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Lee JWY, Liu CCL, Chan JCH, Lai JSM. Predictors of success in selective laser trabeculoplasty for normal tension glaucoma. Medicine (Baltimore) 2014; 93:e236. [PMID: 25526445 PMCID: PMC4603124 DOI: 10.1097/md.0000000000000236] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
To determine the predictors of success for selective laser trabeculoplasty (SLT) in normal tension glaucoma (NTG). This prospective cohort study recruited subjects with unilateral or bilateral NTG on medication. All subjects received a single session of 360° SLT treatment. SLT success was defined as IOP reduction≥20% at 1-month. The following covariates were analyzed via univariate and multivariate analyses: age; sex; lens status; presenting, pre-SLT, and post-SLT IOP's; number and type of medications; SLT shots and energy; and pre-SLT investigations. In 60 eyes of 32 subjects with NTG, there were 30 right eyes and 28 left eyes. The success rate of SLT was 61.7%. Using 3 types of anti-glaucoma medications (coefficient=-2.2, OR=0.1, P=0.02) and a thicker retinal nerve fiber layer thickness (coefficient=-0.04, OR=0.96, P=0.04) were associated with failure (univariate analysis). In multivariate analysis, a higher pre-SLT IOP (coefficient=1.1, OR=3.1, P=0.05) and a lower 1-week IOP (coefficient=-0.8, OR=0.5, P=0.04) were associated with success. SLT was successful in over 60% of treated NTG patients. A higher pre-SLT IOP and a greater IOP reduction at 1-week post-SLT were predictors of a successful outcome.
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Lee JWY, Wong RLM, Chan JCH, Wong IYH, Lai JSM. Differences in corneal parameters between normal tension glaucoma and primary open-angle glaucoma. Int Ophthalmol 2014; 35:67-72. [DOI: 10.1007/s10792-014-0020-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Accepted: 11/14/2014] [Indexed: 11/30/2022]
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Lee JWY, Chan CWS, Chan JCH, Li Q, Lai JSM. The association between clinical parameters and glaucoma-specific quality of life in Chinese primary open-angle glaucoma patients. Hong Kong Med J 2014; 20:274-8. [PMID: 24584567 DOI: 10.12809/hkmj134062] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE. To investigate the association between clinical measurements and glaucoma-specific quality of life in Chinese glaucoma patients. DESIGN. Cross-sectional study. SETTING. An academic hospital in Hong Kong. PATIENTS. A Chinese translation of the Glaucoma Quality of Life-15 questionnaire was completed by 51 consecutive patients with bilateral primary open-angle glaucoma. The binocular means of several clinical measurements were correlated with Glaucoma Quality of Life-15 findings using Pearson's correlation coefficient and linear regression. The measurements were the visual field index and pattern standard deviation from the Humphrey Field Analyzer, Snellen best-corrected visual acuity, presenting intra-ocular pressure, current intra-ocular pressure, average retinal nerve fibre layer thickness via optical coherence tomography, and the number of topical anti-glaucoma medications being used. RESULTS. In these patients, there was a significant correlation and linear relationship between a poorer Glaucoma Quality of Life-15 score and a lower visual field index (r=0.3, r(2)=0.1, P=0.01) and visual acuity (r=0.3, r(2)=0.1, P=0.03). A thinner retinal nerve fibre layer also correlated with a poorer Glaucoma Quality of Life-15 score, but did not attain statistical significance (r=0.3, P=0.07). There were no statistically significant correlations for the other clinical parameters with the Glaucoma Quality of Life-15 scores (all P values being >0.7). The three most problematic activities affecting quality of life were "adjusting to bright lights", "going from a light to a dark room or vice versa", and "seeing at night". CONCLUSION. For Chinese primary open-angle glaucoma patients, binocular visual field index and visual acuity correlated linearly with glaucoma-specific quality of life, and activities involving dark adaptation were the most problematic.
