K S C Yuen

Epiretinal membrane surgery with or without internal limiting membrane peeling

Background:u2002 The purpose of the present paper was to evaluate the visual outcome and recurrence rate of epiretinal membrane (ERM) formation following vitreoretinal surgery with and without internal limiting membrane (ILM) peel.

Immediate pars plana vitrectomy for dislocated intravitreal lens fragments during cataract surgery

PurposeTo assess the outcome of patients who underwent instantaneous pars plana vitrectomy for dislocated lens fragments during cataract surgery.MethodsThe medical records of 29 patients who underwent immediate pars plana vitrectomy for dislocated lens fragments at the same sitting of phacoemulsification surgery were reviewed. Data including patients demographics, preoperative and postoperative vision, risk factors for lens fragment dislocation, and intraoperative and postoperative complications were recorded.ResultsThe mean follow-up period of the patients was 12.3 months (range, 3–47 months). The median preoperative visual acuity was 6/90 (range, LP to 6/15). The median final postoperative visual acuity was 6/18 (range, NLP to 6/9) and the mean improvement in vision after the operation was 4.5 lines. The commonest risk factors for dislocation of lens fragment were late detection of posterior capsule tear, splitting of anterior capsulorrhexis, and hard nucleus. After excluding nine eyes with other pre-existing ocular comorbidities, 10 (50%) eyes had a final visual acuity of 6/12 or better. Complications after surgery included three (10%) cases of retinal detachment and one (3%) patient developed epiretinal membrane. None of the patients in the study developed secondary glaucoma or cystoid macular oedema following surgery.ConclusionImmediate vitrectomy in the same sitting of the cataract surgery is a surgical option in the management of dislocated intravitreal lens fragments when vitreoretinal support is available. Most patients achieve a good visual outcome with reduced risk of secondary glaucoma and cystoid macular oedema after surgery.

Bilateral exudative retinal detachments as the presenting features of idiopathic orbital inflammation

Idiopathic orbital inflammation, also known as orbital pseudotumour, is a term describing a spectrum of idiopathic, non‐neoplastic, non‐infectious, space‐occupying orbital lesion without identifiable local or systemic cause. This disease occurs mainly in young adults and typically presents with acute proptosis, chemosis and limited extraocular movement. Herein an unusual case of idiopathic orbital inflammation presenting with bilateral exudative retinal detachment in a 9‐year‐old girl is described. It demonstrates that prompt diagnosis and corticosteroid treatment can yield good clinical response and significant visual recovery.

Tears and conjunctival scrapings for coronavirus in patients with SARS

Severe acute respiratory syndrome (SARS) was first recognised in Guangdong Province in China and later in Hong Kong in March 2003.1 Within a matter of weeks, the outbreak has evolved to become a global health threat and almost 30 countries have been afflicted with the novel coronavirus strain (SARS-CoV).2 SARS is a highly contagious potentially lethal disease. The main route of transmission is by respiratory droplets, though the virus has also been isolated in stool and in urine. Tears, being one of the body fluids, may potentially harbour the coronavirus. The presence of viruses in these body fluids may affect our precaution practices and sites of sampling for diagnostic tests.nnA prospective interventional case series study was conducted on the identification of the SARS-CoV virus in tear secretions and conjunctival cells of patients with confirmed SARS. Approval was obtained from the ethics committee of the Chinese University of Hong Kong. Consecutive patients with …

Precautions in ophthalmic practice in a hospital with a major acute SARS outbreak: an experience from Hong Kong

Many new infectious diseases in humans have been derived from animal sources in the past 20 years. Some are highly contagious and fatal. Vaccination may not be available and antiviral drugs are not effective enough. Infectious control is important in clinical medicine and in Ophthalmology. Severe acute respiratory syndrome (SARS), as an example, is a highly contagious respiratory disease that has recently been reported in Asia, North America, and Europe. Within a matter of weeks, the outbreak has evolved to become a global health threat and more than 30 countries have been afflicted with a novel Coronavirus strain (SARS-CoV) that is the aetiologic agent of SARS. The primary route of transmission of SARS appears involving close person-to-person contact through droplets. Ophthalmologists may be particularly susceptible to the infection as routine ophthalmic examinations like direct ophthalmoscopy and slit-lamp examination are usually performed in a setting that has close doctor–patient contact. Being the Ophthalmology Department of the only hospital in the world that has just gone through the largest outbreak of SARS, we would like to share our strategy, measures, and experiences of preventing contracting or spreading of SARS infection as an infection control model. SARS is one of the many viruses against which personnel will need protecting in an ophthalmic setting. The experiences attained and the measures established might also apply to other infectious conditions spreading by droplets such as the avian influenza with H5N1.

