G Y S Leung

A randomised trial comparing 0.02% mitomycin C and limbal conjunctival autograft after excision of primary pterygium

Background: Mitomycin C (MMC) and limbal conjunctival autograft (LCAU) are two known useful adjuvants in the prevention of pterygial recurrence. This study was conducted to compare the outcome of these two treatments. Methods: Prospective study on consecutive cases of primary pterygium (February 2001 to March 2002) randomised into two adjuvant groups: (1) intraoperative 0.02% MMC for 5 minutes or (2) LCAU. Patients were followed for recurrence (defined as fibrovascular tissue invading the cornea >1.5mm) and complications for a period of one year. Results: 115 eyes in 114 patients who completed the study were randomised to receive MMC (n = 63) and LCAU (n = 52). There were 10 recurrences (15.9%) in the MMC group and only one recurrence (1.9%) in the LCAU group. There was a statistically significant difference in the recurrence rate between the two groups (p = 0.04). There were a total of three conjunctival cysts, three symblephara, one granuloma, and one dellen. No other visually significant complications were encountered in either group. Conclusion: Although LCAU resulted in better one year success rates, it is technically more difficult and inapplicable in cases with previous limbal disturbance. Simple excision followed by MMC or LCAU are both safe and acceptable adjuvants for pterygium excision. Choice of adjuvant should be carefully made based on assessment of recurrence risk, local practices, and surgeon’s expertise.

The use of autologous serum tears in persistent corneal epithelial defects

AbstractPurpose Persistent corneal epithelial defects (PED) present a very challenging problem to anterior segment surgeons. Autologous serum tears had been demonstrated to be beneficial in the treatment of PED. The current study was conducted to review the local spectrum of indications and to examine the outcome of autologous serum tear usage.Methods All cases of PED treated with autologous serum tears at a tertiary referral centre for the period August 1999 – July 2001 were identified and reviewed.Results A total of 10 eyes from 10 patients were identified (5OD : 5OS). The gender ratio was 7M : 3F and the mean age was 36.8 (range 17–73) years old. The mean duration of PED before the usage of autologous serum tears was 22.4±69.6 days. Six eyes healed within 2 weeks, but two eyes failed to heal after 1 month of treatment and two patients defaulted follow-up. No adverse effects were observed with the addition of autoserum tears.Conclusions The results of the current study correlated well with previous reported studies. Autologous serum tears may be considered as a valuable adjunct in the management of recalcitrant cases of PED.

Late Traumatic Flap Dislocations After LASIK

PURPOSE To report the management and outcome of late onset traumatic dislocation of LASIK flaps. METHODS This retrospective, interventional case series presents three patients with late onset LASIK flap dislocation following mechanical trauma 1 to 7 years postoperatively. RESULTS In all cases, the flap was surgically repositioned. Epithelial ingrowth was removed and diffuse lamellar keratitis was treated with an intensive steroid regimen. All patients returned to their preoperative best spectacle-corrected visual acuity. Aggressive steroid treatment during the perioperative period and meticulous handling of the epithelium are important in preventing further recurrence. CONCLUSIONS Laser in situ keratomileusis flaps may experience mechanical dislocation as late as 7 years postoperatively. Diffuse lamellar keratitis and epithelial ingrowth are associated with flap dislodgment.

Clinical study on cognitive dysfunction after spontaneous subarachnoid haemorrhage: patient profiles and relationship to cholinergic dysfunction.