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Lai JSM. The Role of Goniosynechialysis in the Management of Chronic Angle-Closure Glaucoma. Asia Pac J Ophthalmol (Phila) 2013; 2:277-8. [PMID: 26107027 DOI: 10.1097/apo.0b013e3182a8146b] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Lee JWY, Wong BKT, Yick DWF, Wong IYH, Yuen CYF, Lai JSM. Primary acute angle closure: long-term clinical outcomes over a 10-year period in the Chinese population. Int Ophthalmol 2013; 34:165-9. [DOI: 10.1007/s10792-013-9806-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2012] [Accepted: 05/21/2013] [Indexed: 11/25/2022]
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Lee JWY, Lai JSM, Yick DWF, Yuen CYF. Prospective study on retinal nerve fibre layer changes after an acute episode of phacomorphic angle closure. Int Ophthalmol 2012; 32:577-82. [PMID: 22847248 PMCID: PMC3480582 DOI: 10.1007/s10792-012-9614-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2012] [Accepted: 07/16/2012] [Indexed: 02/07/2023]
Abstract
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 <5 days. Postoperatively, best correct Snellen visual acuity was 0.4 ± 0.2 and IOP at 9 months was 11.0 ± 3.1 mmHg. There was no difference in VCDR and RNFL between the attack and contralateral eye at 3 months post attack (both p = 0.4). At 9 months post attack, there was significant thinning in the average (p = 0.01), superior (p = 0.01), and inferior (p = 0.006) RNFL. There was no significant difference in the pattern standard deviation (PSD) between the two eyes on the Humphrey visual field nor was there any correlation between PSD severity and RNFL thinning (all p > 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.
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Lai JSM, Gangwani RA. Medication-induced acute angle closure attack. Hong Kong Med J 2012; 18:139-145. [PMID: 22477738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023] Open
Abstract
OBJECTIVE To review acute angle closure attacks induced by local and systemic medications. DATA SOURCES PubMed literature searches up to August 2011. STUDY SELECTION The following key words were used for the search: "drug", "iatrogenic", "acute angle closure glaucoma". DATA EXTRACTION A total of 86 articles were retrieved using the key words. Only those concerning acute angle closure attack triggered by local or systemic drug administration were included. For articles on the same or related topics, those published at later or more recent dates were selected. As a result, 44 articles were included and formed the basis of this review. DATA SYNTHESIS An acute attack of angle closure can be triggered by dilatation of the pupil, by anatomical changes in the ciliary body and iris, or by movement of the iris-lens diaphragm. Local and systemic medications that cause these changes have the potential to precipitate an attack of acute angle closure. The risk is higher in subjects who are predisposed to the development of angle closure. Many pharmaceutical agents including ophthalmic eyedrops and systemic drugs prescribed by general practitioners and various specialists (in psychiatry, otorhinolaryngology, ophthalmology, medicine, and anaesthesia) can precipitate an acute angle closure attack. The medications include: anti-histamines, anti-epileptics, antiparkinsonian agents, antispasmolytic drugs, mydriatic agents, sympathetic agents, and botulinum toxin. CONCLUSION Since acute angle closure attack is a potentially blinding eye disease, it is extremely important to be vigilant and aware of ophthalmic and systemic medications that can lead to such attacks in predisposed subjects and to diagnose the condition when it occurs.
