Combined phacoemulsification and trabeculectomy is able to achieve greater reduction in intraocular pressure (IOP), higher rates of complete surgical success and fewer postoperative manipulations and ...visits compared with combined phacoemulsification and Xen implantation in glaucomatous eyes.
Our study aims to compare and understand the differences between the efficacy and safety of XEN45 implantation and trabeculectomy in Asian eyes with glaucoma.
This was a retrospective, single-center, comparative study of consecutive patients who underwent combined phacoemulsification and trabeculectomy (Phaco-Trab) from January 2013 to June 2014 and combined phacoemulsification and XEN45 implantation (Phaco-Xen) from May 2017 to September 2018 in a tertiary Ophthalmology center in Singapore. Outcome measures included IOP, number of anti-glaucoma eyedrops, success rate, factors leading to success/failure, number of postoperative interventions and visits required, and surgical complications.
A total of 137 eyes (91 Phaco-Trab, 46 Phaco-Xen) were included. Phaco-Trab group had greater mean IOP reduction at all time points beyond postoperative month (POM) 1 (mean difference 2.9 to 3.8 mm Hg; P<0.05), and greater reduction in mean number of antiglaucoma eyedrops beyond POM3, thought this was not statistically significant. At POM12, complete success was achieved in 83.5% in Phaco-Trab and 52.2% of Phaco-Xen group, respectively (P<0.001). There was no significant factor associated with surgical failure, other than the difference in surgical procedure. Phaco-Trab group required fewer number of postoperative interventions (P=0.009), with only a mean of 0.1 bleb interventions required per patient, versus 1.5 in Phaco-Xen group (P<0.001). Safety profiles in both groups were comparable, with no statistically significant difference in intraoperative/postoperative complications.
Phaco-Trab has significantly higher reduction in both IOP and number of antiglaucoma medications compared with Phaco-Xen group, with greater surgical success and fewer postoperative manipulations and visits. Safety profiles were comparable.
We aimed to determine the relationship between puberty and growth spurts with peak spherical equivalent (SE) or axial length (AL) velocity in Singapore schoolchildren.
In the Singapore Cohort Study ...of the Risk Factors for Myopia of 1779 schoolchildren, the longitudinal refractive and pubertal status of 892 boys and 887 girls from ages 6 to 14 years were assessed. The study sample included 1329 Chinese, 316 Malays, 114 Indians, and 20 children of other races. Information regarding puberty parameters, age of peak height velocity, age of menarche, and break of voice (BOV) was obtained. Peak velocity was defined as the greatest change in measurements over a period of 1 year. Tanner stage 1 for pubic hair or breast development, in boys and girls, respectively, at age 12 was categorized as "later puberty," whereas stages 2 to 5 corresponded to "earlier puberty." Refractive error was determined by cycloplegic autorefraction using the Canon RK-F5, and AL was measured using the A-scan biometry machine.
The children were examined annually, and the mean number of visits was 5.7 ± 1.3. Age of peak height velocity occurred earlier in girls than in boys (11.0 ± 1.2 vs. 12.0 ± 1.7 years, P < 0.001). Girls with earlier peak height velocity experienced peak AL velocity and peak SE velocity approximately half a year earlier than those with later puberty (mean age of 10.3 ± 1.6 vs. 10.8 ± 1.7 years, P < 0.001; and 10.0 ± 1.5 vs. 10.6 ± 1.25 years, P < 0.001, respectively). Similarly, boys who had earlier peak height velocity also achieved peak AL and peak SE velocity earlier than those who experienced later peak height velocity (mean age of 10.4 ± 1.6 vs. 11.1 ± 1.8 years, P < 0.001; and 10.1 ± 1.5 vs. 10.6 ± 1.7 years, P = 0.01). Both girls and boys who had early peak height velocity had earlier age of onset of myopia than those with later peak height velocity (9.7 ± 1.4 vs. 10.1 ± 1.5 years for girls, P = 0.04; and 9.9 ± 1.5 vs. 10.4 ± 1.6 years for boys, P = 0.03). Myopia progression, in terms of AL velocity, also occurred earlier in boys and girls with earlier peak height velocity (10.2 ± 1.5 vs. 11.0 ± 1.9 for boys, P < 0.001; and 10.2 ± 1.5 vs. 10.7 ± 1.7 for girls, P = 0.004, respectively). The associations were not significant when Tanner staging, age of menarche, or BOV was used to determine stage of puberty.
Boys and girls with earlier peak height velocity experienced earlier peak SE and AL velocity, and age of myopia onset. Thus, variations in the onset and peak progression of myopia may be associated with height spurts.