PurposeWe aimed to explore the cognitive profiles of subarachnoid haemorrhage patients who returned to the community, along with the associated risk factors.MethodsWe recruited 40 Chinese patients with spontaneous subarachnoid haemorrhage 7–27 months after the initial presentation. They had all been discharged to their homes or to care homes for the elderly. For cognitive assessment, we employed the Cognitive Subscale of the Alzheimer Disease Assessment Scale (ADAS-cog) for global cognitive function, the Frontal Assessment Battery (FAB) for frontal lobe function, and the Rivermead Behavioural Memory Test (RBMT) for everyday memory function.ResultsAn ADAS-cog of more than 21/85 (poor global cognitive function) was noted in 14 (35%) patients. A FAB of less than 12/18 (poor frontal lobe function) was noted in 13 (27.5%) patients. An RBMT score of less than 15/26 (poor everyday memory function) was noted in 17 (43.6%) patients. Poor cognitive function was found to be associated with chronic hydrocephalus (in terms of FAB), with clinical vasospasm (in terms of RBMT), and with cerebral infarction (in terms of RBMT).ConclusionsPoor cognitive function was common and occurred in up to 43.6% of the patients, with the verbal and behavioural memory aspects predominantly affected. We did not find a significant association between cholinergic dysfunction and cognitive dysfunction. Organization of future drug trials and cognitive rehabilitation should take into account the association between frontal lobe dysfunction and chronic hydrocephalus.

Preliminary in vitro evaluation of 2-octyl cyanoacrylate (Dermabond) to seal corneal incisions.

Objective: To compare the efficacy of Dermabond® with conventional nylon sutures for sealing linear corneal incisions. Methods: A keratome knife was used to create a 4-mm full-thickness linear corneal incision anterior to the limbal arcade in 20 fresh pig eyes. The incision was sealed with Dermabond® tissue adhesive or closed with 10-0 nylon sutures. A 27-gauge needle connected via tubing to a bottle containing balanced salt solution (BSS) was inserted into the anterior chamber. Infusion pressure was controlled by varying the height of the column of BSS. The tensile strength of the incisions was measured by increasing the infusion pressure to the point where leakage was noted. Results: The mean height at which leakage was detected was 100.20 ± 31.19 cm H2O (equivalent to a pressure of 73.70 ± 22.99 mm Hg) for the nylon suture group (n = 10 eyes) and 113.80 ± 31.20 cm H2O (equivalent to a pressure of 83.71 ± 22.95 mm Hg) for the Dermabond group (n = 10 eyes). The difference was not significant (P = 0.343). Conclusions: The mean leakage pressures were comparable for the 2 groups. Either method of closure should be able to withstand any postoperative increases in intraocular pressure. Dermabond adhesive may be considered as an alternative to conventional sutures in corneal wound closure.

Prospective study on the safety and efficacy of combined conjunctival rotational autograft with intraoperative 0.02% mitomycin C in primary pterygium excision.

Purpose: To describe the novel use of combined conjunctival rotational autograft (CRA) and intraoperative 0.02% mitomycin C (MMC) in the treatment of primary pterygium and to evaluate its safety and efficacy. Methods: Prospective interventional case series comparing with historical controls was conducted. Patients with primary pterygium underwent pterygium excision, MMC was applied to the scleral bed after the surface conjunctiva was harvested, and the CRA was sutured back with a 180-degree rotation. Patients were followed for a minimum of 1 year. Results: Sixty-seven eyes from 67 patients participated in the study, of which 31 (46.3%) were men and 36 (53.7%) were women. The mean age was 58 ± 10.6 years, (range 36-79 years). There were 2 recurrences (3%), one occurring at month 3 and the other at month 9. Compared with historical controls, CRA-MMC resulted in significantly fewer recurrences than MMC alone (P = 0.005) when adjusted for age and was equally effective when compared with limbal-conjunctival autografts. The main postoperative problem was graft injection, which was noted in 41 eyes (61%) at 1 year. Conclusions: To the best of our knowledge, this was the first study on the combined use of CRA and MMC in the treatment of primary pterygium. CRA with MMC was found to be effective in the prevention of recurrence. Although injection remained as a cosmetic concern, it was a safe alternative to limbal-conjunctival autograft in cases where mobilizing autologous conjunctival tissue would not be feasible.