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Lee JWY, Lai JSM, Lam RF, Wong BKT, Yick DWF, Tse RKK. Retrospective analysis of the risk factors for developing phacomorphic glaucoma. Indian J Ophthalmol 2011; 59:471-4. [PMID: 22011492 PMCID: PMC3214418 DOI: 10.4103/0301-4738.86316] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2010] [Accepted: 06/05/2011] [Indexed: 11/04/2022] Open
Abstract
AIM To determine the risk factors for developing phacomorphic glaucoma in eyes with mature cataracts. MATERIALS AND METHODS This is a case-control study comprising of 90 eyes with phacomorphic glaucoma and 90 age- and sex-matched control eyes with mature cataracts without phacomorphic glaucoma. Patients with pre-existing glaucoma, previous intraocular surgery and /or absence of documented axial lengths were excluded from this study. Binary logistic regression analysis of the variables, axial length and anterior chamber depth, was performed. Anterior chamber depth of the contralateral eye was used as a proxy measure of the pre-phacomorphic state in the eye with phacomorphic glaucoma as majority of them first presented to our center during the phacomorphic attack without prior measurements of the pre-phacomorphic ACD or lens thickness; therefore, their anterior chamber depth would not be representative of their pre-phacomorphic state. Axial length of 23.7 mm was selected as a cut-off for dichotomized logistic regression based on the local population mean from published demographic data. RESULTS The mean age was 73.1 ± 10.2 years. All phacomorphic and control eyes were ethnic Chinese. The mean presenting intraocular pressures were 49.5 ± 11.8 mmHg and 16.7 ± 1.7 mmHg in the phacomorphic and control eyes respectively (P< 0.0001), whilst the median Snellen best corrected visual acuity were light perception and hand movement in the phacomorphic and control eyes respectively. Eyes with phacomorphic glaucoma had shorter axial length of 23.1 ± 0.9 mm median when compared with that of control eyes, 23.7 ± 1.5 mm (P = 0.0006). Eyes with AL ≤ 23.7 mm were 4.3 times as likely to develop phacomorphic glaucoma when compared with AL > 23.7 mm (P = 0.003). CONCLUSION Axial length less than ≤ 23.7 mm was a risk factor for developing phacomorphic glaucoma. Eyes with AL shorter than the population mean were 4.3 times as likely to develop phacomorphic glaucoma compared with eyes with longer than average AL. In an area where phacomorphic glaucoma is prevalent and medical resources are limited, patients with AL shorter than their population mean may be considered for earlier elective cataract extraction as a preventive measure.
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Lau SYF, So KF, Lo ACY, Chan HHL, Lai JSM. A New Acute Attack of Angle Closure Glaucoma Animal Model with Healon 5. Iperception 2011. [PMCID: PMC5393824 DOI: 10.1068/ic298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Acute angle closure glaucoma (AACG) is an ocular emergency and sight -threatening disease in which the intraocular ocular pressure (IOP) rises suddenly due to blockage of aqueous humor outflow. It can cause permanent loss in visual acuity and visual field. In animal study, the well-established model to study AACG is by fluid infusion and by adjusting the bottle level, a high IOP can be induced in a few seconds. However, there is no blockage of aqueous outflow and the pressure rise is unrealistically fast. To mimic human AACG, we suggest to use Healon 5, an ophthalmic viscosurgical device, which is injected intracamerally to block the aqueous outflow. The IOP is allowed to build up naturally. We found that, with this technique, the IOP elevated at a rate of 0.57 mmHg/min before it hit 40 mmHg, which is considered as AACG in human. The maximum IOP registered was above 70 mmHg. Thinning of retinal nerve fiber layer (RNFL) and neural cells lost were seen. Visual function evaluated by ERG showed reduction in a-wave, b-wave, photopic negative response (PhNR) and oscillatory potentials (OPs) activities. In conclusion, Healon 5 is effective in inducing acute transient rise in IOP which mimics human AACG.
