Clement Wn Chan

Bilateral Deepening of Upper Lid Sulcus From Topical Bimatoprost Therapy

PURPOSE To report a new adverse effect related to treatment with bimatoprost. METHOD Case report. A 43-year-old Asian female with bilateral glaucoma was noticed to have bilateral deepening of upper lid sulcus 3 months after beginning treatment with bimatoprost 0.03%. RESULTS Bimatoprost was discontinued due to cosmetic reasons, and there was improvement of the lid sulcus deepening bilaterally 4 weeks after stopping the drug. CONCLUSIONS Deepening of upper lid sulcus is one of the adverse effects related to treatment with bimatoprost. This effect may be more prominent in Asians who have relatively full upper lid sulcus.

Exotropic Drift and Ocular Alignment After Surgical Correction for Intermittent Exotropia

PURPOSE To evaluate changes in the angle of deviation over time and compare the motor success rate with different initial postoperative deviation in patients undergoing surgical correction for intermittent exotropia. METHODS Forty-eight patients aged between 1 and 10 years who underwent bilateral lateral rectus recession for intermittent exotropia were retrospectively evaluated. Preoperative and postoperative ocular deviations at 1 week, 1 month, and 6 months were analyzed. Full surgical correction was attempted in all patients. Motor success was defined as ocular deviation within 10 prism diopters of orthophoria at 6 months postoperatively. RESULTS The follow-up period ranged from 6 months to 3 years. Although most patients had exotropic drift, this drift was greater in patients with initial esotropia (86.7%) and orthophoria (70.0%) compared to patients with exotropia (26.1%). Motor success was achieved in 29 (60.4%) patients. There was no statistical difference between ocular alignment at 1 week postoperatively and final motor success (P = .782). There was good correlation between ocular alignment at 1 week and 6 months postoperatively (rho = 0.585, P < .001). Age and preoperative deviation were not found to be associated with motor success. CONCLUSIONS The success rate appears to be unaffected by initial ocular alignment, suggesting that deliberate initial overcorrection may be unnecessary. Future studies are warranted to evaluate the long-term stability of this alignment.

Corneal collagen cross-linking demarcation line depth assessed by Visante OCT After CXL for keratoconus and corneal ectasia.

PURPOSE To report the demarcation line depth after corneal collagen cross-linking (CXL) for keratoconus and postoperative LASIK ectasia with Visante (Carl Zeiss Meditec) optical coherence tomography (OCT) and investigate correlations between this depth and preoperative parameters and postoperative visual and keratometry outcomes. METHODS Retrospective interventional case series of 40 eyes with keratoconus or postoperative LASIK ectasia treated with riboflavin ultraviolet-A CXL. Ophthalmic evaluation included uncorrected distance visual acuity, corrected distance visual acuity (CDVA), corneal topography (Pentacam, Oculus Optikgeräte GmbH), and postoperative anterior segment OCT. Correlation analyses were performed. Statistical significance was indicated by P<.05. RESULTS At 6 months postoperative, mean demarcation line depth was 281.4±53.3 μm. Thinner minimal corneal thickness (r=0.413, P=.008), older age (r=-0.490, P=.001), higher grading of ectasia (for both keratoconus and postoperative LASIK ectasia) (r=-0.332, P=.044), female sex (r=0.343, P=.030), postoperative LASIK ectasia (r=-0.420, P=.007), and longer duration of disease (r=-0.377, P=.023) were correlated with shallower demarcation line depth. Forward stepwise multiple linear regression analysis showed that among all preoperative factors, minimal corneal thickness (standardized β=0.473, P=.003) and age (standardized β=-0.317, P=.036) were significantly associated with demarcation line depth. The CXL demarcation line depth and change in CDVA (r=-0.16, P=.325) and change of the steepest keratometry at 6 months (r=0.084, P=.637) were not correlated. CONCLUSIONS The Visante OCT can be used for assessing CXL demarcation line depth. The demarcation line depth may decrease with the severity of ectasia and age.

