripheral iridoplasty (ALPI) and systemic intraocular pressure (IOP)-lowering medications in the immediate management of acute phacomorphic angle closure.Methods: Consecutive cases of acute phacomorphic angle closure were randomized to receive ALPI and an intravenous or oral carbonic anhydrase inhibitor as initial treatment. Intravenous mannitol was administered for presenting IOP &amp;gt; 60 mmHg or IOP &amp;gt; 40 mmHg 2 hours posttreatment in both arms.Results: Of 10 consecutive cases, six received medical therapy and four received ALPI. Fifty percent in the medical group and none in the ALPI group required intravenous mannitol. The ALPI group took less time to achieve IOP &amp;lt; 25 mmHg (18.8 &amp;plusmn; 7.5 minutes versus 115.0 &amp;plusmn; 97.0 minutes, P = 0.001, F test); had a greater IOP reduction within 30 minutes (69.8% &amp;plusmn; 7.7% versus 40.9 &amp;plusmn; 23.9%, P = 0.03, t-test); and had a consistently smaller post-attack cup to disc ratio (0.50 &amp;plusmn; 0.02 versus 0.60 &amp;plusmn; 0.20, P = 0.002, F test).Conclusion: ALPI offers greater safety, consistency, and efficacy than systemic IOP-lowering medications as initial treatment for phacomorphic angle closure.Keywords: phacomorphic, glaucoma, argon laser peripheral iridoplasty, medical, intraocular pressur

Hallux valgus orthosis characteristics and effectiveness : a systematic review with meta-analysis

202202 bchyVersion of RecordOthersThe authors would like to acknowledge the Departmental Grant of Institute of Textiles and Clothing, The Hong Kong Polytechnic University (grant number PolyU RHRM) for funding this project.Publishe

The immediate effects of hallux valgus orthoses : a comparison of orthosis designs

202302 bcwwAccepted ManuscriptOthersThe Hong Kong Polytechnic UniversityPublishe

Argon Laser Peripheral Iridoplasty versus Systemic Intraocular Pressure Lowering Medications as the Immediate Management for Acute Phacomorphic Angle Closure

BACKGROUND: The purpose of this study was to compare the efficacy and safety of argon laser peripheral iridoplasty (ALPI) and systemic intraocular pressure (IOP)-lowering medications in the immediate management of acute phacomorphic angle closure. METHODS: Consecutive cases of acute phacomorphic angle closure were randomized to receive ALPI and an intravenous or oral carbonic anhydrase inhibitor as initial treatment. Intravenous mannitol was administered for presenting IOP > 60 mmHg or IOP > 40 mmHg 2 hours posttreatment in both arms. RESULTS: Of 10 consecutive cases, six received medical therapy and four received ALPI. Fifty percent in the medical group and none in the ALPI group required intravenous mannitol. The ALPI group took less time to achieve IOP < 25 mmHg (18.8 ± 7.5 minutes versus 115.0 ± 97.0 minutes, P = 0.001, F test); had a greater IOP reduction within 30 minutes (69.8% ± 7.7% versus 40.9 ± 23.9%, P = 0.03, t-test); and had a consistently smaller post-attack cup to disc ratio (0.50 ± 0.02 versus 0.60 ± 0.20, P = 0.002, F test). CONCLUSION: ALPI offers greater safety, consistency, and efficacy than systemic IOP-lowering medications as initial treatment for phacomorphic angle closure

Assessment of glaucomatous optic neuropathy in phacomorphic angle closure

To investigate the retinal nerve fibre layer (RNFL) changes after an acute attack of phacomorphic angle closure. This prospective study involved ten cases of phacomorphic angle closure that underwent cataract extraction and intraocular lens insertion after intraocular pressure lowering. Apart from visual acuity and intraocular pressure (IOP), RNFL thickness and vertical cup disc ratio (VCDR) were measured by optical coherence tomography (OCT) at 3-9 months post attack. Humphrey visual field assessment was performed at 9 months post attack. All cases had mean phacomorphic duration of 0.2. Patients with <5 days duration of phacomorphic angle closure are likely to have reasonable postoperative vision. An acute episode of phacomorphic angle closure can trigger an accelerated RNFL thinning despite normal IOP and open angles, most noticeable in the superior and inferior quadrants, occurring between 3 and 9 months post attack. Glaucomatous optic neuropathy in the attack eye was evident by OCT but not by visual field assessment at the same time interval

Intervention of arch support : a quantitative study

Applied Human Factors and Ergonomics (AHFE) 2022 International Conference, Jul 24 - 28, 2022, New York, United States of America202301 bcwwVersion of RecordOthersThe Hong Kong Polytechnic UniversityPublishe