Objective:
To study the structural changes in the choroid of diabetic patients following cataract surgery, using choroidal vascularity index and choroidal thickness.
Methods:
A prospective ...case–control study was conducted in 18 diabetic and 18 non-diabetic patients undergoing cataract surgery (phacoemulsification) in one eye. Enhanced depth imaging optical coherence tomography images were obtained before and after surgery. Niblack’s image binarization of images was performed to derive the choroidal vascularity index. Independent sample T-test compared the differences of choroidal vascularity index and choroidal thickness between diabetic and non-diabetic patients.
Results:
The baseline choroidal vascularity index was significantly lower in diabetic patients for both operated (mean difference vs non-diabetic: 0.0184, 95% CI: 0.004–0.0324, p = 0.012) and non-operated (mean difference vs non-diabetic: 0.0145, 95% CI: 0.003–0.0256, p = 0.012) eyes. Choroidal thickness increased following cataract surgery (diabetes: mean difference = 12.4, 95% CI: 0.70–24.0, adjusted p = 0.036; non-diabetic: mean difference = 21.0, 95% CI: 4.39–37.6, adjusted p = 0.011).
Conclusion:
Diabetic patients have reduced choroidal vascularity index than non-diabetic patients, suggestive of possible reduction in choroidal vascularity in diabetes. Choroidal thickness increased following cataract surgery in both diabetic and non-diabetic patients.
Background Glaucoma is the leading cause of irreversible blindness. Normal tension glaucoma (NTG) is a subset of open-angle glaucoma, demonstrating glaucomatous optic nerve damage in the absence of ...raised intraocular pressure (IOP). NTG is more prevalent in Asian populations. While generally slow-progressing, NTG may be associated with significant central visual field loss. In recent years, minimally invasive glaucoma surgery has been added to the armamentarium of glaucoma surgery. This prospective study aims to evaluate 12-month surgical outcomes of combined iStent inject (Glaukos Corporation, Laguna Hills, CA) implantation and phacoemulsification in Asian eyes with NTG. Methods This is a prospective, single-centre case series of 30 eyes followed up until 12 months after surgery. Outcome measures included IOP, number of glaucoma medications, best-corrected visual acuity (BCVA) and intra and postoperative complications. Results Mean age of subjects was 73.1 + or - 6.3 years. Majority were ethnic Chinese (n = 27, 90%). Baseline medicated mean IOP was 13.8 + or - 2.4 mmHg and mean number of glaucoma medications was 1.3 + or - 0.7. Mean Humphrey visual field mean deviation was - 13.7 + or - 7.6. The mean IOP reduction at all timepoints from postoperative month (POM) 3 onwards was statistically significant (all P < 0.05), with mean reduction of 1.2 mmHg (95% CI: 0.1-2.2, P = 0.037) by POM12. There was statistically significant reduction in mean number of medications from postoperative day (POD) 1 onwards (all P < 0.05), with mean decrease of 1.0 medication (95% CI: 0.9-1.1, P < 0.001) by POM12. By POM12, 25 (83.3%) eyes were medication-free. Three (10%) eyes had stent occlusion by iris requiring laser iridoplasty. One eye had gross hyphema which resolved on conservative management before POM1. Mean BCVA improved from the baseline 0.3 + or - 0.3 logMAR to 0.1 + or - 0.1 logMAR postoperatively (P < 0.001). There were no major adverse or sight-threatening events. No eyes required further glaucoma surgery during the 12-month follow-up period. Conclusion Asian eyes with NTG which underwent combined iStent inject implantation and phacoemulsification demonstrated a significant and sustained reduction in IOP and glaucoma medications, up to 12 months postoperatively. Keywords: iStent inject, Normal tension glaucoma, Minimally invasive glaucoma surgery, Asian
Community Eye Clinics (CEC) increase accessibility of specialist ophthalmic services in the community, reducing demand for tertiary eye services. This paper aims to evaluate the impact of CEC on ...first-visit referrals from Hougang Polyclinic (HOU) to Tan Tock Seng Hospital Ophthalmology Specialist Outpatient Clinic (SOC).PURPOSECommunity Eye Clinics (CEC) increase accessibility of specialist ophthalmic services in the community, reducing demand for tertiary eye services. This paper aims to evaluate the impact of CEC on first-visit referrals from Hougang Polyclinic (HOU) to Tan Tock Seng Hospital Ophthalmology Specialist Outpatient Clinic (SOC).A retrospective analysis was performed on first-visit referrals from Hougang Polyclinic (HOU) to Tan Tock Seng Hospital