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Lee JWY, Lai JSM, Yick DWF, Tse RKK. Retrospective case series on the long-term visual and intraocular pressure outcomes of phacomorphic glaucoma. Eye (Lond) 2010; 24:1675-80. [DOI: 10.1038/eye.2010.108] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Tham CCY, Kwong YYY, Leung DYL, Lam SW, Li FCH, Chiu TYH, Chan JCH, Lam DSC, Lai JSM. Phacoemulsification vs phacotrabeculectomy in chronic angle-closure glaucoma with cataract: complications [corrected]. ACTA ACUST UNITED AC 2010; 128:303-11. [PMID: 20212200 DOI: 10.1001/archophthalmol.2010.12] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To compare the complications of phacoemulsification alone vs combined phacotrabeculectomy in chronic angle-closure glaucoma (CACG) with coexisting cataract. METHODS Patients with CACG with coexisting cataract recruited into 2 randomized controlled trials comparing phacoemulsification alone vs combined phacotrabeculectomy were pooled for analysis. The first trial recruited patients with medically controlled intraocular pressure, while the second trial recruited patients with medically uncontrolled intraocular pressure. The 2 trials had otherwise identical study designs. All patients were reviewed every 3 months for 2 years after surgery. The main outcome measure was the surgical complications of phacoemulsification alone vs combined phacotrabeculectomy in CACG eyes with cataract. RESULTS One hundred twenty-three CACG eyes with cataract from 123 patients were included. Sixty-two CACG eyes were randomized to receive phacoemulsification alone, and 61 eyes had combined phacotrabeculectomy. In the phacoemulsification group, 5 of the 62 CACG eyes (8.1%) had a total of 5 surgical complications. In the combined phacotrabeculectomy group, 16 of the 61 CACG eyes (26.2%) had a total of 19 surgical complications. The difference in the proportion of eyes with 1 or more surgical complications between the 2 treatment groups was statistically significant (P = .007, Pearson chi(2) test). There was no statistically significant difference in final visual acuity or glaucomatous progression during the 24-month follow-up. CONCLUSIONS Combined phacotrabeculectomy resulted in significantly more surgical complications than phacoemulsification alone in CACG eyes with coexisting cataract. There was no difference in visual acuity or disease progression between the 2 treatment groups.
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Yeung JCC, Chung CF, Lai JSM. Orbital myiasis complicating squamous cell carcinoma of eyelid. Hong Kong Med J 2010; 16:63-65. [PMID: 20124577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023] Open
Abstract
Myiasis is infestation of the body by fly maggots. Immobile patients with skin wounds in exposed areas are at high risk of developing myiasis. We report a case of orbital myiasis from the species Chrysomya bezziana complicating squamous cell carcinoma of the eyelid. Magnetic resonance imaging of the orbit is useful for delineating the extent of the infestation and identifying residual maggots. In extensive orbital myiasis, exenteration is needed to prevent intracranial extension of tissue destruction.
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Chung CF, Lai JSM. Enophthalmos caused by an orbital venous malformation. Hong Kong Med J 2009; 15:299-300. [PMID: 19652241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023] Open
Abstract
Orbital vascular malformations usually present with proptosis. We report a case where a patient with an orbital venous malformation presented with enophthalmos. Since many underlying orbital pathologies, including orbital metastases, can cause enophthalmos, it is important to investigate patients properly. Computed tomographic imaging of the orbit remains the most useful tool in the management of patients with enophthalmos.
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Abstract
Angle closure glaucoma remains a major challenge for ophthalmologists. The three main challenges in the treatment of angle closure glaucoma are, firstly, to achieve rapid reduction of intraocular pressure in acute angle closure glaucoma, secondly, to prevent progression to chronic angle closure glaucoma, and thirdly, to manage established chronic angle closure glaucoma. Incisional surgery for angle closure glaucoma is typically required when laser surgery and/or medical therapy fail to control the intraocular pressure or control progressive synechial closure. The role for surgical iridectomy and emergency trabeculectomy in the modern management of acute angle closure glaucoma is diminishing. Trabeculectomy, goniosynechialysis, cyclodestructive procedures, and glaucoma implant are effective surgical options for chronic angle closure glaucoma, but none of them have been shown to be more effective than the others with proper comparative clinical trials. Trabeculectomy and goniosynechialysis are often combined with cataract extraction, which appears to offer additional pressure-control benefits to patients with chronic angle closure glaucoma.
