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Chan JCH, Siddiqui A. Pharmacological Treatment of Heart Failure: Recent Advances. Curr Cardiol Rev 2024; 20:29-38. [PMID: 38284706 DOI: 10.2174/011573403x270178231228061314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Revised: 11/15/2023] [Accepted: 11/29/2023] [Indexed: 01/30/2024] Open
Abstract
BACKGROUND Heart failure is a clinical condition with high mortality and morbidity that occurs when the heart is unable to pump enough blood to meet the metabolic demands of the body. The pharmacological management of heart failure has been revolutionized over the past decade with novel treatments. OBJECTIVE The aim of the review is to highlight the recent pharmacological advances in the management of heart failure. RESULTS Sodium-glucose cotransporter-2 inhibitor (SGLT2i), iron carboxymaltose, finerenone, omecamtiv mecarbil, and vericiguat have been shown to reduce hospitalization for heart failure. However, only SGLT2i, vericiguat, and omecamtiv mecarbil have been shown to reduce cardiovascular death. Finerenone has been shown to reduce cardiovascular events and renal adverse outcomes in patients with diabetes and kidney disease. Currently, only SGLT2i has been studied in patients beyond the heart failure with reduced ejection fraction population. CONCLUSION The current quadruple therapy in the treatment of heart failure has demonstrated a reduction in the hospitalization of patients and a decrease in mortality associated with the condition. Individualized heart failure therapy research have shown some benefit in select heart failure patients. Further research on novel therapies will help improve heart failure patient outcomes.
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Affiliation(s)
- Jonathan C H Chan
- Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
- Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, Canada
| | - Areeb Siddiqui
- College of Medicine and Veterinary Medicine, Edinburgh Medical School, Edinburgh, Scotland
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Liu K, You QS, Chen A, Choi D, White E, Chan JCH, Choy BNK, Shih KC, Wong JKW, Ng ALK, Cheung JJC, Ni MY, Lai JSM, Leung GM, Wong IYH, Huang D, Tan O. Sector-Based Regression Strategies to Reduce Refractive Error-Associated Glaucoma Diagnostic Bias When Using OCT and OCT Angiography. Transl Vis Sci Technol 2023; 12:10. [PMID: 37713187 PMCID: PMC10506684 DOI: 10.1167/tvst.12.9.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 08/03/2023] [Indexed: 09/16/2023] Open
Abstract
Purpose This cross-sectional study aimed to investigate the sectoral variance of optical coherence tomography (OCT) and OCT angiography (OCTA) glaucoma diagnostic parameters across eyes with varying degrees of refractive error. Methods Healthy participants, including individuals with axial ametropia, enrolled in the Hong Kong FAMILY cohort were imaged using the Avanti/AngioVue OCT/OCTA system. The OCT and OCTA parameters obtained include peripapillary nerve fiber layer thickness (NFLT), peripapillary nerve fiber layer plexus capillary density (NFLP-CD), and macular ganglion cell complex thickness (GCCT). Sectoral measurements of NFLT, NFLP-CD, and GCCT were based on sectors and hemispheres. Results A total of 1339 eyes from 791 participants were stratified based on spherical equivalent refraction: high myopia (<-6 D), low myopia (-6 D to -1 D), emmetropia (-1 D to 1 D), and hyperopia (>1 D). Multivariable broken stick regression models, accounting for age, sex, and signal strength, showed that all NFLT sectors except temporally, the inferior GCCT hemisphere, and half of the NFLP-CD sectors were more affected by ametropia-related covariates than the corresponding global parameters. As expected, the false-positive rates in those sectors were elevated. Finally, sector-specific axial length (AL) and spherical equivalent (SE) adjustments helped reduce the elevated false-positive rates. Conclusions The effect of optical magnification is even more prominent among sectors than the global parameters. AL- and SE-based adjustments should be individualized to each sector to mitigate this magnification bias effectively. Translational Relevance Identifying sectoral differences among diagnostic parameters and adopting these sector-based adjustments into commercial OCT systems will hopefully reduce false-positive rates related to refractive error.
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Affiliation(s)
- Keke Liu
- Casey Eye Institute, Oregon Health & Science University, Portland, OR, USA
- Department of Ophthalmology, Duke University School of Medicine, Durham, NC, USA
| | - Qi Sheng You
- Casey Eye Institute, Oregon Health & Science University, Portland, OR, USA
| | - Aiyin Chen
- Casey Eye Institute, Oregon Health & Science University, Portland, OR, USA
| | - Dongseok Choi
- Casey Eye Institute, Oregon Health & Science University, Portland, OR, USA
| | - Elizabeth White
- Casey Eye Institute, Oregon Health & Science University, Portland, OR, USA
| | - Jonathan C. H. Chan
- Department of Ophthalmology, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Bonnie N. K. Choy
- Department of Ophthalmology, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Kendrick C. Shih
- Department of Ophthalmology, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Jasper K. W. Wong
- Department of Ophthalmology, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Alex L. K. Ng
- Department of Ophthalmology, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Janice J. C. Cheung
- Department of Ophthalmology, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Michael Y. Ni
- School of Public Health, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
- The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong
- Healthy High Density Cities Lab, HKUrbanLab, The University of Hong Kong, Hong Kong
| | - Jimmy S. M. Lai
- Department of Ophthalmology, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Gabriel M. Leung
- School of Public Health, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Ian Y. H. Wong
- Department of Ophthalmology, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
- Department of Ophthalmology, Hong Kong Sanatorium & Hospital, Hong Kong
| | - David Huang
- Casey Eye Institute, Oregon Health & Science University, Portland, OR, USA
| | - Ou Tan
- Casey Eye Institute, Oregon Health & Science University, Portland, OR, USA
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Lian J, Lam CLK, Thach TQ, McGhee S, Fung CSC, Kwong ASK, Chau CKV, Chan JCH. Screening interval for diabetic retinopathy: a personalised approach (abridged secondary publication). Hong Kong Med J 2023; 29 Suppl 3:33-35. [PMID: 37357589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/27/2023] Open
Affiliation(s)
- J Lian
- School of Optometry, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - C L K Lam
- Department of Family Medicine and Primary Care, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - T Q Thach
- School of Public Health, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - S McGhee
- School of Public Health, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - C S C Fung
- Department of Family Medicine and Primary Care, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - A S K Kwong
- Department of Family Medicine and Primary Health Care, Hong Kong West Cluster, Hospital Authority, Hong Kong SAR, China
| | - C K V Chau
- Department of Family Medicine and Primary Healthcare, Queen Mary Hospital, Hong Kong SAR, China
| | - J C H Chan
- Department of Ophthalmology, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
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Watson KE, Schindel TJ, Chan JCH, Tsuyuki RT, Al Hamarneh YN. A photovoice study on community pharmacists' roles and lived experiences during the COVID-19 pandemic. Res Social Adm Pharm 2023; 19:944-955. [PMID: 36935325 PMCID: PMC10008092 DOI: 10.1016/j.sapharm.2023.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 02/28/2023] [Accepted: 03/04/2023] [Indexed: 03/18/2023]
Abstract
BACKGROUND Community pharmacists were the face of the health response to the unprecedented COVID-19 pandemic. Their pivotal role during the pandemic has been widely recognized, as they adapted to continue to provide a higher level of care to their patients. OBJECTIVE The objective of this study was to gain a deeper understanding of frontline pharmacists' lived experiences of the COVID-19 pandemic and its impact on their roles. METHODS Photovoice, a visual research method that uses participant-generated photographs to articulate their experiences, was used with semi-structured interviews to explore pharmacists' lived experiences. Frontline community pharmacists who provided direct patient care during the COVID-19 pandemic in Alberta, Canada were recruited. Participants were asked to provide 3-5 photos that reflected on how they see themselves as a pharmacist and/or represents what they do as a pharmacist. Data analysis incorporated content, thematic and visual analysis and was facilitated using NVivo software. A published conceptual framework model was used as the foundation of the analysis with care taken to include new concepts. Ethics approval was obtained from the University of Alberta health research ethics board. RESULTS Interviews were conducted with 21 participants and they 71 photos. This study advanced the conceptual framework model presented in a scoping review, of what was made visible (pharmacists' information, public health, and medication management roles) and what was invisible but made visible by the pandemic (pharmacists' leadership roles). It was revealed through the reflective nature of this study the important leadership role pharmacists have in their communities. CONCLUSIONS This study highlighted the work of community pharmacists responding to the COVID-19 pandemic through their information, public health, medication management, and leadership roles. Their experiences also made visible the cost their work had on them as they did more to adapt and continually respond as the pandemic evolved. Pharmacists recognized their role as leaders in their practice and communities.
