Hung-Ming Lee

A randomized double-masked crossover study comparing latanoprost 0.005% with unoprostone 0.12% in patients with primary open-angle glaucoma and ocular hypertension

PURPOSE To compare the intraocular pressure)-lowering effect and side effects of latanoprost 0.005% once daily with unoprostone 0.12% twice daily. METHODS Sixty patients with primary open-angle glaucoma or ocular hypertension were randomized to receive either latanoprost once daily in the evening and placebo once daily in the morning, or unoprostone twice daily in the morning and evening. The study was double masked and followed a crossover design with two treatment periods of 1 month separated by a 3-week washout period. The intraocular pressure was measured at 9 AM and 5 PM on the baseline and day 28 visits, and at 9 AM on day 2 and day 14 visits of each treatment period. The 9 AM measurement was taken 2 hours and 13 hours after the last drop of unoprostone and latanoprost, and the 5 PM measurement was at 10 and 21 hours, respectively. The mean of the measurements was calculated. Safety parameters were also recorded. RESULTS Fifty-six patients completed both treatment periods and had intraocular pressure data available for evaluation. After 1 month of treatment, latanoprost significantly reduced intraocular pressure (mean +/- SEM) by 6.1 +/- 0.5 mm Hg (P <.001) and unoprostone by 4.2 +/- 0.4 mm Hg (P <.001) adjusted from an overall baseline of 22.3 +/- 0.5 mm Hg and 23.2 +/- 0.4 mm Hg, respectively. The difference of 1.9 mm Hg between treatments was statistically significant in favor of latanoprost [P =.003, analysis of covariance (ANCOVA)]. Unadjusted analysis of responders using the percentage decrease in intraocular pressure showed that the proportion of responders in the latanoprost-treated group was greater than in the unoprostone-treated group. Adverse ocular symptoms and findings were mild in both treatment groups. Eye redness and ocular irritation were the most frequently reported events. CONCLUSIONS Latanoprost once daily was significantly more effective in reducing intraocular pressure compared with unoprostone twice daily after 1 month of treatment in patients with primary open-angle glaucoma and ocular hypertension. Both drugs were well tolerated with few ocular adverse events.

Subjective visual experience during extracapsular cataract extraction and intraocular lens implantation under retrobulbar anaesthesia

Purpose To investigate the subjective visual experience of patients during cataract surgery under retrobulbar anaesthesia.Methods One hundred cataract patients who underwent routine extracapsular cataract extraction and intraocular lens implantation under retrobulbar anaesthesia were interviewed by the authors on the same day after their operation regarding their visual experience in the operated eye during surgery.Results Forty-three men and 57 women were included in the study. Their mean age was 68.4 years (range 40-87 years). Their pre-operative best corrected visual acuity ranged from 6/12 to perception of light. Eighty-four eyes had no other ocular pathology apart from cataract. Twenty patients reported no light perception during the surgery. The rest reported that they could see light (80 patients), one or more colours (56 patients), movements (39 patients), flashes (36 patients), instruments (16 patients) and/or the surgeons fingers or hands (10 patients). The colours seen included red (29 patients), yellow (29 patients), green (12 patients), blue (11 patients) and orange (2 patients). Fifteen patients saw a spectrum of colours similar to that of the rainbow. Forty-four patients reported that the brightness of light changed during the operation. Five patients found their visual experience frightening. There was no correlation between those who found the experience frightening and the sex or age of patient, presence of coexisting ocular pathology, duration of operation, whether the operation was the first or second cataract operation in the patient, or the type of visual sensation experienced.Conclusion Many patients undergoing cataract surgery under retrobulbar anaesthesia experience a variety of visual sensations that may be frightening in a small proportion of cases.

Endogenous Klebsiella endophthalmitis.

Purpose To report 4 cases of endogenous Klebsiella endophthalmitis. This disease is a rare but devastating complication of Klebsiella sepsis. Familiarity with its varied clinical presentations would aid in early diagnosis and institution of appropriate therapy.Methods We report 5 eyes of 4 patients with endogenous Klebsiella endophthalmitis from December 1995 to September 1996 and review the literature regarding previously successfully treated cases.Results The mean age of the patients was 67.5 years (range 37–85 years). One patient had bilateral involvement. At presentation, 3 eyes had a visual acuity of no perception of light (NPL) and the 1 patient with bilateral involvement had an acuity of counting fingers in one eye and 20/40 in the other. The primary source of sepsis was the pulmonary system in 2 patients, the hepatobiliary system in 1 patient and the urinary tract in 1 patient. One patient had coexisting diabetes mellitus. Two patients had a pupillary hypopyon. Local and systemic treatment with an aminoglycoside and cephalosporin was initiated. Despite treatment, 2 eyes remained NPL. One eye developed a globe perforation and was eviscerated. The patient with bilateral involvement was treated within 8 h and recovered fully with a final visual acuity of 20/20 in both eyes.Conclusion It is important to have a high index of suspicion in patients with septicaemia presenting with intraocular inflammation, especially in diabetics with suppurative liver disease, urinary tract infection or pulmonary infection. As the visual prognosis for patients with Klebsiella endophthalmitis is generally poor, early diagnosis and treatment with intravenous and intravitreal antibiotics may improve the visual outcome.