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Pong JCF, Tang WWT, Lai JSM. Toxic endothelial cell destruction syndrome after intraocular lens repositioning with intracameral epinephrine. J Cataract Refract Surg 2008; 34:1990-1. [PMID: 19006750 DOI: 10.1016/j.jcrs.2008.05.059] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2008] [Accepted: 05/19/2008] [Indexed: 11/29/2022]
Abstract
A 66-year-old Chinese man developed corneal endothelial decompensation after intraocular lens (IOL) repositioning using intracameral epinephrine was performed. The presentation was compatible with toxic endothelial cell destruction syndrome, which is caused by prolonged, direct exposure of the corneal endothelium to relatively high concentrations of intracameral epinephrine. Despite its effective and immediate mydriatic effect, intracameral epinephrine is not recommended for intraoperative mydriasis in procedures such as IOL repositioning or secondary IOL implantation in which minimal irrigating solution is used.
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Pong JCF, Tang EWH, Chan JCH, Lai JSM, Au W. Corneal thickness. Ophthalmology 2008; 115:2315-6; author reply 2316-2316.e1. [PMID: 19041483 DOI: 10.1016/j.ophtha.2008.08.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2008] [Accepted: 08/07/2008] [Indexed: 11/30/2022] Open
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Li KKW, Yuen HKL, Lai JSM, Wong D. Does the internal limiting membrane regenerate? Clin Exp Ophthalmol 2008; 36:579-80. [PMID: 18954322 DOI: 10.1111/j.1442-9071.2008.01833.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Tham CCY, Lai JSM, Kwong YYY, Lam SW, Chan JCH, Chiu TYH, Lam DSC. Correlation of previous acute angle-closure attack with extent of synechial angle closure in chronic primary angle-closure glaucoma patients. Eye (Lond) 2008; 23:920-3. [PMID: 18425065 DOI: 10.1038/eye.2008.108] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
AIM To document any correlation between previous acute angle-closure attack and the extent of synechial angle closure in chronic primary angle-closure glaucoma (PACG) patients. METHODS Consecutive cases of chronic PACG with patent peripheral iridotomy had gonioscopy performed. The extents of synechial angle closure of those chronic PACG eyes with previous documented acute angle-closure attack were compared to those eyes without such a history. RESULTS A total of 102 chronic PACG eyes of 102 patients were recruited. Twenty-seven eyes (26.5%) had a previous documented acute angle closure, while 75 eyes (73.5%) did not. The mean extent of synechial angle closure +/-1 SD was 307+/-68 degrees (range, 150-360 degrees) in those chronic PACG eyes with a history of previous acute angle closure, compared to 266+/-89 degrees (range, 90-360 degrees) in those chronic PACG eyes without such a history (P=0.03, Student's t-test). There were no statistically significant differences between the two groups in age, LogMAR visual acuity, intraocular pressure (IOP), number of glaucoma eye drops, vertical cup-to-disk ratio, mean deviation or pattern SD in Humphrey automated perimetry, and anterior chamber depth (P>0.05). CONCLUSION Previous acute angle-closure attack correlated with more extensive synechial angle closure in chronic PACG patients in this study.
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Yeung JCC, Lai JSM. Reversible tetracycline staining of adult dentition in the treatment of chronic blepharitis. Eye (Lond) 2007; 21:1440-1. [PMID: 17704757 DOI: 10.1038/sj.eye.6702957] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Li KKW, Tang EWH, Lai JSM, Wong D. Pseudomonas aeruginosa choroidal abscess in a patient with bronchiectasis. Int Ophthalmol 2007; 28:287-90. [PMID: 17687520 DOI: 10.1007/s10792-007-9126-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2006] [Accepted: 06/28/2007] [Indexed: 10/23/2022]
Abstract
PURPOSE To report a case of Pseudomonas aeruginosa endophthalmitis with choroidal abscess formation in a patient with bronchiectasis. METHODS Case report. RESULTS A 75-year-old gentleman with bronchiectasis and P. aeruginosa pneumonia developed painless loss of right eye vision. The patient had previously undergone bronchoscopy to exclude pulmonary neoplasm. Slit-lamp examination revealed intense anterior chamber inflammation with hypopyon and B-scan ophthalmic ultrasound showed a choroidal mass consistent with choroidal abscess. Systemic and topical antibiotics did not prevent further progression of the infection. Patient declined pars plana vitrectomy and opted for enucleation. Polymerase-chain-reaction-based restriction fragment-length polymorphism (PCR-RFLP) of the enucleated eye confirmed P. aeruginosa to be the causative organism. CONCLUSION P. aeruginosa cannot be completely eradicated by systemic antibiotics, and bronchial colonization of P. aeruginosa can remain a potential source for metastatic infection. P. aeruginosa choroidal abscess, previously reported only in patients with cystic fibrosis, can also occur in bronchiectasis. Physicians should therefore have a high index of suspicion of endogenous endophthalmitis and treat aggressively, especially in patients with subretinal invasion and abscess formation.