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Affiliation(s)
- Kaitlyn E Watson
- EPICORE Centre, Department of Medicine, University of Alberta, Canada.
| | - Theresa J Schindel
- Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Canada
| | - Jonathan C H Chan
- EPICORE Centre, Department of Medicine, University of Alberta, Canada; Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Canada
| | - Ross T Tsuyuki
- EPICORE Centre, Department of Medicine, University of Alberta, Canada; Department of Pharmacology, University of Alberta, Canada
| | - Yazid N Al Hamarneh
- EPICORE Centre, Department of Medicine, University of Alberta, Canada; Department of Pharmacology, University of Alberta, Canada
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Chan JCH, Cowley E, Chan M. Practical Pharmacological Treatment of Heart Failure: Does Ejection Fraction Matter Anymore? J Cardiovasc Dev Dis 2023; 10:114. [PMID: 36975878 PMCID: PMC10059810 DOI: 10.3390/jcdd10030114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 03/06/2023] [Accepted: 03/08/2023] [Indexed: 03/12/2023] Open
Abstract
Heart failure (HF) is a complex clinical syndrome involving structural and/or functional abnormalities of the heart. Heart failure is often classified based on left ventricular ejection fraction, which serves as a predictor of mortality. The majority of the data supporting disease-modifying pharmacological therapies are from patients with reduced ejection fraction (less than 40%). However, with the recent results from the sodium glucose cotransporter-2 inhibitor trials, there is renewed interest in identifying potential beneficial pharmacological therapies. This review focuses on and includes pharmacological HF therapies across the spectrum of ejection fraction, providing an overview of the novel trials. We also examined the effects of the treatments on mortality, hospitalization, functional status, and biomarker levels to further investigate the interplay between ejection fraction and HF.
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Affiliation(s)
- Jonathan C. H. Chan
- Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, AB T6G 2R3, Canada;
- Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB T6G 2R3, Canada
| | - Emily Cowley
- Department of Pharmacy, University of Alberta Hospital, Edmonton, AB T6G 2B7, Canada
| | - Michael Chan
- Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB T6G 2R3, Canada
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Liu K, Tan O, You QS, Chen A, Chan JCH, Choy BNK, Shih KC, Wong JKW, Ng ALK, Cheung JJC, Ni MY, Lai JSM, Leung GM, Liu L, Huang D, Wong IYH. Regression-Based Strategies to Reduce Refractive Error-Associated Glaucoma Diagnostic Bias When Using OCT and OCT Angiography. Trans Vis Sci Tech 2022; 11:8. [PMID: 36112104 PMCID: PMC9487171 DOI: 10.1167/tvst.11.9.8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Purpose The purpose of this study was to correct refractive error-associated bias in optical coherence tomography (OCT) and OCT angiography (OCTA) glaucoma diagnostic parameters. Methods OCT and OCTA imaging were obtained from participants in the Hong Kong FAMILY cohort. The Avanti/AngioVue OCT/OCTA system was used to measure the peripapillary nerve fiber layer thickness (NFLT), peripapillary nerve fiber layer plexus capillary density (NFLP-CD), macular ganglion cell complex thickness (GCCT), and macular superficial vascular complex vascular density (SVC-VD). Healthy eyes, including ones with axial ametropia, were enrolled for analysis. Results A total of 1346 eyes from 792 participants were divided into 4 subgroups: high myopia (<−6D), low myopia (−6D to −1D), emmetropia (−1D to 1D), and hyperopia (>1D). After accounting for age, sex, and signal strength, multivariable regression showed strong dependence in most models for NFLT, GCCT, and NFLP-CD on axial eye length (AL), spherical equivalent (SE) refraction, and apparent optic disc diameter (DD). Optical analysis indicated that AL-related transverse optical magnification variations predominated over anatomic variations and were responsible for these trends. Compared to the emmetropic group, the false positive rates were significantly (Chi-square test P < 0.003) elevated in both myopia groups for NFLT, NFLP-CD, and GCCT. Regression-based adjustment of these diagnostic parameters with AL or SE significantly (McNemar test P < 0.03) reduced the elevated false positive rates. Conclusions Myopic eyes are biased to have lower NFLT, GCCT, and NFLP-CD measurements. AL- and SE-based adjustments were effective in mitigating this bias. Translational Relevance Adoption of these adjustments into commercial OCT systems may reduce false positive rates related to refractive error.
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Affiliation(s)
- Keke Liu
- Casey Eye Institute, Oregon Health & Science University, Portland, OR, USA
- John A. Burns School of Medicine, University of Hawai'i, Honolulu, HI, USA
| | - Ou Tan
- Casey Eye Institute, Oregon Health & Science University, Portland, OR, USA
| | - Qi Sheng You
- Casey Eye Institute, Oregon Health & Science University, Portland, OR, USA
| | - Aiyin Chen
- Casey Eye Institute, Oregon Health & Science University, Portland, OR, USA
| | - Jonathan C. H. Chan
- Department of Ophthalmology, LKS Faculty of Medicine, The University of Hong Kong, The University of Hong Kong, Hong Kong, China
| | - Bonnie N. K. Choy
- Department of Ophthalmology, LKS Faculty of Medicine, The University of Hong Kong, The University of Hong Kong, Hong Kong, China
| | - Kendrick C. Shih
- Department of Ophthalmology, LKS Faculty of Medicine, The University of Hong Kong, The University of Hong Kong, Hong Kong, China
| | - Jasper K. W. Wong
- Department of Ophthalmology, LKS Faculty of Medicine, The University of Hong Kong, The University of Hong Kong, Hong Kong, China
| | - Alex L. K. Ng
- Department of Ophthalmology, LKS Faculty of Medicine, The University of Hong Kong, The University of Hong Kong, Hong Kong, China
| | - Janice J. C. Cheung
- Department of Ophthalmology, LKS Faculty of Medicine, The University of Hong Kong, The University of Hong Kong, Hong Kong, China
| | - Michael Y. Ni
- School of Public Health, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, Hong Kong, China
- The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong Special Administrative Region, China
- Healthy High Density Cities Lab, HKUrbanLab, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Jimmy S. M. Lai
- Department of Ophthalmology, LKS Faculty of Medicine, The University of Hong Kong, The University of Hong Kong, Hong Kong, China
| | - Gabriel M. Leung
- School of Public Health, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, Hong Kong, China
| | - Liang Liu
- Casey Eye Institute, Oregon Health & Science University, Portland, OR, USA
| | - David Huang
- Casey Eye Institute, Oregon Health & Science University, Portland, OR, USA
| | - Ian Y. H. Wong
- Department of Ophthalmology, LKS Faculty of Medicine, The University of Hong Kong, The University of Hong Kong, Hong Kong, China
- Department of Ophthalmology, Hong Kong Sanatorium & Hospital, Hong Kong, China
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Silva AE, Lyu A, Leat SJ, Khan S, Labreche T, Chan JCH, Li Q, Woo GC, Woo S, Cheong AMY, Thompson B. A differential effect of visual cortex tDCS on reading of English and Chinese in patients with central vision loss. Brain Stimul 2022; 15:1215-1217. [PMID: 36044975 DOI: 10.1016/j.brs.2022.08.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Revised: 08/13/2022] [Accepted: 08/23/2022] [Indexed: 11/02/2022] Open
Affiliation(s)
- A E Silva
- School of Optometry and Vision Science, University of Waterloo, Ontario, Canada.