Analgesic effect of supplemental intracameral lidocaine during phacoemulsification under topical anaesthesia: a randomised controlled trial.

Aims To determine the analgesic effect of supplemental intracameral lidocaine 1% during phacoemulsification under topical anaesthesia, and to assess the risk factors associated with pain. Methods In a double-masked, randomised, clinical trial, 506 patients undergoing phacoemulsification under topical anaesthesia were randomised to receive a supplemental intracameral injection of either 0.5 cc of 1% lidocaine (277 patients, 54.7%) or balanced salt solution (BSS) (229 patients, 45.3%). Patients were interviewed by a trained interviewer using a standardised questionnaire. The main outcome measure was intraoperative pain, scored on a visual analogue scale of 0–10. Logistic regression was performed to assess ORs. Results 125 of 277 patients (45.1%) experienced pain in the lidocaine group, compared with 123 of 229 patients (53.7%) in the BSS group. The proportion of patients who experienced pain was significantly lower in the intracameral lidocaine group compared with the BSS group (multivariate OR 0.68, 95% CI 0.47 to 0.97; p=0.034). The median pain score (range) was 0.0 for intracameral lidocaine group compared with 1.0 for BSS group (p=0.039). Pain was more common in females (54.3% vs 43.6%; OR 1.56), non-Chinese (62.3% vs 46.9%; OR 2.13) and those who had previous cataract surgery to the fellow eye (55.3% vs 44.7%; OR 1.61). Conclusion The use of 0.5 cc of 1% intracameral lidocaine during phacoemulsification under topical anaesthesia significantly reduces pain experienced by patients. Risk factors for pain include females, non-Chinese and previous cataract surgery.

Visually significant opacification of hydrophilic acrylic intraocular lenses--a clinico-pathological analysis.

Purpose To describe the clinic-pathological analysis of the visually significant opacification of the Cirrus International Hydroflex™ foldable hydrophilic acrylic intraocular lens (IOL) (model SC600-2, Medical Developmental Research Inc., Clearwater, Florida) and to highlight that this IOL is the same model as the Acryflex™ SC600-2 IOL, by the same manufacturer. Methods Retrospective review of five eyes of four patients with opacification of their Cirrus International Hydroflex™ foldable hydrophilic acrylic IOLs (model SC600-2) after uncomplicated phacoemulsification and IOL implantation. Two IOLs were explanted from two patients 14 to 24 months after initial implantation. Each explanted lens was divided into equal halves, one half for scanning electron microscopy (SEM) study and the other half for transmission electron microscopy (TEM) examination. SEM and TEM samples were also subjected to energy dispersive X-ray analysis (EDX). Results The IOL opacification was detected 14 to 24 months after uncomplicated phacoemulsification and IOL implantation. EDX analysis showed that the crystals contained calcium and phosphorus, presumably calcium phosphate. Conclusions The Cirrus Inter national Hydroflex™ foldable hydrophilic acr ylic IOL (model SC600-2) is associated with opacification, that appeared worse centrally than peripherally. This is the same model as the Acryflex™ SC600-2 IOL, made by the same manufacturer. The opacification consists of calcium and phosphate.

Selective argon laser suturelysis versus needle suturelysis to treat induced corneal astigmatism after cataract surgery

Purpose: To compare the complications and subjective experience of patients having argon laser suturelysis (LS) with those of patients having needle suturelysis (NS) for corneal astigmatism after extracapsular cataract extraction (ECCE). Setting: Department of Ophthalmology, Tan Tock Seng Hospital, Singapore. Methods: This prospective study comprised 30 patients (30 eyes) with more than 3.00 diopters of with‐the‐rule astigmatism after ECCE. A minimum of 5 weeks after surgery, 2 sutures along the steepest meridian were lysed by the same surgeon, 1 by a needle and the other by laser using a Hoskins lens. Patients were randomized to receive NS first followed by LS or LS followed by NS. The complications were recorded. The patients subjectively graded their fear and discomfort/pain during suturelysis using a scale from 0 to 10. Patient preference for either procedure was also recorded. Results: The complications of NS were conjunctival epithelial defect (17/30), subconjunctival hemorrhage (13/30), and corneal abrasion (4/30) and of LS, minor conjunctival burn (1/30) and conjunctival epithelial defect (1/30). The mean subjective fear and discomfort/pain scores in the NS group were significantly higher than in the LS group (P = .0010 and P = .0014, respectively). Nineteen patients preferred LS, 3 preferred NS, and 8 had no preference for either procedure. Conclusion: Argon laser suturelysis was associated with fewer complications than NS and was preferred by patients.