Brief Communication Ophthalmic plastic and orbital surgery in Taiwan

Abstract We describe in this paper the current status of ophthalmic plastic and orbital surgery in Taiwan. Data were collected from the Bureau of National Health Insurance of Taiwan, the Bulletin of the Taiwan Ophthalmic Plastic and Reconstructive Society, and the Statistics Yearbook of Practicing Physicians and Health Care Organizations in Taiwan by the Taiwan Medical Association. We ascertained that 94 ophthalmologists were oculoplastic surgeons and accounted for 5.8% of 1621 ophthalmologists in Taiwan. They had their fellowship training abroad (most ophthalmologists trained in the United States of America) or in Taiwan. All ophthalmologists were well trained and capable of performing major oculoplastic surgeries. The payment rates by our National Health Insurance for oculoplastic and orbital surgeries are relatively low, compared to Medicare payments in the United States. Ophthalmologists should promote the concept that oculoplastic surgeons specialize in periorbital plastic and aesthetic surgeries. However, general ophthalmologists should receive more educational courses on oculoplastic and cosmetic surgery

Extended Silicone Oil Tamponade in Primary Vitrectomy for Complex Retinal Detachment in Proliferative Diabetic Retinopathy: A Long-Term Follow-up Study

PURPOSE. To investigate long-term anatomic and functional results of extended silicone oil (SO) tamponade in primary vitrectomy for patients with proliferative diabetic retinopathy (PDR) and complex retinal detachment (RD). METHODS. From January 1999 to June 2005, clinical records of consecutive patients with PDR who underwent primary vitrectomy with extended SO tamponade for complex RD were retrospectively reviewed. Main outcome measures included anatomic outcome, functional outcome, and postoperative complications. Statistical analyses were used to determine factors affecting anatomic and functional outcomes and to evaluate the potential adverse effects on vision from long- term oil tamponade. RESULTS . Fifty-four eyes of 45 patients (18 male and 27 female) were included in this series. All patients underwent follow-up >= 12 months (28.2+/-15.1 months; range: 12 to 69 months). Anatomic success was achieved in 85.2% at the third month postoperatively and 83. 3% at last follow-up. Breaks with adjacent unreleased traction was identified as the only variable associated with final anatomic success (OR=0.173, p=0.024). Best-corrected visual acuity (BCVA) improved or remained unchanged in 89% at the third month postoperatively and in 78% at last follow -up. Ambulatory vision was achieved in 41% at the third month postoperative and 44% at last follow- up. Preoperative BCVA was identified as the only variable statistically associated with final BCVA (p<0.001) (multivariate analysis) . The change of BCVA from the third month to last follow-up has no correlation with follow-up duration in the 45 eyes with final anatomic success (Pearson correlation coefficient = -0.022, p=0.888). Postoperative complications included peri-silicone oil proliferation in 4 eyes, neovascular glaucoma in 4 eyes, oil migration into anterior chamber in 9 eyes, and pupillary- block induced IOP elevation in 5 eyes. CONCLUSIONS. Prolonged SO tamponade may provide anatomic success and functional stability after primary diabetic vitrectomy. Significant complications compromising visual prognosis were uncommon with prolonged SO tamponade

Full-Thickness Central Corneal Grafts in Lamellar Keratoscleroplasty to Treat Limbal Dermoids

Purpose To assess the surgical outcomes in patients who underwent lamellar keratoscleroplasty with full-thickness central corneal grafts for limbal dermoids. Design Retrospective, noncomparative, analysis of a consecutive case series with chart review. Participants Ten patients (6 male, 4 female; mean age, 12.3±5.0 years; range, 5.7–22.4 years) with 10 limbal dermoids in 10 eyes undergoing lamellar keratoscleroplasty with full-thickness central corneal grafts between 1992 and 2003 at National Taiwan University Hospital were studied. Methods The medical records and external eye photographs were reviewed. Main Outcome Measures Best- corrected visual acuity (BCVA), corneal astigmatism and topography, cosmetic outcomes, and surgical complications were measured as outcome indicators. For analysis of the surgical effect on corneal astigmatism, the 9 patients with topographic data available were divided into 2 groups according to their preoperative corneal astigmatism (group 1, ≥6 diopters [D]; group 2, <6 D). Results The mean earliest recorded BCVA and the latest postoperative BCVA were 6/30 and 6/10, respectively, and the improvement of BCVA after operation combined with amblyopia treatment was 4.9±3.6 lines on a Snellen chart. Patients with preoperative astigmatism ≥6.0 D (9.7±1.0 D; n = 4) were found to have a marked decrease in astigmatism after surgery (astigmatism change, 5.2±1.7 D). Patients with preoperative astigmatism <6.0 D (3.4±0.2 D; n = 5) were found to have an insignificant increase in astigmatism after surgery (astigmatism change, 0 .0±0.6 D). After surgery, significant corneal opacity was found in 1 patient; mild bluish scleral hue was found in 3 patients. Surgical complications included prolonged reepithelialization, interface neovascularization, graft rejection, and steroid glaucoma. Conclusions Using full-thickness central corneal grafts in lamellar keratoscleroplasty for limbal dermoids achieved good cosmetic results with limited postoperative complications. Operation may markedly reduce corneal astigmatism in patients with high preoperative corneal astigmatism. Visual prognosis is good in patients undergoing surgery combined with adequate amblyopia treatment