Anti‐vascular endothelial growth factor for myopic choroidal neovascularization

Myopic choroidal neovascularization (CNV) is a vision‐threatening complication in the eyes with pathological myopia, which is particularly prevalent among young and middle‐aged Asians globally. To date, the verteporfin in photodynamic therapy study is the only randomized‐controlled study in treatment of subfoveal myopic CNV. However, its long‐term benefit is controversial. Recently, intravitreal injections of anti‐vascular endothelial growth factors have shown promising results. In the absence of randomized‐controlled trial comparing the efficacy of anti‐vascular endothelial growth factors with photodynamic therapy and placebo, the purpose of this article is to review the current studies on functional and anatomical outcomes in both subfoveal and juxtafoveal myopic CNV. Furthermore, the influences of various doses and frequencies, as well as age and previous photodynamic therapy treatment on its effect are described.Myopic choroidal neovascularization (CNV) is a vision-threatening complication in the eyes with pathological myopia, which is particularly prevalent among young and middle-aged Asians globally. To date, the verteporfin in photodynamic therapy study is the only randomized-controlled study in treatment of subfoveal myopic CNV. However, its long-term benefit is controversial. Recently, intravitreal injections of anti-vascular endothelial growth factors have shown promising results. In the absence of randomized-controlled trial comparing the efficacy of anti-vascular endothelial growth factors with photodynamic therapy and placebo, the purpose of this article is to review the current studies on functional and anatomical outcomes in both subfoveal and juxtafoveal myopic CNV. Furthermore, the influences of various doses and frequencies, as well as age and previous photodynamic therapy treatment on its effect are described.

Clinical outcomes of a cardiac rehabilitation and maintenance program for Chinese patients with congestive heart failure

Purpose. To investigate the effectiveness of a standard Cardiac Rehabilitation Programme (CRP) and an Extended Maintenance Programme (EMP) for patients with congestive heart failure (CHF). Method. Subjects with CHF discharged from hospitalization were invited to participate in a 6-week CRP followed by a 12-week EMP. Outcome variables included New York Heart Association functional classification, distance covered in a 6 minute-walk distance (6MWD), health-related quality of life (HRQOL) questionnaire and rate of hospital re-admission. Results. Of 58 invited subjects, 26 completed the CRP and 18 continued with EMP. Subjects who participated in CRP and EMP showed superior improvement in 6MWT and HRQOL scores (p < 0.05) compared with those who did not participate in either program (control). Subjects who continued with the EMP demonstrated further improved performance compared with those who participated in CRP only. Of those re-admitted to hospital with symptoms associated with CHF, 73% were patients from the control group; 21% were those who completed the CRP and 6% were patients who completed the EMP. Conclusion. CRP is effective in improving functional capacity, HRQOL and reduces hospital readmission for patients with CHF. An EMP provides opportunities for further improvement in outcome. However there is a need to improve the patient participation rate of the programme in the Chinese community.

Reemergence of syphilitic uveitis masquerading as other diseases: a report of two cases.

During a 6-month period in 2010, 2 patients with uveitis were examined at our department and diagnosed with ocular syphilis. They initially presented with symptoms and signs resembling Harada’s disease and Behçet’s disease and were therefore treated with systemic steroids with suboptimal responses. When laboratory workup revealed neurosyphilis, they were given a course of intravenous penicillin G, which led to significant clinical and visual improvement. Epidemiological data indicates a worldwide reemergence of syphilis and a high degree of suspicion is necessary in view of its multitude of presenting ocular signs without pathognomonic features.

Predictive Factors Affecting the Short Term and Long Term Exodrift in Patients with Intermittent Exotropia after Bilateral Rectus Muscle Recession and Its Effect on Surgical Outcome

Purpose. To determine the predictive factors that affect short term and long term postoperative drift in intermittent exotropia after bilateral lateral rectus recession and to evaluate its effect on surgical outcome. Methods. Retrospective review of 203 patients with diagnosis of intermittent exotropia, who had surgical corrections with more than 3 years of followup. Different preoperative parameters were obtained and evaluated using Pearsons correlation analysis. Results. The proportion of exodrift increased from 62% at 6 weeks to 84% at 3 years postoperatively. The postoperative drift was 4.3 ± 8.1 PD at 6 weeks, 5.8 ± 8.4 PD at 6 months, 7.2 ± 8.3 PD at 1 year, 7.4 ± 8.4 PD at 2 years, and 7.7 ± 8.5 PD at 3 years. Preoperative deviation and initial overcorrection were significant factors affecting the postoperative drift at 3 years (r = 0.177, P = 0.011, r = −0.349, and P < 0.001, resp.). Conclusions. Postoperative exodrift along three years occurs in a majority of patients after bilateral lateral rectus recession for intermittent exotropia. The long term surgical success is significantly affected by this postoperative exodrift. A larger preoperative deviation and a larger initial overcorrection are associated with a larger early and late postoperative exodrift.