| | - A Lyu
- School of Optometry, The Hong Kong Polytechnic University, Hong Kong, China
| | - S J Leat
- School of Optometry and Vision Science, University of Waterloo, Ontario, Canada; Centre for Eye and Vision Research, 17W Science Park, Hong Kong, China
| | - S Khan
- School of Optometry and Vision Science, University of Waterloo, Ontario, Canada
| | - T Labreche
- School of Optometry and Vision Science, University of Waterloo, Ontario, Canada; Centre for Eye and Vision Research, 17W Science Park, Hong Kong, China
| | - J C H Chan
- Department of Ophthalmology, The University of Hong Kong, Hong Kong
| | - Q Li
- Department of Ophthalmology, The University of Hong Kong, Hong Kong, China
| | - G C Woo
- School of Optometry, The Hong Kong Polytechnic University, Hong Kong, China; Centre for Eye and Vision Research, 17W Science Park, Hong Kong, China
| | - S Woo
- School of Optometry and Vision Science, University of Waterloo, Ontario, Canada
| | - A M Y Cheong
- School of Optometry, The Hong Kong Polytechnic University, Hong Kong, China; Centre for Eye and Vision Research, 17W Science Park, Hong Kong, China.
| | - B Thompson
- School of Optometry and Vision Science, University of Waterloo, Ontario, Canada; Centre for Eye and Vision Research, 17W Science Park, Hong Kong, China
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Lai JSM, Chan HHL, Chan JCH, Lo ACY, Lee JWY, Chang RCC, So KF. Neuroprotective effects of wolfberry in normal tension glaucoma: abridged secondary publication. Hong Kong Med J 2022; 28 Suppl 1:46-47. [PMID: 35260518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023] Open
Affiliation(s)
- J S M Lai
- Department of Ophthalmology, The University of Hong Kong
| | - H H L Chan
- Department of Ophthalmology, The University of Hong Kong
| | - J C H Chan
- Department of Ophthalmology, The University of Hong Kong
| | - A C Y Lo
- Department of Ophthalmology, The University of Hong Kong
| | - J W Y Lee
- Department of Ophthalmology, The University of Hong Kong
| | - R C C Chang
- Department of Ophthalmology, The University of Hong Kong
| | - K F So
- Department of Ophthalmology, The University of Hong Kong
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Tsuyuki RT, Al Hamarneh YN, Chan JCH, Dobie J, Santarossa TM, So R, Wu Q, Watson KE. Pharmacy, we have an image problem . . . (and here's a solution). Can Pharm J (Ott) 2021; 154:353-354. [PMID: 34777641 DOI: 10.1177/17151635211050029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Wong IYH, Wong RLM, Chan JCH, Kawasaki R, Chong V. Incorporating Optical Coherence Tomography Macula Scans Enhances Cost-effectiveness of Fundus Photography-Based Screening for Diabetic Macular Edema. Diabetes Care 2020; 43:2959-2966. [PMID: 33004465 DOI: 10.2337/dc17-2612] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2017] [Accepted: 09/13/2020] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To compare four screening strategies for diabetic macular edema (DME). RESEARCH DESIGN AND METHODS Patients attending diabetic retinopathy screening were recruited and received macular optical coherence tomography (OCT), in addition to visual acuity (VA) and fundus photography (FP) assessments, as part of the standard protocol. Two retina specialists provided the reference grading by independently assessing each subject's screened data for DME. The current standard protocol (strategy A) was compared for sensitivity, specificity, quality-adjusted life-year (QALY) gained, and incremental cost-effectiveness ratio (ICER) with three alternative candidate protocols using a simulation model with the same subjects. In strategy B, macular hemorrhage or microaneurysm on FP were removed as surrogate markers for possible DME. Strategy C used best-corrected instead of habitual/pinhole VA and added central subfield thickness (CST) >290 μm on OCT in suspected cases as a confirmation marker for possible DME. Strategy D used CST >290 μm OCT in all subjects as a surrogate marker for suspected DME. RESULTS We recruited 2,277 subjects (mean age 62.80 ± 11.75 years, 43.7% male). The sensitivities and specificities were 40.95% and 86.60%, 22.86% and 95.63%, 32.38% and 100%, and 74.47% and 98.34% for strategies A, B, C, and D, respectively. The costs (in U.S. dollars) of each QALY gained for strategies A, B, C, and D were $7,447.50, $8,428.70, $5,992.30, and $4,113.50, respectively. CONCLUSIONS The high false-positive rate of the current protocol generates unnecessary referrals, which are inconvenient for patients and costly for society. Incorporating universal OCT for screening DME can reduce false-positive results by eightfold, while improving sensitivity and long-term cost-effectiveness.
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Affiliation(s)
- Ian Y H Wong
- Department of Ophthalmology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China .,Department of Ophthalmology, Hong Kong Sanatorium and Hospital, Hong Kong, China
| | - Raymond L M Wong
- Department of Ophthalmology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China .,Department of Ophthalmology, Hong Kong Eye Hospital, Hong Kong, China
| | - Jonathan C H Chan
- Department of Ophthalmology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Ryo Kawasaki
- Department of Ophthalmology, Osaka University, Osaka, Japan
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11
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Ho CHM, Chiang CL, Lee FAS, Chan JCH, Yeung CSY, Choi CKK, Wong FCS, Tung SY. Albumin-bilirubin versus Child-Pugh Grade as a Predictor of Survival after Individualised Hypofractionated Radiotherapy for Hepatocellular Carcinoma. Hong Kong Journal of Radiology 2020. [DOI: 10.12809/hkjr2016971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- CHM Ho
- Department of Clinical Oncology, Tuen Mun Hospital, Tuen Mun, Hong Kong
| | - CL Chiang
- Department of Clinical Oncology, Tuen Mun Hospital, Tuen Mun, Hong Kong; Department of Clinical Oncology, The University of Hong Kong, Pokfulam, Hong Kong; Department of Clinical Oncology, The University of Hong Kong–Shenzhen Hospital, Shenzhen, China
| | - FAS Lee
- Department of Clinical Oncology, Tuen Mun Hospital, Tuen Mun, Hong Kong
| | - JCH Chan
- Department of Clinical Oncology, Queen Elizabeth Hospital, Jordan, Hong Kong
| | - CSY Yeung
- Department of Clinical Oncology, Tuen Mun Hospital, Tuen Mun, Hong Kong
| | - CKK Choi
- Department of Clinical Oncology, Tuen Mun Hospital, Tuen Mun, Hong Kong
| | - FCS Wong
- Department of Clinical Oncology, Tuen Mun Hospital, Tuen Mun, Hong Kong
| | - SY Tung
- Department of Clinical Oncology, Tuen Mun Hospital, Tuen Mun, Hong Kong
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Abstract
Despite advances in ophthalmic diagnostics, the direct ophthalmoscope remains a key clinical skill taught to medical students and is the tool of choice for retina examination among non-ophthalmic physicians. However, in recent years viable alternatives have become available. The coronavirus disease 2019 (COVID-19) pandemic has forced a major re-thinking in medical education worldwide. In this commentary, we examined the current merits and limitations of the direct ophthalmoscope in both the clinical sense and in the context of infection control. Furthermore, we compared the direct ophthalmoscope with alternatives, including commercially available portable non-mydriatic fundus cameras, that would allow a change in focus during ophthalmic teaching. We concluded that the latter will better prepare our medical students for the age of telemedicine and deep-learning systems. While the COVID-19 pandemic will not be the sole reason for the ‘death’ of the direct ophthalmoscope, the global situation will inevitably serve to expedite long overdue changes in our teaching of ophthalmic skills to non-ophthalmic physicians.
