Consensual ophthalmotonic reaction – Results from a retrospective human study & a prospective animal study

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Two-Year Clinical Results After Selective Laser Trabeculoplasty for Normal Tension Glaucoma

Open Access JournalThis article aims to investigate the clinical results at 2 years after selective laser trabeculoplasty (SLT) for normal tension glaucoma (NTG). This prospective cohort study recruited NTG patients taking antiglaucoma medication. Subjects were excluded if they had previous glaucoma surgery/laser or corneal pathologies. All subjects underwent a 1-month washout. A single session of SLT was performed to 360° of the trabecular meshwork. Medication was resumed at 1 month to achieve a targeted 30% intraocular pressure (IOP) reduction from the post-washout/pre-SLT IOP. IOP was measured every 3 months and medication use was recorded at 3, 6, 12, and 24 months. Subjects with a secondary SLT or cataract extraction were excluded from IOP and medication analyses. At 24 months, 34 of the initial 45 right eyes were eligible for analyses. There were significant IOP reductions at all time intervals (except at 1 week) following SLT when compared to the prestudy (without medication) or pre-SLT (post-washout) IOP (P 20% from pre-SLT, without medication) was achieved in 11.1% (5/45). Reductions in IOP and medication use were evident at 2 years following SLT for the treatment of NTG whereas 11% remained medication free. Trial Registrations: The Clinical Trials Register of the University of Hong Kong HKCTR1847. The European Clinical Trials Database 2014-003305-15 (August 11, 2014).published_or_final_versio

Intraoperative fracture of phacoemulsification sleeve

Background: We describe a case of intraoperative fracture of phacoemulsification sleeve during phacoemulsification surgery. Case presentation. Phacoemulsification surgery was performed in the left eye of a 58-year-old lady with grade II nuclear sclerosis & grade I cortical cataract. Towards the end of quadrant removal, there was anterior chamber instability with impaired followability of nuclear fragments. The distal part of the fractured sleeve remained inside the anterior chamber upon removal of the phacoemulsification probe. The retained sleeve was retrieved with a pair of forceps through the corneal incision site, which did not require widening. There was no missing fragments retained intraocularly and the patient had an uneventful recovery with vision of 20/25 at three months post-operatively. Conclusion. Phacoemulsification sleeve fracture is an uncommon complication. With early identification of this condition and proper management, major complications can be avoided. © 2010 Shum et al; licensee BioMed Central Ltd.published_or_final_versio

Intraocular Pressure Elevation in the Contralateral Untreated Eye Following Selective Laser Trabeculoplasty in Rabbit Eyes

Our study aimed at evaluating if a single session of unilateral selective laser trabeculoplasty would affect the intraocular pressure of the fellow untreated eye in rabbits. Eleven rabbits were involved. 360° selective laser trabeculoplasty with 532 nm frequency-doubled green Nd:YAG laser was performed over the right eyes. The mean intraocular pressure of both eyes at baseline, 3 hours, 24 hours, 3 days and 7 days after laser were measured. The baseline mean intraocular pressure of the right eye and the left eye were 8.07 ± 1.72 mmHg and 8.27 ± 1.56 mmHg respectively (p=0.78). The mean intraocular pressure of the treated eye was lower than the baseline from 3 hours through 3 days after laser, with a maximum mean decrease of 1.36 mmHg on Day 3. On the contrary, the mean intraocular pressures of the untreated eyes were higher than the baseline throughout the study, particularly at later course (1.91 mmHg on Day 3 and 1.85 mmHg on Day 7). This suggests the change of intraocular pressure in one eye after selective laser trabeculoplasty, leads to a change in the pressure of the fellow eye. It is thought that a neuronal and humoral response is triggered centrally after unilateral intraocular pressure change. The detailed mechanisms would require further studies to evaluate. The rising intraocular pressure trend in the contralateral untreated eye suggests that response may continue to exert its action for some time after the initial laser. This is the first reported study of intraocular pressure elevation of the untreated eye following contralateral selective laser trabeculoplasty.published_or_final_versio

Randomized Crossover Study Showing Nurse-Led Same Day Review Replacing Next Day Review in Uneventful Phacoemulsification to Be Safe and Efficacious

Purpose . To study whether nurse led same-day review (SDR) after uneventful phacoemulsification can replace next-day review (NDR) in terms of safety and efficacy. Setting . Patients are recruited from an ophthalmology outpatient clinic in Hong Kong. Design . A prospective, randomized crossover study conducted from November 2012 to 2014. Methods . Inclusion criteria include cataract surgery naïve patients undergoing phacoemulsification under local anaesthesia. All patients were seen by our ophthalmic nurse 2 hours after surgery. Before undergoing phacoemulsification of the first eye, patients were randomized to be reviewed on day 1 or 7 after surgery. Surgeons and reviewing doctors were blinded to patient allocation. For the patients’ second eye surgery, group allocation will cross over. Primary outcome measures include visual improvement and patient satisfaction questionnaire. Other measures include cataract characteristics, surgical details, and complications. Statistical tests include paired t -test, Wilcoxon signed rank test, and Chi-square test. Results . 164 eyes from 82 patients were available. Visual improvement, satisfaction, and complications were comparable between both groups. Conclusions . A nurse led SDR can replace NDR in uneventful phacoemulsification in terms of safety and efficacy. Patient satisfaction is also comparable in the setting of Asian culture and when transportation is not a major concern.published_or_final_versio