Ophthalmic plastic and orbital surgery in Taiwan

We describe in this paper the current status of ophthalmic plastic and orbital surgery in Taiwan. Data were collected from the Bureau of National Health Insurance of Taiwan, the Bulletin of the Taiwan Ophthalmic Plastic and Reconstructive Society, and the Statistics Yearbook of Practicing Physicians and Health Care Organizations in Taiwan by the Taiwan Medical Association. We ascertained that 94 ophthalmologists were oculoplastic surgeons and accounted for 5.8% of 1621 ophthalmologists in Taiwan. They had their fellowship training abroad (most ophthalmologists trained in the United States of America) or in Taiwan. All ophthalmologists were well trained and capable of performing major oculoplastic surgeries. The payment rates by our National Health Insurance for oculoplastic and orbital surgeries are relatively low, compared to Medicare payments in the United States. Ophthalmologists should promote the concept that oculoplastic surgeons specialize in periorbital plastic and aesthetic surgeries. However, general ophthalmologists should receive more educational courses on oculoplastic and cosmetic surgery

Factors Influencing Intraocular Pressure Changes after Laser In Situ Keratomileusis with Flaps Created by Femtosecond Laser or Mechanical Microkeratome.

The aim of this study is to describe factors that influence the measured intraocular pressure (IOP) change and to develop a predictive model after myopic laser in situ keratomileusis (LASIK) with a femtosecond (FS) laser or a microkeratome (MK). We retrospectively reviewed preoperative, intraoperative, and 12-month postoperative medical records in 2485 eyes of 1309 patients who underwent LASIK with an FS laser or an MK for myopia and myopic astigmatism. Data were extracted, such as preoperative age, sex, IOP, manifest spherical equivalent (MSE), central corneal keratometry (CCK), central corneal thickness (CCT), and intended flap thickness and postoperative IOP (postIOP) at 1, 6 and 12 months. Linear mixed model (LMM) and multivariate linear regression (MLR) method were used for data analysis. In both models, the preoperative CCT and ablation depth had significant effects on predicting IOP changes in the FS and MK groups. The intended flap thickness was a significant predictor only in the FS laser group (P < .0001 in both models). In the FS group, LMM and MLR could respectively explain 47.00% and 18.91% of the variation of postoperative IOP underestimation (R2 = 0.47 and R(2) = 0.1891). In the MK group, LMM and MLR could explain 37.79% and 19.13% of the variation of IOP underestimation (R(2) = 0.3779 and 0.1913 respectively). The best-fit model for prediction of IOP changes was the LMM in LASIK with an FS laser

Glaucoma, Alzheimer's disease, and Parkinson's disease: an 8-year population-based follow-up study.

BACKGROUND:Glaucoma is the leading cause of irreversible blindness worldwide and primary open-angle glaucoma (POAG) is the most common type of glaucoma. An association between POAG and the subsequent risk of Alzheimer's disease (AD) and Parkinson's disease (PD) was unclear. OBJECTIVE:To investigate the association between POAG (including normal-tension glaucoma) and the subsequent risk of AD or PD 8 years following a diagnosis of POAG. METHODS:We performed a retrospective, propensity-score-matched analysis of a population-based cohort consisting of patients with and without POAG aged 60 years and older. Control patients without POAG were propensity-score matched to POAG patients based on their baseline characteristics. RESULTS:The incidence rates and confidence intervals (CIs) of AD among the patients with and without POAG were 2.85 (95% CI: 2.19-3.70) and 1.98 (95% CI: 1.68-2.31) per 1000 person-years, respectively. The incidence rates of PD among the POAG and non-POAG cohorts were 4.36 (95% CI: 3.52-5.39) and 4.37 (95% CI: 3.92-4.86) per 1000 person-years, respectively. Kaplan-Meier failure curves showed that the POAG patients had a higher risk of AD than the control patients did (log-rank test, P= .0189). However, the cumulative PD hazard ratios for the POAG and non-POAG patients did not differ significantly (log-rank test, P= .9953). CONCLUSION:In elderly patients, POAG is a significant predictor of AD, but POAG is not a predictor of PD