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Affiliation(s)
- Kendrick C Shih
- Department of Ophthalmology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong, SAR.
| | - Charlene Y C Chau
- Department of Ophthalmology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong, SAR
| | - Jonathan C H Chan
- Department of Ophthalmology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong, SAR
| | - Jasper K W Wong
- Department of Ophthalmology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong, SAR
| | - Jimmy S M Lai
- Department of Ophthalmology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong, SAR
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13
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Shih KC, Kwong ASK, Wang JHL, Wong JKW, Ko WWK, Lai JSM, Chan JCH. Diabetic retinopathy screening during the coronavirus disease 2019 pandemic. Eye (Lond) 2020; 34:1246-1247. [PMID: 32367007 PMCID: PMC7197359 DOI: 10.1038/s41433-020-0928-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 04/22/2020] [Accepted: 04/22/2020] [Indexed: 11/09/2022] Open
Affiliation(s)
- Kendrick C Shih
- Department of Ophthalmology, University of Hong Kong, Hong Kong, Hong Kong
| | - Alfred S K Kwong
- Department of Family Medicine and Primary Healthcare, Hong Kong West Cluster, Hospital Authority, Hong Kong, Hong Kong
| | - Jenny H L Wang
- Department of Family Medicine and Primary Healthcare, Hong Kong West Cluster, Hospital Authority, Hong Kong, Hong Kong
| | - Jasper K W Wong
- Department of Ophthalmology, University of Hong Kong, Hong Kong, Hong Kong
| | - Welchie W K Ko
- Department of Family Medicine and Primary Healthcare, Hong Kong West Cluster, Hospital Authority, Hong Kong, Hong Kong
| | - Jimmy S M Lai
- Department of Ophthalmology, University of Hong Kong, Hong Kong, Hong Kong
| | - Jonathan C H Chan
- Department of Ophthalmology, University of Hong Kong, Hong Kong, Hong Kong.
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You QS, Choy BKN, Chan JCH, Ng ALK, Shih KC, Cheung JJC, Wong JKW, Shum JWH, Ni MY, Lai JS, Leung GM, Wong TY, Wong IYH. Prevalence and Causes of Visual Impairment and Blindness among Adult Chinese in Hong Kong – The Hong Kong Eye Study. Ophthalmic Epidemiol 2020; 27:354-363. [DOI: 10.1080/09286586.2020.1755444] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
- Qi Sheng You
- Department of Ophthalmology, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China
- Casey Eye Institute, Oregon Health Science University, Portland, Washington, USA
| | - Bonnie K. N. Choy
- Department of Ophthalmology, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Jonathan C. H. Chan
- Department of Ophthalmology, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Alex L. K. Ng
- Department of Ophthalmology, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Kendrick C. Shih
- Department of Ophthalmology, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Janice J. C. Cheung
- Department of Ophthalmology, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Jasper K. W. Wong
- Department of Ophthalmology, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Jennifer W. H. Shum
- Department of Ophthalmology, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Michael Y. Ni
- School of Public Health, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Jimmy Sm Lai
- Department of Ophthalmology, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Gabriel M. Leung
- School of Public Health, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Tien Yin Wong
- Department of Ophthalmology, Singapore National Eye Center, Singapore
| | - Ian Y. H. Wong
- Department of Ophthalmology, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China
- Department of Ophthalmology, Hong Kong Sanatorium and Hospital, Hong Kong, China
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15
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You QS, Chan JCH, Ng ALK, Choy BKN, Shih KC, Cheung JJC, Wong JKW, Shum JWH, Ni MY, Lai JSM, Leung GM, Cheung CMG, Wong TY, Wong IYH. Macular Vessel Density Measured With Optical Coherence Tomography Angiography and Its Associations in a Large Population-Based Study. Invest Ophthalmol Vis Sci 2020; 60:4830-4837. [PMID: 31747685 DOI: 10.1167/iovs.19-28137] [Citation(s) in RCA: 71] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose We investigate macular perfusion and the systemic and ocular associations in a population-based setting. Methods In this cross-sectional study, 2018 adults residing in Hong Kong underwent detailed ophthalmic examinations after consenting to participate. Macular perfusion was measured with optical coherence tomography angiography (OCTA) using the split-spectrum amplitude decorrelation angiography algorithm. The parafoveal flow index and vessel area density were quantified using automated custom-built software. Results Of the 2018 participants, the OCTA measurements were available for 1940, and 1631 (84.1%) had good quality scans. The right eyes of these 1631 participants (43.1% men) were included for final analysis. Mean age was 49.8 years (range, 18-92 years). Mean global macular vessel density was 47.3% and 55.1% for the superficial and deep retinal layers, respectively. In multivariate analysis, lower superficial vessel density remained significantly associated with lower signal strength index (SSI; P < 0.001, standardized β = 0.607) and male sex (P < 0.001, β = 0.162), and borderline associated with older age (P = 0.09, β = -0.045) and longer axial length (AL; P = 0.09, β = -0.037), while lower deep layer vessel density was significantly associated with lower SSI (P < 0.001, standardized β = 0.667), longer AL (P < 0.001, β = -0.097), and higher creatinine (P < 0.001, β = -0.072). Conclusions This large population-based study provided normative OCTA data of macular vessel density and demonstrated that a lower superficial retinal vessel density was significantly associated with lower SSI and male sex, while a lower deep layer retinal vessel density was significantly associated with lower SSI, longer AL, and higher level of creatinine. These associations must be considered when interpreting clinical quantitative OCTA data.
