Jovina See

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.

The epidemiology of ocular trauma in Singapore: perspective from the emergency service of a large tertiary hospital.

Purpose To describe the epidemiology of ocular trauma from the perspective of the emergency service of a large tertiary hospital in Singapore.Methods A prospective survey was conducted over a 3 month period (August to October 1997) on all patients seen at the ophthalmic unit at the Singapore General Hospitals emergency service. Data on clinical presentation, type and cause of injury and use of eye protective devices (EPD) were collected via a standardised interview and examination.Results A total of 870 persons presented with a diagnosis of ocular trauma, out of the 1631 patients seen during the study period. Compared with non-trauma cases, trauma cases were more likely to be male (odds ratio (OR): 4.2, 95% confidence interval (95% CI): 3.2, 5.4), non-residents (OR: 6.2, 95% CI: 3.7, 10.5), younger than 40 years of age (OR: 3.2, 95% CI: 2.7, 4.1) and less likely to require follow-up or hospital admission (OR: 0.2, 95% CI: 0.2, 0.3). The three most common types of injuries were superficial foreign body (58.2%), corneal abrasion (24.9%) and blunt trauma (12.6%), while open globe injury occurred in only 17 cases (2%). Comparison with a 10% random sample of all cases seen in the previous 9 months (n = 284) revealed no significant time variation in the types of injuries (p = 0.63). Work-related injuries accounted for 590 (71.4%) cases, where grinding, cutting metal and drilling were the specific activities in more than 90% of the cases. In appropriate settings, only 21.7% of patients with work-related injuries used EPD; 43.7% were provided with EPD, but did not use them at the time of injury; and the remaining 34.6% reported that EPD were not provided.Conclusions Ocular trauma at the emergency service level in Singapore involved mainly young non-resident men, were work-related and associated with well-defined activities, and were generally minor. The low prevalence of EPD use reinforces the need for a review of the design and implementation of occupational eye safety programmes, especially among non-resident workers.

Micropulse transscleral diode laser cyclophotocoagulation in the treatment of refractory glaucoma.

Background:  Transscleral diode laser cyclophotocoagulation (TSCPC) is an established method of treatment for refractory glaucoma, but is associated with significant complications. This study evaluates the efficacy and safety of a new form of TSCPC using micropulse diode laser and trans‐pars plana treatment with a novel contact probe.

Imaging of the anterior segment in glaucoma

Although constituting only about a quarter of all glaucoma, angle closure glaucoma causes a disproportionate amount of visual morbidity and is predicted to be responsible for almost half of bilateral blindness by 2020. Early detection and treatment of angle closure significantly improves visual prognosis. Identification of eyes at risk of angle closure currently relies on opportunistic case detection, often by gonioscopy. However, gonioscopy is a highly subjective technique and often leads to misdiagnosis and underdetection of angle closure. More recently, various imaging modalities that allow a more objective assessment of the anterior segment structures, including anterior segment optical coherence tomography and the scanning peripheral anterior chamber depth analyser, have come under close scrutiny for their potential in screening for angle closure. Their accuracy and repeatability, advantages and disadvantages as well as their ease of use are all important to consider whether they are intended for use in the clinical setting or if they are to be incorporated into mass screening programs. Furthermore, their place alongside gonioscopy and more established technologies such as ultrasound biomicroscopy must be considered. The aim of this paper is to review the anterior segment imaging technologies that are currently available.

High-definition imaging of trabeculectomy blebs using spectral domain optical coherence tomography adapted for the anterior segment.

Background:  The aim of this work was to image trabeculectomy blebs using spectral domain optical coherence tomography (SDOCT).

Surgical Treatment of Angle-Closure Glaucoma

The main objective of surgical treatment in angle closure is to quickly decrease the intraocular pressure and therefore reduce the risk of further glaucomatous optic nerve damage. Surgical treatment of angle-closure glaucoma also helps to ensure that progressive angle closure does not occur, and that the risk of acute angle closure is abolished. The surgical options are diverse and include laser surgery, filtering surgery, lens extraction, combined lens extraction and filtering surgery, angle widening procedures such as goniosynechialysis, lens extraction combined with goniosynechialysis or a combination of procedures.

Facial Scanning With a Digital Camera: A Novel Way of Screening for Primary Angle Closure.

Purpose:We hypothesize that patients with primary angle closure (PAC) have common significant facial characteristics that set them apart from an age-matched, sex-matched, and race-matched control population. The primary objective of this study was to test whether a 3-dimensional (3D) camera could pick up these differences in order to differentiate PAC patients from controls. Patients:A total of 55 patients with PAC and 38 controls were included in the study. Materials and Methods:Cases and controls had their facial photographs taken using a 3-dimensional digital camera (3dMdFace System). The facial features in the captured photographs were analyzed using a computer software (Neural Network Toolbox). A regression formula was devised to show whether these facial parameters could be used to distinguish between patients and controls. Results:Thirteen facial parameters were measured, and using a regression formula and neural network classification we were able to mathematically distinguish patients from controls using this method of screening. Conclusions:PAC patients have distinct facial features that may be differentiated from those of normal individuals mathematically using 3D photography. There is potential for this 3D facial scanning technology in screening for PAC in the general population.