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Lam DSC, Tham CCY, Lai JSM, Leung DYL. Current approaches to the management of acute primary angle closure. Curr Opin Ophthalmol 2007; 18:146-51. [PMID: 17301617 DOI: 10.1097/icu.0b013e32808374c9] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Recent advances in the management of acute primary angle closure include argon laser peripheral iridoplasty, immediate anterior chamber paracentesis, and cataract or lens extraction by phacoemulsification. This review summarizes current thoughts on the role of these treatment modalities. RECENT FINDINGS Argon laser peripheral iridoplasty has been shown to be superior to treatments using combined topical and systemic medications in controlling intraocular pressure in acute primary angle closure. Immediate paracentesis has been shown to be very effective for aborting the condition. This is a good alternative for suitable cases and especially in settings in which laser equipment is not readily available. Cataract or lens extraction by phacoemulsification appears to be promising in preventing progression to chronic angle closure glaucoma after acute primary angle closure. SUMMARY Surgical trials are underway to examine the role of cataract/lens extraction in post-acute primary angle closure. This technique has the potential to prevent recurrence of the condition and progression to chronic angle closure glaucoma. With existing and upcoming new data on managing acute primary angle closure, it is hopeful that a more optimal treatment algorithm will be established soon.
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Abstract
We report a case of crystalline keratopathy caused by Alocasia macrorrhiza. The diagnosis was made based on the observation of needle-like crystals in the corneal stroma following injury to that eye. The condition resolved in 3 months with the disappearance of the crystals confirmed by follow-up confocal microscopy.
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Tham CCY, Kwong YYY, Lai JSM, Lam DSC. Effect of a previous acute angle closure attack on the corneal endothelial cell density in chronic angle closure glaucoma patients. J Glaucoma 2006; 15:482-5. [PMID: 17106359 DOI: 10.1097/01.ijg.0000212273.73100.31] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To document the effect of a previous acute angle closure attack on the corneal endothelial cell density in chronic angle closure glaucoma (CACG) patients. METHODS Consecutive cases of CACG with patent peripheral iridotomy had their central corneal endothelial cell density measured by specular microscopy. The corneal endothelial cell density of those CACG eyes with a previous documented acute angle closure attack were compared with those eyes without such a history, to determine the effect of a previous acute angle closure attack on corneal endothelial cell density. RESULTS From July 2003 to July 2005, a total of 52 CACG eyes of 52 patients fulfilling the study criteria were recruited. Thirteen eyes (25%) had a previous documented acute angle closure attack, whereas 39 eyes (75%) did not. The mean central corneal endothelial cell density +/-1 standard deviation was 2271.7+/-312.9 (range, 1556 to 2661) cells/mm in those CACG eyes with previous acute angle closure, and 2570.0+/-429.9 (range, 1669 to 3861) cells/mm in those CACG eyes without previous acute angle closure (P < 0.05, Student t test). A previous acute angle closure attack in a CACG eye correlates with a 11.6% reduction in corneal endothelial cell density, compared with a CACG eye without such a history. There were no statistically significant differences between the 2 groups in age, LogMAR visual acuity, intraocular pressure, number of glaucoma eye drops, vertical cup-to-disk ratio, mean deviation or pattern standard deviation in Humphrey automated perimetry (P > 0.05). CONCLUSIONS A previous acute angle closure attack correlates with a significantly reduced corneal endothelial cell density in CACG patients.
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