Ophthalmology Specialist Outpatient Clinic (SOC) over a similar 3-months period before and after the introduction of CEC in August 2018 (1 January to 31 March in 2018 and 2019, respectively). Data pertaining to patients' presenting complaints, referral reasons, final diagnoses, follow-up plans, and need for ophthalmic intervention were obtained.METHODSA retrospective analysis was performed on first-visit referrals from Hougang Polyclinic (HOU) to Tan Tock Seng Hospital Ophthalmology Specialist Outpatient Clinic (SOC) over a similar 3-months period before and after the introduction of CEC in August 2018 (1 January to 31 March in 2018 and 2019, respectively). Data pertaining to patients' presenting complaints, referral reasons, final diagnoses, follow-up plans, and need for ophthalmic intervention were obtained.We included 978 patients in our study. There was a 27.5% reduction in the number of first-visit referrals seen at SOC after the establishment of CEC. Patients were more likely to be referred on to sub-specialty eye clinics (10.8% vs. 12.9%, p= p = .304) and receive more ophthalmic interventions (15% vs. 16.3%, p = .066) than prior to CEC.RESULTSWe included 978 patients in our study. There was a 27.5% reduction in the number of first-visit referrals seen at SOC after the establishment of CEC. Patients were more likely to be referred on to sub-specialty eye clinics (10.8% vs. 12.9%, p= p = .304) and receive more ophthalmic interventions (15% vs. 16.3%, p = .066) than prior to CEC.The CEC provides greater accessibility to eye care within the community. Optometrists are upskilled to manage patients with stable eye conditions, whilst eye specialists can provide timely care to the SOC for patients with more severe eye conditions.CONCLUSIONThe CEC provides greater accessibility to eye care within the community. Optometrists are upskilled to manage patients with stable eye conditions, whilst eye specialists can provide timely care to the SOC for patients with more severe eye conditions.
The XEN45 Gel Stent is a subconjunctival filtering device that has demonstrated promising efficacy. This meta-analysis quantitatively evaluates reported complications and interventions after XEN45 ...implantation in the treatment of open angle glaucoma (OAG).
Pilot, cohort, observational studies, and randomised controlled trials that included at least ten patients undergoing ab interno or externo XEN45 surgery, with or without phacoemulsification were deemed eligible for inclusion. A meta-analysis of proportions with random-effect models was performed using the meta routine in R version 3.2.1. Outcomes included the rate of complications and post-operative interventions.
One hundred and fifty-two studies were identified on initial literature search and 33 were included in final analysis. Numerical hypotony was the most common post-operative complication, involving 20% of patients (95% CI: 10-31%). Post-operative gross hyphema occurred in 14% (95% CI: 7-22%) and transient intra-ocular pressure (IOP) spikes (>30 mmHg) in 13% (95% CI: 4-27%). Stent exposure occurred in 1% (95% CI: 0-2%). Stent migration occurred in 1% (95% CI: 0-3%). XEN45 revision and/or a second XEN45 implantation was performed in 5% of patients (95% CI: 3-7%). Stent relocation was performed in 3% (95% CI: 1-7%). A second glaucoma procedure was performed in 11% (95% CI: 8-15%). 26% underwent one (95% CI: 17-36%), 13% underwent two (95% CI: 5-24%) while 4% underwent three (95% CI: 2-6%) bleb needling procedures. 35% of patients (95% CI: 29-40%) required at least one needling. The average rate of needling per patient was 0.38 (95% CI: 0.20-0.59). However, there is a lack of high-quality data, with 8 of the 33 studies assessed to have a moderate to high risk of bias.
While literature suggests that XEN45 Gel Stent implantation is safe in the treatment of OAG, the overall current level of evidence is low and further studies are needed. More than a third of patients require at least one post-operative bleb needling procedure.
Introduction
In recent years there has been a spurt of peer-reviewed publications on the ophthalmic complications of dengue fever. The authors aim to review the ocular manifestations, utility of ...relevant diagnostic tests, management, prognosis, and sequelae of dengue-related ocular complications.
Methods
A comprehensive literature search was conducted on Medline, PubMed, and Google Scholar databases. Only articles published or translated into the English language were considered, and key data from the full article of each paper was extracted and evaluated.