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Affiliation(s)
- Qi Sheng You
- Department of Ophthalmology, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong.,Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing.,Casey Eye Institute, Oregon Health & Science University, Portland, Oregon, United States
| | - Jonathan C H Chan
- Department of Ophthalmology, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Alex L K Ng
- Department of Ophthalmology, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Bonnie K N Choy
- Department of Ophthalmology, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Kendrick C Shih
- Department of Ophthalmology, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Janice J C Cheung
- Department of Ophthalmology, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Jasper K W Wong
- Department of Ophthalmology, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Jennifer W H Shum
- Department of Ophthalmology, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Michael Y Ni
- School of Public Health, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Jimmy S M Lai
- Department of Ophthalmology, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Gabriel M Leung
- School of Public Health, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
| | | | | | - Ian Y H Wong
- Department of Ophthalmology, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong.,Department of Ophthalmology, Hong Kong Sanatorium & Hospital, Hong Kong
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Cai Y, Choy BNK, Zhu MM, Li BB, Chan JCH, Ho WL, Lai JSM. Prospective study on a novel treatment for leaking cystic bleb: Efficacy and safety of collagen crosslinking. Clin Exp Ophthalmol 2019; 47:749-756. [PMID: 31017701 DOI: 10.1111/ceo.13520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 02/26/2019] [Accepted: 03/15/2019] [Indexed: 11/28/2022]
Abstract
IMPORTANCE Management of cystic bleb leak is difficult. It would be essential to look for a method to strengthen the original pathological conjunctiva and reverse bleb leak. BACKGROUND To evaluate the long-term efficacy and safety of collagen crosslinking in patients with leaking cystic bleb. DESIGN Prospective interventional case series at a university-based hospital. PARTICIPANTS Twelve eyes in 12 subjects with late-onset bleb leak from cystic bleb, without indications for prompt surgical interventions were included. METHODS The subjects underwent crosslinking with 0.1% riboflavin application to bleb surface, followed by ultraviolet irradiation for 30 minutes. The subjects were followed up at baseline and at 1 week, 1 month, 3 months, 6 months post-treatment and then every 6 months afterwards. MAIN OUTCOME MEASURES Interval from treatment to cessation of bleb leak, recurrence rate of bleb leak and side effects of treatment. RESULTS The mean follow-up after crosslinking was 29.33 ± 12.45 months. Bleb leak subsided in 11 (92%) of 12 patients after a single session of crosslinking, after 1 to 8 weeks (median 3 weeks). Time to leak cessation was significantly correlated with the number of prior glaucoma interventions (R = .71, P = .014). Bleb wall at 3 months was significantly thicker than at baseline (0.70 ± 0.67 vs 0.81 ± 0.62 mm, P = .008). None of the patients experienced any complications. CONCLUSIONS AND RELEVANCE Crosslinking achieves resolution of cystic bleb leak which lasts for at least 12 months, without the need of subsequent surgical interventions. Crosslinking is a simple, non-invasive treatment for bleb leak. It aims to restore the integrity of conjunctiva.
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Affiliation(s)
- Yu Cai
- Department of Ophthalmology, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong.,Department of Ophthalmology, Peking University First Hospital, Key Laboratory of Visual Impairment and Rehabilitation of Peking University, Beijing, China
| | - Bonnie N K Choy
- Department of Ophthalmology, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong
| | - Ming M Zhu
- Department of Ophthalmology, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong
| | - Bai B Li
- Department of Ophthalmology, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Jonathan C H Chan
- Department of Ophthalmology, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong
| | - Wing L Ho
- Department of Ophthalmology, Grantham Hospital, Hong Kong West Cluster, Hong Kong, Hong Kong
| | - Jimmy S M Lai
- Department of Ophthalmology, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong
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17
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Shum JWH, Lam WWT, Choy BNK, Chan JCH, Ho WL, Lai JSM. Development and pilot-testing of patient decision aid for use among Chinese patients with primary open-angle glaucoma. BMJ Open Ophthalmol 2018; 2:e000100. [PMID: 29354724 PMCID: PMC5751868 DOI: 10.1136/bmjophth-2017-000100] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Revised: 09/20/2017] [Accepted: 09/28/2017] [Indexed: 11/18/2022] Open
Abstract
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.
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Affiliation(s)
- Jennifer W H Shum
- Department of Ophthalmology, The University of Hong Kong, Hong Kong, China
| | - Wendy W T Lam
- School of Public Health, The University of Hong Kong, Hong Kong, China
| | - Bonnie N K Choy
- Department of Ophthalmology, The University of Hong Kong, Hong Kong, China
| | - Jonathan C H Chan
- Department of Ophthalmology, The University of Hong Kong, Hong Kong, China
| | - Wing Lau Ho
- Department of Ophthalmology, Queen Mary Hospital, Hong Kong, China
| | - Jimmy S M Lai
- Department of Ophthalmology, The University of Hong Kong, Hong Kong, China
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Chan JCH, Leung AKC, Fong ST, Chiu HM, Ngan RKC. Management of Chordoma in a Tertiary Hospital in Hong Kong. Hong Kong J Radiol 2017. [DOI: 10.12809/hkjr1716854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Abstract
UNLABELLED This 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 < 0.0001). Medications were likewise significantly reduced at all time intervals following SLT (P < 0.0001). At 24 months, the IOP was 11.5% lower than the prestudy IOP, 22.0% lower than the pre-SLT IOP, and medication use was reduced by 41.1% (P < 0.0001). Six out of 45 eyes (13.3%) required a secondary SLT. Absolute success (IOP reduction >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).
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Affiliation(s)
- Jacky W Y Lee
- From the Department of Ophthalmology (JWYL), Caritas Medical Centre; Department of Ophthalmology (JWYL, JJWS, JSML), The University of Hong Kong; and Department of Ophthalmology (JCHC), Queen Mary Hospital, Hong Kong
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Gangwani RA, Lee JWY, Mo HY, Sum R, Kwong ASK, Wang JHL, Tsui WWS, Chan JCH, Lai JSM. The Correlation of Retinal Nerve Fiber Layer Thickness With Blood Pressure in a Chinese Hypertensive Population. Medicine (Baltimore) 2015; 94:e947. [PMID: 26061324 PMCID: PMC4616465 DOI: 10.1097/md.0000000000000947] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
To investigate the association between retinal nerve fiber layer (RNFL) thickness and blood pressure (BP) in subjects with systemic hypertension. Subjects with systemic hypertension on anti-hypertensive medications were screened by fundus photography and referred for glaucoma work-up if there was enlarged vertical cup-to-disc (VCDR) ratio ≥0.6, VCDR asymmetry ≥0.2, or optic disc hemorrhage. Workup included a complete ophthalmological examination, Humphrey visual field test, and RNFL thickness measurement by optical coherence tomography. The intraocular pressure (IOP) and RNFL thicknesses (global and quadrant) were averaged from both eyes and the means were correlated with: the systolic BP (SBP), diastolic BP (DBP), and mean arterial pressure (MAP) using Pearson correlation. Among 4000 screened hypertensive subjects, 133 were referred for glaucoma workup and 110 completed the workup. Of the 4000 screened subjects, 1.3% had glaucoma (0.9% had normal tension glaucoma [NTG], 0.2% had primary open angle glaucoma, and 0.2% had primary angle closure glaucoma), whereas 0.3% were NTG suspects. The SBP was negatively correlated with the mean superior RNFL thickness (P = 0.01). The DBP was negatively correlated with the mean global (P = 0.03), superior (P = 0.02), and nasal (P = 0.003) RNFL thickness. The MAP was negatively correlated with the mean global (P = 0.01), superior (P = 0.002), and nasal (P = 0.004) RNFL thickness while positively correlated with the mean IOP (P = 0.02). In medically treated hypertensive subjects, glaucoma was present in 1.3%, with NTG being most prevalent. MAP control may help with IOP lowering and RNFL preservation, although future prospective studies will be needed.