A prospective study of fusional convergence parameters in Chinese patients with intermittent exotropia

PURPOSE To evaluate the correlation between different fusional convergence parameters and the Newcastle Control Score (NCS) in children with intermittent exotropia. METHODS In this consecutive prospective observational series, 101 Chinese children with intermittent exotropia were examined by a single observer, who assessed the level of control using the revised NCS and measured the angle of deviation and fusional convergence. Levels of control were defined according to the NCS as good (0-3), moderate (4-6), or poor (7-9). The correlation between the different fusional convergence parameters and the NCS was evaluated. RESULTS The total convergence amplitude was similar among the different control groups (P = 0.288 and P = 0.628 at near and at distance, respectively). The convergence reserve was higher in the good control group compared with the moderate and poor control groups, both at near (P = 0.001) and at distance (P = 0.001). Among all fusional convergence parameters, we determined that the fusional reserve ratio had strongest correlation with control (near ratio: r = -0.66, P = 0.001; distant ratio: r = -0.59, P = 0.001). Among patients with a fusional reserve ratio ≥ 2 at distance, 100% (5 of 5 patients) of these patients demonstrated good control (NCS ≤ 3). CONCLUSIONS In children with intermittent exotropia, the total convergence amplitude was similar among different levels of control. The convergence reserve was lower in the poor control group. Fusional reserve ratio ≥ 2 was an indicator of good control in patients.

Refractive changes after pediatric intraocular lens implantation in Hong Kong children.

PURPOSE To report the refractive changes after cataract surgery and intraocular lens (IOL) implantation in Hong Kong Chinese children. METHODS The clinical records of all patients who had cataract extraction and IOL implantation before age 18 years and with more than 2 years of follow-up were studied retrospectively. The refractive errors of all patients determined by cycloplegic refraction at 6 weeks, 3 months, 6 months, and 1 year postoperatively and then annually thereafter were included for analysis. Patients were stratified into groups according to their age at IOL implantation for analysis. RESULTS Twenty-six eyes (81.3%) had developmental cataracts, 3 eyes (9.4%) had traumatic cataracts, and 3 eyes (9.4%) were iatrogenic (from surgical or medical treatment). Patients demonstrated a mean myopic shift (diopters) of -5.53 (0 to 2 years old) -4.68 (3 to 5 years old), -2.60 (6 to 8 years old), -0.42 (9 to 11 years), and -0.09 (> 11 years). There was no significant difference in myopic shift between eyes that were operated on and those that were not. No statistically significant differences in refractive change were found in comparing males to females, unilateral to bilateral cases, traumatic to non-traumatic cases, amblyopic to nonamblyopic eyes, primary to secondary intraocular lenses, or polymethylmethacrylate to acrylic IOLs. CONCLUSION The postoperative myopic shift in pediatric patients undergoing IOL implantation is greatest in the younger age groups and persists until at least 8 years of age. The mean rate of myopic shift also decreases with age. The refractive development of the pseudophakic eyes was not significantly different from the fellow phakic eyes.

Retinal nerve fiber layer thickness after a single attack of primary acute angle-closure glaucoma measured with optical coherence tomography.

BACKGROUND AND OBJECTIVE After a single unilateral acute primary angle-closure glaucoma attack, retinal nerve fiber layer (RNFL) may be thinned. The current study measured the RNFL thickness using optical coherence tomography in eyes with normal visual fields after recovery from a single attack of acute primary angle-closure glaucoma. PATIENTS AND METHODS Twenty-one patients and age-matched control subjects underwent optical coherence tomography scanning after recovery from a single unilateral acute primary angle-closure glaucoma attack. Data from the affected eyes, normal fellow eyes, and control subjects were compared. RESULTS Average RNFL thickness was 91.3 +/- 16.4 microm in the affected eyes, 100.1 +/- 16.4 microm in the fellow eyes, and 100.2 +/- 16.7 microm in the control eyes. Significant thinning was present in the affected eyes compared to the fellow eyes (P = .001) and the control eyes (P = .04). CONCLUSION RNFL thickness was found to be significantly thinner in the eyes with angle-closure glaucoma.