Results
The authors’ search yielded 29 articles. A total of 686 patients with a mean age of 33.4 years (range 14–73 years) were included. Blurring of vision was the most common presenting symptom followed by scotoma. Ocular findings were mostly seen in the posterior pole of the fundus, manifesting as retinal hemorrhages, macular edema, foveolitis, vasculitis, and optic neuropathy. Most patients with dengue-related ophthalmic complications recover spontaneously without any treatment. Patients with severe visual loss or bilateral involvement were treated with systemic steroids and occasionally immunoglobulins. Prognosis of dengue-related ophthalmic complications is favorable; almost all patients had normal or showed improvement in visual acuity and complete resolution of dengue ophthalmic complications was noted in almost all cases.
Conclusion
The pathological process of dengue ophthalmic complications is complex and clinical manifestations varied. Ophthalmic complications are usually seen in young adults who often present at the nadir of thrombocytopenia. Despite good recovery of vision and resolution of clinical signs in most patients, ophthalmologists and physicians should be aware and vigilant as isolated reports of cases of dengue ophthalmic complications with poor visual acuity refractory to treatment have been reported.
A 70-year-old Indian lady had a history of bilateral laser peripheral iridotomy (LPI) for primary angle closure. Subsequently she developed cataract in both the eyes. Right eye cataract surgery was ...complicated by an anterior capsule rupture, which was discovered intra-operatively at the site of the LPI. Trypan blue was used to stain the anterior capsule to delineate the anterior capsule defect. An attempt at continuous curvilinear capsulorhexis was unsuccessful, and the anterior capsulotomy was completed with scissors. To the best of our knowledge the surgical management of cataract in the presence of anterior capsule rupture as a result of LPI has not been reported. Awareness of this potential complication of LPI will aid in planning for successful phacoemulsification cataract surgery.
This study aims to compare the efficacy and safety of combined phacoemulsification with iStent inject (Phaco-iStent) and Hydrus microstent (Phaco-Hydrus).
This was a retrospective comparative study ...of patients who underwent Phaco-iStent from April 2019 to August 2020 and Phaco-Hydrus from August 2019 to December 2020 at a tertiary eye centre in Singapore. Sixty-nine Phaco-iStent eyes and 49 Phaco-Hydrus eyes were included in this study. Complete surgical success was defined as freedom from second glaucoma surgery, Intraocular pressure (IOP) of 18 mmHg or less, and discontinuation of all antiglaucoma medications.
At 12 months, both Phaco-iStent and Phaco-Hydrus groups had comparable surgical success rate (68.1% vs 51%,
=0.061), reduction in antiglaucoma medication use (-1.3 ± 0.1 vs -1.4 ± 0.10,
=0.880) and intraocular pressure reduction (-1.1 ± 0.5 mmHg vs -1.6 ± 0.9 mmHg,
=0.323). Overall intraoperative and postoperative complications rate were similar in both groups, though hyphema was more commonly seen in early postoperative period in the Phaco-Hydrus compared to the Phaco-iStent group (8% vs 0%,
=0.028), with majority of cases resolving without any need for surgical intervention. Device obstruction was also more common in the Phaco-Hydrus group compared to the Phaco-iStent group (14% vs 4.3%,
=0.04).
Phaco-iStent and Phaco-Hydrus have similar surgical efficacy and safety profiles at 12 months.
To develop and validate a deep learning system (DLS) for estimation of vertical cup-to-disc ratio (vCDR) in ultra-widefield (UWF) and smartphone-based fundus images.
A DLS consisting of two ...sequential convolutional neural networks (CNNs) to delineate optic disc (OD) and optic cup (OC) boundaries was developed using 800 standard fundus images from the public REFUGE data set. The CNNs were tested on 400 test images from the REFUGE data set and 296 UWF and 300 smartphone-based images from a teleophthalmology clinic. vCDRs derived from the delineated OD/OC boundaries were compared with optometrists' annotations using mean absolute error (MAE). Subgroup analysis was conducted to study the impact of peripapillary atrophy (PPA), and correlation study was performed to investigate potential correlations between sectoral CDR (sCDR) and retinal nerve fiber layer (RNFL) thickness.
The system achieved MAEs of 0.040 (95% CI, 0.037-0.043) in the REFUGE test images, 0.068 (95% CI, 0.061-0.075) in the UWF images, and 0.084 (95% CI, 0.075-0.092) in the smartphone-based images. There was no statistical significance in differences between PPA and non-PPA images. Weak correlation (r = -0.4046, P < 0.05) between sCDR and RNFL thickness was found only in the superior sector.
We developed a deep learning system that estimates vCDR from standard, UWF, and smartphone-based images. We also described anatomic peripapillary adversarial lesion and its potential impact on OD/OC delineation.
Artificial intelligence can estimate vCDR from different types of fundus images and may be used as a general and interpretable screening tool to improve community reach for diagnosis and management of glaucoma.
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