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Affiliation(s)
- Rita A Gangwani
- From the Department of Ophthalmology, The University of Hong Kong (RAG, JWYL, JSML), Department of Ophthalmology, Queen Mary Hospital (RAG, JCHC, JSML), Department of Ophthalmology, Caritas Medical Centre (JWYL), Department of Family Medicine and Primary Health Care, Hospital Authority (HYM, ASKK, JHLW, WWST), and School of Optometry, The Hong Kong Polytechnic University, Hong Kong (RS)
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Lee JWY, Fu L, Chan JCH, Lai JSM. Twenty-four-hour intraocular pressure related changes following adjuvant selective laser trabeculoplasty for normal tension glaucoma. Medicine (Baltimore) 2014; 93:e238. [PMID: 25501089 PMCID: PMC4602790 DOI: 10.1097/md.0000000000000238] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Revised: 10/10/2014] [Accepted: 10/10/2014] [Indexed: 01/29/2023] Open
Abstract
To investigate intraocular pressure (IOP) related patterns before and after selective laser trabeculoplasty (SLT) for normal tension glaucoma (NTG).In this prospective cohort study, 18 NTG patients underwent SLT. Success was defined as IOP reduction ≥ 20% by Goldmann applanation tonometry. 24-hour IOP-related pattern recording with a contact lens sensor (CLS) (SENSIMED Triggerfish, Sensimed, Switzerland) was done before (baseline) and 1 month after SLT. A cosine function was fitted to the mean CLS patterns for each individual in the SLT success and non-success groups and the amplitude before and after SLT was calculated. Diurnal, nocturnal, and 24-hour CLS pattern local variability was determined for pre- and post-SLT sessions. Cosine amplitude and variability were compared before and after SLT by group using paired t-tests, with α = 0.05. Patients (11 women, 7 men) had a mean age of 65.1 ± 13.7 years. Mean IOP was 15.3 ± 2.2 mm Hg at baseline and was reduced by 17.0% to 12.7 ± 1.8 mm Hg 1 month after SLT (P = 0.001). SLT was successful in 8 patients (44%). The amplitude of the fitted cosine was reduced by 24.6% in the success group, but displayed an amplitude increase of 19.2% post-SLT in the non-success group. Higher diurnal local variability of the CLS pattern was observed after SLT in non-success subjects (P = 0.002), while nocturnal variability showed no significant change. The increase in diurnal variability in the non-success group led to an increase in 24-hour variability in this group (P = 0.001). No change in local variability (diurnal, nocturnal, and 24-hour) was seen in the success group. The IOP-related pattern cosinor amplitude was reduced in NTG patients with a successful SLT treatment whereas the non-success group exhibited an increase of cosine amplitude. Higher diurnal and 24-hour CLS pattern variability was observed in non-success patients 1 month post-SLT.
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Affiliation(s)
- Jacky W Y Lee
- From the Department of Ophthalmology, Caritas Medical Centre, (JWYL); The Department of Ophthalmology, The University of Hong Kong (JWYL, LF); and The Department of Ophthalmology, Queen Mary Hospital, Hong Kong, SAR, People's Republic of China (JCHC)
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22
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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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Affiliation(s)
- Jacky W Y Lee
- From the Department of Ophthalmology, Caritas Medical Centre, (JWYL); The Department of Ophthalmology, The University of Hong Kong, (JWYL, JSML); Department of Applied Mathematics, The Hong Kong Polytechnic University (CCLL); and The Department of Ophthalmology, Queen Mary Hospital, Hong Kong, SAR, People's Republic of China (JCHC)
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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] [What about the content of this article? (0)] [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] [What about the content of this article? (0)] [Affiliation(s)] [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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Affiliation(s)
- Jacky W Y Lee
- Department of Ophthalmology, The University of Hong Kong, Pokfulam, Hong Kong
| | - Catherine W S Chan
- Department of Ophthalmology, The University of Hong Kong, Pokfulam, Hong Kong
| | - Jonathan C H Chan
- Department of Ophthalmology, Queen Mary Hospital, Pokfulam, Hong Kong
| | - Q Li
- Department of Ophthalmology, The University of Hong Kong, Pokfulam, Hong Kong
| | - Jimmy S M Lai
- Department of Ophthalmology, The University of Hong Kong, Pokfulam, Hong Kong
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Affiliation(s)
- Clement C Y Tham
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Eye Hospital, 147K Argyle St, Kowloon, Hong Kong, China.
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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] [What about the content of this article? (0)] [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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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Affiliation(s)
- C C Y Tham
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, People's Republic of China.
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Lai JSM, Tham CCY, Chan JCH. The Clinical Outcomes of Cataract Extraction by Phacoemulsification in Eyes With Primary Angle-Closure Glaucoma (PACG) and Co-Existing Cataract. J Glaucoma 2006; 15:47-52. [PMID: 16378018 DOI: 10.1097/01.ijg.0000196619.34368.0a] [Citation(s) in RCA: 131] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate the clinical outcomes of minimally invasive cataract extraction by phacoemulsification, with primary intraocular lens implantation, in eyes with primary angle-closure glaucoma (PACG) and co-existing cataract. MATERIALS AND METHODS Consecutive primary angle-closure glaucoma patients with co-existing visually significant cataract were invited to participate in this prospective study. After obtaining informed consent, cataract extraction by phacoemulsification through a clear corneal incision was performed under topical anesthesia. Foldable intraocular lenses were implanted in the same setting. These patients were then followed up for a minimum of 1 year. Outcome measures included intraocular pressure (IOP), requirement for glaucoma drugs, and visual acuity. RESULTS Twenty-one primary angle-closure glaucoma eyes of 21 patients were recruited. Mean age (+/- SD) was 73.7 +/- 8.1 years (range, 60-87 years). There were 12 female patients and 9 male patients, with 13 right eyes and 8 left eyes. Nine eyes (42.9%) had history of acute primary angle closure. Mean follow-up duration was 20.7 +/- 3.6 months (range, 13-26 months). Intraocular pressure was decreased from a mean preoperative level of 19.7 +/- 6.1 mm Hg (range, 11 mm Hg-40 mm Hg) to 15.5 +/- 3.9 mm Hg (range, 9 mm Hg-26 mm Hg) at final follow-up (P = 0.022) (paired t test). The number of glaucoma eye drops required was decreased from a mean preoperative level of 1.91 +/- 0.77 (range, 1-3) to 0.52 +/- 0.87 (range, 0-3) at final follow-up (P < 0.001) (paired t test). In 10 eyes (47.6%), visual acuity improved significantly after surgery. In 9 eyes (42.9%), visual acuity remained the same. In 2 eyes (9.5%), visual acuity deteriorated significantly after surgery. Mean cup-to-disc ratio was 0.6 +/- 0.2 (range, 0.3-0.9) preoperatively, and 0.7 +/- 0.2 (range, 0.3-0.9) postoperatively (P = 0.047) (paired t test). CONCLUSIONS In primary angle-closure glaucoma patients with co-existing cataract, cataract extraction alone (by phacoemulsification) can significantly reduce both intraocular pressure and the requirement for glaucoma drugs.
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Affiliation(s)
- Jimmy S M Lai
- Department of Ophthalmology, United Christian Hospital, Kowloon, Hong Kong SAR, Peoples' Republic of China.