Ocular screening in severe acute respiratory syndrome

n Abstractn n To investigate the ocular manifestations of patients with severe acute respiratory syndrome (SARS) and to monitor the possible ocular complications arising from the treatment regimen with high-dose systemic corticosteroid drugs.n n n Designn Prospective, observational cohort case series.n n n Methodsn Ninety eyes from 45 patients with the diagnosis of SARS during an epidemic outbreak in Hong Kong were analyzed. Relevant medical and ophthalmic histories were taken. Ophthalmic examinations, including best-corrected visual acuity, intraocular pressure, slit-lamp, and indirect ophthalmoscopy examination, were performed at baseline and at 2-month and 3-month follow-up.n n n Settingn Faculty practice in university hospital.n n n Resultsn Only two patients had mild elevated intraocular pressure at baseline and at subsequent follow-up. There was no loss of visual acuity, cataract progression, or increased cup–disk ratio. Fundus examinations were unremarkable in all patients.n n n Conclusionsn Our study did not demonstrate any ocular manifestations in patients with SARS. The treatment regimen of high-dose corticosteroid also did not show any significant ocular complications. Routine ocular screening of patients with SARS for diagnosis or for complications might not be indicated.n n

Photodynamic therapy for recurrent myopic choroidal neovascularisation after limited macular translocation surgery

Limited macular translocation (LMT) is one of the treatment options for subfoveal choroidal neovascularisation (CNV) resulting from pathological myopia.1 The fundamental surgical principle involves the transposition of the foveal neurosensory retina to a new site with more healthy underlying retinal pigment epithelium.1,2 Direct laser photocoagulation is usually employed as an adjunct measure in eradicating the original CNV after the surgery. It has been observed that geometrically sizeable translocation is a prerequisite for a long term surgical success.2,3 The degree of translocation is, however, not often predictable and any ineffective displacement may render the subsequent laser photocoagulation extremely difficult or even impossible to perform.2,4 As a result, the recurrent or persistent CNV intruding the newly relocated fovea may jeopardise the final visual outcomes.4,5 Photodynamic therapy (PDT) may be considered a viable adjunct treatment option in such circumstance.nnA 41 year old woman with pathological myopia of −11.0 dioptres in both eyes presented with a subfoveal CNV and subretinal …

Time taken to do external and endoscopic endonasal dacryocystorhinostomy (DCR) surgery

present in the anterior chamber. A thin-walled bleb existed at the upper side of the conjunctiva. However, no opaque or leakage was seen in the bleb. The fundus was invisible because of extreme vitreous opacity. A pars plana vitrectomy was conducted with a tentative diagnosis of bleb-related endophthalmitis. The retina was mostly intact and several exudative lesions with white vessels were observed at the nasal and inferior mid-peripheries of the fundus (Figure 1). Suspecting of a viral infection, vitreous humour was sampled. Whereas the culture examination resulted in no bacterial growth, varicella-zoster virus (VZV)specific DNA was detected by polymerase chain reaction (PCR). The patient was diagnosed as ARNS caused by VZV. Intravenous infusion of acyclovir of 750 mg/day and oral corticosteroid of 40 mg/day with topical corticosteroid were initiated. The white-exudative lesions gradually subsided and became necrotic degeneration. Visual acuity improved up to 160/200 in the right eye 2 months after vitrectomy. To our knowledge, this is the first description of ARNS mimicking bleb-related endophthalmitis. We should be aware that viral infection could masquerade clinical features resembling a bacterial endophthalmitis.

Preoperative videotape sessions and patient satisfaction with cataract surgery

We read with interest the article by Pager.1 The study showed that a preoperative videotape session describing the experience of day stay cataract surgery resulted in a significant increase in overall satisfaction during the immediate postoperative period.nnPatient satisfaction has drawn increasing attentions in all field of medicine for medical, financial, and litigation reasons. Age, types …

The Ahmed glaucoma valve in refractory glaucoma: experiences in Indian eyes.

A diagnosis of a large peripapillary disciform in association with optic disc drusen was made. As the peripapillary disciform was threatening the fovea, it was decided to treat the lesion with argon laser photocoagulation. Follow-up at 2 weeks following treatment revealed an improvement in visual acuity, which was now 6/9–1 with marked resolution of retinal oedema. Fundus fluorescein angiography showed a well-treated peripapillary disciform (Figure 1b), although there was some residual leakage at the temporal disc margin.