Consensual ophthalmotonic reaction in Chinese patients following augmented trabeculectomy or ExPRESS shunt implantation

INTRODUCTION: Consensual ophthalmotonic reaction (COR) was first described in 1924. Studies following monocular application of glaucoma drops and laser trabeculoplasty showed a drop in fellow eye intraocular pressure (IOP). However, studies following monocular surgery showed heterogeneous results. The purpose of this study was to investigate the COR in Chinese patients who have received monocular filtration surgery. METHODS: A noncomparative retrospective study of 65 eyes undergoing filtration surgery in Queen Mary Hospital was conducted. The IOP was obtained at baseline and postoperative days 1, 3, 7 and 14. Patient's age, sex, type of glaucoma and surgery, preoperative medications, postoperative bleb status, and number of interventions were tabulated. The postoperative IOP measurements over both eyes were obtained, and the readings were averaged to decrease the chances of extreme readings being a one-off event and allow for regression to the mean bias. RESULTS: COR was observed in the unoperated fellow eye. The mean preoperative IOP and averaged postoperative IOP were 17.2 +/- 5.2 mm Hg and 20.1 +/- 8.9 mm Hg, respectively (P 30% from baseline, while none showed IOP drop >30% from baseline. DISCUSSION: Following monocular penetrating filtration surgery, our Chinese population demonstrated a significant fellow eye IOP increase in the early postoperative period. We should bear in mind the influence of COR and take care to measure the fellow eye IOP following monocular surgery.published_or_final_versio

Suprachoroidal Hemorrhage with Delayed Rebleeding as the First Presentation of Bullous Pemphigoid Associated Acquired Hemophilia

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Development and pilot-testing of patient decision aid for use among Chinese patients with primary open-angle glaucoma

Background: A patient decision aid (PDA) is a tool for shared decision making (SDM), which emphasises patient empowerment. It is useful in chronic diseases and when there are multiple, no best single treatment option. Although SDM is prevalent in Western countries, its use is limited in Chinese societies, where the adoption of a paternalistic approach is strong. Here, we report the development, acceptance and pilot test results of a PDA targeted at Chinese patients with primary open-angle glaucoma (POAG). Methods: We developed a PDA designed for use in Chinese patients with POAG. Recruited subjects were given our PDA. Baseline evaluation included decision conflict scale (DCS), validated glaucoma adherence questionnaires and glaucoma knowledge questionnaire. Subjects were briefed through the PDA and instructed to read it that day. Three to four weeks later, follow-up questionnaire as described above were conducted with the addition of acceptance questionnaires. Results: Data from 65 subjects were available. The PDA was well received among subjects. DCS improved from 48.9±20.4 at baseline to 34.3±20.3 during follow-up, with P<0.01. Validated medication adherence questionnaires and knowledge showed improvement from baseline, which was statistically significant. Conclusions: The use of PDA among Chinese subjects with POAG demonstrated positive reception and acceptance. Evaluation of its initial effects shows improvement in DCS, medication adherence and glaucoma knowledge. The implementation of SDM and PDA among Chinese subjects with POAG is encouraged. Future studies with randomised design and later evaluation time points can further reveal the impacts of PDA among Chinese subjects with POAG.published_or_final_versio

Visual Field Compromised In Patients Suffering From Severe Menorrhagia

Purpose: To evaluate menorrhagia as a risk factor for compromised visual field Design: A cross-sectional cohort study Participants: 25 Menorrhagic patients and 23 non-menorrhagic female subjects Methods: Patients were recruited from the Obstetrics and Gynaecology clinic and divided into two groups. Those suffering from active menorrhagia were allocated into the disease group while those had never suffered from menorrhagia constituted the control group. All subjects completed a pictorial blood assessment chart (PBAC) to quantify the severity of their menorrhagia. All subjects then underwent an eye examination and investigations including visual field and optical coherent tomography. Main Outcome Measures: The mean PBAC was compared between the disease group and the control group. Correlation analysis was tested between PBAC and visual field global indices. Results: Subjects suffering from menorrhagia have a compromised performance in visual field when compared with subjects with no menorrhagia. A positive association was observed between the severity of menorrhagia and a poorer visual field performance. Conclusions: Menorrhagia may be a risk factor for visual field defects. Further research is encouraged to evaluate whether it may be a risk factor for glaucoma development or progression.published_or_final_versio

Consensual ophthalmotonic reaction

Conference Theme: Myopia and Oculoplasti