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Chan JCH, Lai JSM, Tham CCY. Comparison of Postoperative Refractive Outcome in Phacotrabeculectomy and Phacoemulsification With Posterior Chamber Intraocular Lens Implantation. J Glaucoma 2006; 15:26-9. [PMID: 16378014 DOI: 10.1097/01.ijg.0000196620.41991.b6] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To compare the postoperative refractive outcomes following phacotrabeculectomy and phacoemulsification with posterior chamber intraocular lens implantation. METHODS A retrospective comparative study of 90 consecutive patients (95 eyes) with cataract with or without co-existing glaucoma who had undergone uncomplicated phacotrabeculectomy or phacoemulsification by a single surgeon. The biometry prediction error was determined for each case by the difference between the actual postoperative refraction and the preoperative predicted refractive outcome, in spherical equivalent. This was followed by a comparative analysis of the mean biometry prediction error, and the number of cases with error >0.50 D or 1.00 D. All biometry measurements were performed by one of the two qualified optometrists. RESULTS The mean and absolute mean biometry prediction error of the 25 eyes that received phacotrabeculectomy (+0.20 D, absolute error 0.96 D) was comparable to the 70 eyes that received phacoemulsification (-0.14 D, absolute error 0.68 D), P = 0.18 (absolute error, P = 0.12). The proportion of cases with prediction error >0.50 D or 1.00 D was 60% or 40% for phacotrabeculectomy, and 44% or 17% for phacoemulsification, respectively. Phacotrabeculectomy was more likely to have a prediction error >1.00 D (P = 0.02) and a myopic shift of >0.50 D or 1.00 D (P = 0.03 or 0.02, respectively). No significant differences were found with regard to the frequency of hyperopic shift or prediction error >0.50 D. There was no significant difference in either the mean error or the frequency of the different types of error for the different biometry operators, types of glaucoma, or postoperative intraocular pressure control success status. CONCLUSION Myopically shifted prediction error was significantly more frequent following posterior chamber intraocular lens implantation with phacotrabeculectomy compared with phacoemulsification, even when surgery was uncomplicated and performed by the same surgeon.
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Affiliation(s)
- Jonathan C H Chan
- Department of Ophthalmology, United Christian Hospital, Hong Kong SAR, China
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Lai JSM, Tham CCY, Chua JKH, Poon ASY, Chan JCH, Lam SW, Lam DSC. To compare argon laser peripheral iridoplasty (ALPI) against systemic medications in treatment of acute primary angle-closure: mid-term results. Eye (Lond) 2005; 20:309-14. [PMID: 16021197 DOI: 10.1038/sj.eye.6701867] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To compare the clinical outcome of argon laser peripheral iridoplasty (ALPI) against systemic medications in treatment of acute primary angle-closure (APAC). METHODS Consecutive patients with APAC were recruited and randomized to receive one of two treatment options: immediate ALPI or systemic acetazolamide +/- mannitol. All eyes were followed up for at least 6 months after laser iridotomy. Main outcome measures were intraocular pressure (IOP) and requirement for glaucoma medications. RESULTS A total of 41 eyes (39 patients) were randomized into the ALPI group, and 38 eyes (32 patients) into the medical treatment group. There were no significant differences between the two groups in sex, age, presenting IOP, and duration of attack. Mean follow-up duration +/- SD was 15.7 +/- 5.8 months. There were no significant differences between the two groups in mean final IOP and requirement for glaucoma medications. CONCLUSIONS There were no statistically significant differences in mean IOP and requirement for glaucoma drugs between APAC eyes treated with ALPI and systemic medications.
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Affiliation(s)
- J S M Lai
- United Christian Hospital, Kowloon, Hong Kong, People's Republic of China.
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Lai JSM, Tham CCY, Chan JCH, Lam DSC. Diode Laser Transscleral Cyclophotocoagulation as Primary Surgical Treatment for Medically Uncontrolled Chronic Angle Closure Glaucoma. J Glaucoma 2005; 14:114-9. [PMID: 15741811 DOI: 10.1097/01.ijg.0000151890.41239.c5] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate the long-term efficacy and safety of diode laser transscleral cyclophotocoagulation as primary surgical treatment of medically uncontrolled chronic angle closure glaucoma. PATIENTS AND METHODS Thirteen eyes of 13 Chinese patients with medically uncontrolled chronic angle closure glaucoma were treated with diode laser transscleral cyclophotocoagulation between February 2000 and May 2001, and followed up for over 18 months. Post-treatment anti-glaucoma medications were adjusted according to intraocular pressure. If intraocular pressure remained above 21 mm Hg despite medications for more than 4 weeks after cyclophotocoagulation, the procedure was repeated. RESULTS Mean follow-up +/- SD was 26.5 +/- 4.2 months. Two eyes required repeat cyclophotocoagulation at 6 weeks. Rate of relative success, defined as maintaining an intraocular pressure of 21 mm Hg or below with or without medications, was 92.3% (12 of 13 eyes). Rate of absolute success, defined as maintaining an intraocular pressure of 21 mm Hg or below without medications, was 0% (0 of 13 eyes). Mean +/- SD intraocular pressure was reduced from 36.4 +/- 12.6 mm Hg pre-operatively, to 18.7 +/- 12.2 mm Hg at final follow-up (P = 0.003, paired t test). The mean +/- SD number of intraocular pressure-lowering eye drops was reduced from 2.0 +/- 0.8 pre-operatively, to the lowest point of 0.5 +/- 0.8 at 12 months, and then gradually increased to 2.1 +/- 0.9 at final follow-up. The visual acuity improved after treatment in 2 of 13 eyes (15.4%), remained unchanged in 6 of 13 eyes (46.2%) and deteriorated in 5 of 13 eyes (38.5%). No major complications were encountered. CONCLUSION Diode laser cyclophotocoagulation appeared to be an effective and safe primary surgical treatment of medically uncontrolled chronic angle closure glaucoma, with intraocular pressure-lowering effect persisting for up to two years.
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Affiliation(s)
- Jimmy S M Lai
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Peoples' Republic of China.
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Tham CCY, Lai JSM, Poon ASY, Chan JCH, Lam SW, Chua JKH, Lam DSC. Immediate argon laser peripheral iridoplasty (ALPI) as initial treatment for acute phacomorphic angle-closure (phacomorphic glaucoma) before cataract extraction: a preliminary study. Eye (Lond) 2004; 19:778-83. [PMID: 15359230 DOI: 10.1038/sj.eye.6701651] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To study the safety and efficacy of immediate argon laser peripheral iridoplasty (ALPI) as initial treatment of acute phacomorphic angle-closure (phacomorphic glaucoma) before cataract extraction. METHODS In all, 10 consecutive patients with acute phacomorphic angle-closure and intraocular pressure (IOP) > or =40 mmHg were recruited into the study. Each patient received topical atropine (1%) and timolol (0.5%), and immediate ALPI as initial treatment. The IOP at 15, 30, 60, and 120 min, and then 1 day, after ALPI were documented by applanation tonometry. Systemic IOP-lowering drugs were only started if IOP remained above 40 mmHg at 2 h after ALPI. Cataract extraction was subsequently performed as definitive treatment. RESULTS In total, 10 patients (five male, five female), with a mean age+/-SD of 73.1+/-10.3 years were recruited. Mean duration of symptomatic attack was 128+/-232 h. After ALPI, the mean IOP was reduced from 56.1+/-12.5 to 45.3+/-14.5 mmHg at 15 min, 37.6+/-7.5 mmHg at 30 min, 34.2+/-9.7 mmHg at 60 min, 25.5+/-8.7 mmHg at 120 min, and 13.6+/-4.2 mmHg at 1 day. In one patient, systemic acetazolamide was administered, because the IOP remained above 40 mmHg at 2 h after ALPI. All 10 patients had uncomplicated cataract extraction performed within 4 days after ALPI. No complications from the laser procedure were encountered. CONCLUSION Immediate ALPI, replacing systemic antiglaucomatous medications, appeared to be safe and effective as first-line treatment of acute phacomorphic angle-closure.