Successful treatment of surgically induced necrotizing scleritis with tacrolimus

A 46‐year‐old man developed surgically induced necrotizing scleritis (SINS) 7 months following uneventful primary bare sclera pterygium excision. The patient underwent two scleral patch grafts for SINS but despite the use of cyclophosphamide and azathioprine, the scleral patch grafts failed within 1 month of surgery on both occasions. Tacrolimus was used for his third scleral patch graft. No recurrence of necrotizing scleritis was observed for 2 years. Tacrolimus may be considered as a valuable adjunctive immunosuppressant in the management of resistant necrotizing scleritis.

A modified technique of scleral fixated intraocular lenses for aphakic correction

AbstractPurposeTo examine the safety and efficacy of a modified scleral fixated intraocular lens (SFIOL) technique combining a scleral tunnel for intraocular lens (IOL) insertion, horizontal passage of sutures, and performing anterior vitrectomy through self-sealing pars plana sclerostomies.MethodsRetrospective review of all patients who underwent SFIOL for aphakic correction at the Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong (a tertiary referral centre) between October 2000 and December 2001 with either the modified or conventional techniques.ResultsA total of 20 eyes were identified. Eight modified (Group 1) and 12 conventional (Group 2) with a mean follow-up of 18.3 months. Postoperatively, all the eyes improved on unaided preoperative acuity and they all had a stable and well-positioned IOL. In all, 85% (7/8) of eyes in Group 1 maintained or improved best-corrected visual acuity.ConclusionsThe modified SFIOL technique was found to be as safe and effective as conventional techniques. The main advantages of this technique include easy intraoperative suture management and superior globe maintenance.

Randomised controlled trial on the effectiveness of lidocaine gel vs tetracaine drops as the sole topical anaesthetic agent for primary pterygium surgery

PurposeTo determine the effectiveness of lidocaine 2% gel vstetracaine 1% drops in primary pterygium surgery.MethodsThis was a prospective, randomised controlled trial. Forty consecutive patients who had primary pterygium underwent surgical excision of primary pterygium and mitomycin C. Patients were randomised into two groups. Group 1 received tetracaine 1% drops and solcoseryl eye gel (Solco Basel AG, Switzerland). Group 2 received xylocaine 2% gel (lidocaine hydrochloride 2% gel, AstraZeneca, Sweden) topically and normal saline drops 0.9%. Additional tetracaine drops were given to patients who experienced pain preoperatively. The primary outcome was the pain experienced during and after surgery. Immediately after the operation, pain and discomfort scores were assessed by the patients and doctor using a 10-point linear analogue scale. The stages of the operation were divided into the following: stage 1—first incision, stage 2—pterygium body excision, stage 3—conjunctival suturing, and stage 4—immediate postoperative after patching.ResultsThere was no statistically significant difference in the mean pain scores experienced during pterygium excision (3.03±2.35 for the lidocaine group and 3.98±2.18 for the tetracaine group). However, for stage 3, there was a statistically significant difference in mean pain scores experienced during closure (P=0.03) (0.47±0.84 for the lidocaine gel group and 1.43±1.66 for the tetracaine group), with patients of group 2 experienced less pain. The mean number of additional drops required by the eyes in lidocaine gel group was also significantly (0.16±0.11) less than the tetracaine group (0.67±0.09, P=0.001).ConclusionsTopical administration of lidocaine 2% gel or tetracaine 1 % drops are both effective anaesthetic agents for primary pterygium surgery and mitomycin C. However, lidocaine gel is superior to tetracaine eye drops and its application is more convenient with a less frequent application and a sustained duration of action.

Rivastigmine for cognitive impairment after spontaneous subarachnoid haemorrhage: a pilot study

Background and objective:  Rivastigmine has been shown to be effective for patients with mild‐to‐moderate Alzheimer’s disease. Its effect on cognitive impairment after aneurysmal subarachnoid haemorrhage has not been previously studied. The aim of the study is to evaluate the efficacy and safety of rivastigmine 3 mg/day over 12 weeks in patients with aneurysmal subarachnoid haemorrhage and persistent cognitive impairment.