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Affiliation(s)
- C C Y Tham
- Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong, Hong Kong, People's Republic of China
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Lai JSM, Tham CCY, Chan JCH, Lam DSC. Phacotrabeculectomy in Treatment of Primary Angle-closure Glaucoma and Primary Open-angle Glaucoma. Jpn J Ophthalmol 2004; 48:408-11. [PMID: 15295672 DOI: 10.1007/s10384-003-0075-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2003] [Accepted: 11/28/2003] [Indexed: 12/01/2022]
Abstract
PURPOSE To evaluate the surgical outcome of combined phacoemulsification, posterior chamber intraocular lens implantation, and trabeculectomy (phacotrabeculectomy) in patients with primary angle-closure glaucoma (PACG) or primary open-angle glaucoma (POAG). METHODS The records of 57 consecutive patients (65 eyes) with PACG or POAG that were treated with phacotrabeculectomy were reviewed retrospectively. There were 31 eyes with PACG and 34 with POAG. The mean follow-up period was 21.0 +/- 8.3 months. The visual acuity, intraocular pressure (IOP), number of medications, and complications were evaluated. RESULTS The mean IOP and the number of glaucoma medications decreased significantly after phacotrabeculectomy in both groups. The mean IOP reduction was significantly greater in eyes with PACG (P < 0.05). The absolute success rates were 87.1% and 70.6% in PACG and POAG, respectively. The difference in the success rates was not significant (P = 0.297). The early postoperative complication rates were similar in both groups. CONCLUSIONS Phacotrabeculectomy results in greater IOP reduction in eyes with PACG than in those with POAG, but the overall success rates were not significantly different.
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Affiliation(s)
- Jimmy S M Lai
- Department of Ophthalmology, United Christian Hospital, Kowloon, Hong Kong.
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Lai JSM, Tham CCY, Chan JCH, Yip NKF, Tang WWT, Li PSH, Yeung JCC, Lam DSC. Scanning laser polarimetry in patients with acute attack of primary angle closure. Jpn J Ophthalmol 2003; 47:543-7. [PMID: 14636842 DOI: 10.1016/j.jjo.2003.08.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE To compare the retinal nerve fiber layer measurements of attacked eyes with their fellow eyes after a single unilateral attack of acute primary angle closure (APAC). METHODS Patients with a single episode of APAC in 1 eye, successfully treated with laser peripheral iridotomy, were recruited. Eyes with persistently raised intraocular pressure (IOP) after resolution of the acute attack were excluded. Scanning laser polarimetry was carried out at 6 months after remission of the acute attack. The various parameters between the attacked and the fellow eyes were compared using the Student t-test. RESULTS Twenty-six patients (24 female and 2 male, mean age 66.9+/-8.1 years) were recruited. The duration of the APAC ranged from 5 to 98 hours (mean, 36.3 hours). The mean presenting IOP during the acute attack was 62.0+/-9.4 mm Hg. Only the mean inferior ratio and the ellipse modulation showed a statistically significant difference between the attacked and the fellow eyes among the 12 standard scanning laser polarimetry measurement parameters. CONCLUSION No severe retinal nerve fiber layer damage was documented in eyes that suffered a single episode of APAC with duration of attack up to 48 hours. With duration of attack longer than 48 hours, retinal nerve fiber layer damage was detected.
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Affiliation(s)
- Jimmy S M Lai
- Department of Ophthalmology, United Christian Hospital, Kowloon, Hong Kong
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Abstract
PURPOSE To evaluate the efficacy and safety of diode laser transscleral cyclophotocoagulation in the treatment of chronic angle-closure glaucoma. PATIENTS AND METHODS A prospective, non-comparative interventional pilot study was conducted. Fourteen eyes of 14 Chinese patients with chronic angle-closure glaucoma whose intraocular pressures were greater than 21 mm Hg on medications were treated with diode laser transscleral cyclophotocoagulation using the G-probe at the United Christian Hospital between February 2000 and May 2001. The inferior 270 degrees quadrant (from 2 to 11 o'clock for right eye and from 1 to 10 o'clock for left eye) was treated and the patients were followed up regularly. The initial laser energy was set at 2,000 mWatt with a duration of 2 seconds. The post-treatment anti-glaucoma medications were adjusted according to the intraocular pressure. If medications failed to lower the intraocular pressure to below 21 mm Hg, cyclophotocoagulation to the same inferior 270 degrees quadrant was repeated. RESULTS All patients completed a 12-month follow-up period. The total success rate defined as IOP < 21 mm Hg with or without medication(s) was 85.7% at 1 year of follow-up review. The mean +/- SD intraocular pressure decreased from pre-treatment level of 36.9 +/- 11.7 mm Hg to 18.9 +/- 6.5 mm Hg at 1 year after treatment. The difference was statistically significant (P < 0.001) (Paired t test). The mean +/- SD number of IOP-lowering eyedrops was significantly reduced from 1.9 +/- 0.7 before cyclophotocoagulation to 0.4 +/- 0.8 at 1 year after treatment (P = 0.0002) (Paired t test). Two eyes required repeat treatment. Seven eyes (50%) had atonic pupil following the laser treatment. CONCLUSION Diode laser transscleral cyclophotocoagulation is effective in lowering the intraocular pressure in chronic angle-closure glaucoma and its effect lasts for at least 1 year.
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Affiliation(s)
- Jimmy S M Lai
- Department of Ophthalmology, United Christian Hospital, Kowloon, Hong Kong.
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Abstract
PURPOSE To determine and compare the incidence of postoperative nausea and vomiting in patients having phacoemulsification under topical or retrobulbar anesthesia. SETTING Department of Ophthalmology, United Christian Hospital, Hong Kong, China. METHODS In this prospective randomized clinical trial, patients scheduled for routine phacoemulsification with posterior chamber intraocular lens implantation under local anesthesia without sedation were randomized to receive topical anesthesia or retrobulbar anesthesia. One hundred seven eyes of 107 Chinese patients were included. There were 49 patients and 58 patients of similar age and sex distribution in the retrobulbar group and topical group, respectively. Postoperative nausea and vomiting (PONV), the need for an antiemetic, and intraocular pressure (IOP) were recorded 1 day after surgery. Also recorded were the patient's preexisting risk factors for PONV (if any), fasting time, duration of surgery, and intraoperative complications or need for supplementary anesthesia or analgesia. RESULTS The overall incidence of PONV in the entire study group was 3.7% (4 patients). No statistically significant differences in PONV were found between the 2 anesthesia techniques, although 6.1% (3 of 49) in the topical group had nausea compared with 1.7% (1 of 58) in the retrobulbar group. No significant differences were found in the fasting time, duration of surgery, or postoperative IOP between patients who had PONV and those who did not. CONCLUSIONS Topical and retrobulbar anesthesia were associated with a low incidence of PONV in routine phacoemulsification. There were no statistically significant differences in PONV between the 2 anesthesia techniques. No significant correlation was found between the incidence of PONV and the duration of surgery, presence of complications, fasting time, postoperative IOP, or history of PONV or motion sickness.
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Affiliation(s)
- Jonathan C H Chan
- Department of Ophthalmology, United Christian Hospital, Kwun Tong, Kowloon, Hong Kong, People's Republic of China
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