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  Most popular articles (Since March 16, 2017)

 
 
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REVIEW ARTICLES
The diagnostic challenge of evaluating papilledema in the pediatric patient
Brandon McCafferty, Collin M McClelland, Michael S Lee
January-March 2017, 7(1):15-21
DOI:10.4103/tjo.tjo_17_17  PMID:29018749
Pseudopapilledema is a fairly common finding in ophthalmic practice, and in many cases, the diagnosis is straightforward. However, an accurate diagnosis can challenge the most seasoned clinicians, and missing true papilledema can result in life-threatening or vision-threatening consequences. In this review, we describe the clinical findings and a diagnostic algorithm to distinguish pseudopapilledema and papilledema in the pediatric patients. We also describe the clinical evaluation once a diagnosis of papilledema has been established.
  2,373 313 2
Multifocal intraocular lenses: Types, outcomes, complications and how to solve them
Liberdade C Salerno, Mauro C Tiveron, Jorge L Alió
October-December 2017, 7(4):179-184
DOI:10.4103/tjo.tjo_19_17  PMID:29296549
The multifocal intraocular lenses (IOLs) available are often able to restore visual function and allow spectacle independence after their implantation with great levels of patient satisfaction. The factors associated with the postoperatory success include the careful selection of the patient, the knowledge about the IOLs' design, and their visual performance added to the proper surgical technique and management of possible complications as demonstrated by the evidence available.
  1,795 422 1
Optical coherence tomography angiography: Technical principles and clinical applications in ophthalmology
Ahmed M Hagag, Simon S Gao, Yali Jia, David Huang
July-September 2017, 7(3):115-129
DOI:10.4103/tjo.tjo_31_17  PMID:28966909
Optical coherence tomography angiography (OCTA) is a functional extension of OCT that provides information on retinal and choroidal circulations without the need for dye injections. With the recent development of high-speed OCT systems and efficient algorithms, OCTA has become clinically feasible. In this review article, we discuss the technical principles of OCTA, including image processing and artifacts, and its clinical applications in ophthalmology. We summarize recent studies which qualitatively or quantitatively assess disease presentation, progression, and/or response to treatment.
  1,581 419 7
Pearls and pitfalls in the management of Duane syndrome
Seyhan B Ozkan
January-March 2017, 7(1):3-11
DOI:10.4103/tjo.tjo_20_17  PMID:29018747
Duane syndrome (DS) is a common form of congenital cranial dysinnervation disorders. The ocular motility pattern lies in a wide clinical spectrum, and the choice of treatment must be individualized depending on the severity of the clinical findings. There is no perfect method of treatment and no real “cure” in DS. In this paper, the aim is to give some guidelines to the reader for selection of the most appropriate treatment method for the patient.
  1,693 218 1
Pharmacological therapy for amblyopia
Anupam Singh, Ritu Nagpal, Sanjeev Kumar Mittal, Chirag Bahuguna, Prashant Kumar
April-June 2017, 7(2):62-69
DOI:10.4103/tjo.tjo_8_17  PMID:29018759
Amblyopia is the most common cause of preventable blindness in children and young adults. Most of the amblyopic visual loss is reversible if detected and treated at appropriate time. It affects 1.0 to 5.0% of the general population. Various treatment modalities have been tried like refractive correction, patching (both full time and part time), penalization and pharmacological therapy. Refractive correction alone improves visual acuity in one third of patients with anisometropic amblyopia. Various drugs have also been tried of which carbidopa & levodopa have been popular. Most of these agents are still in experimental stage, though levodopa-carbidopa combination therapy has been widely studied in human amblyopes with good outcomes. Levodopa therapy may be considered in cases with residual amblyopia, although occlusion therapy remains the initial treatment choice. Regression of effect after stoppage of therapy remains a concern. Further studies are therefore needed to evaluate the full efficacy and side effect profile of these agents.
  1,462 253 -
SPECIAL REPORT
How to effectively manage myopia
Ann Yi-Chiun Chuang
January-March 2017, 7(1):44-47
DOI:10.4103/tjo.tjo_24_17  PMID:29018754
Myopia has become epidemic in the world. Without effective control, the progression may lead to excessive myopia with severe complications affecting vision and ocular alignment. The genetic factors and environmental factors of myopia are closely interrelated to each other. Asian ethnicity and parental myopia, among other genetic factors, influence the refractive outcome dramatically when environmental risk factors such as hours of near work and reading distance are analyzed. Outdoor activities are protective measures that retard myopia progression. Total time under the sun and not the specific outdoor activities are contributing factors. Current effective treatments for myopia include atropine of high, moderate, and low doses, relative peripheral myopia-inducing devices, and bifocal spectacles including prism bifocal spectacle lenses. Although atropine is considered highly effective in randomized controlled trials, it is not well tolerated in a clinical setting, especially in high dosage. Since the severity of rebound effect of atropine after cessation of usage and the side effects are directly related to the concentration of the medication, it is recommended that low-dose atropine is used in the initial attempt. Higher concentration for better control can be considered when compliance is observed. Devices that induce relative peripheral myopia such as orthokeratology are moderately effective interventions that are well accepted by children who wish to be spectacle free. Bifocal spectacles generally have low effect in myopia control. Prism bifocal spectacle lenses may have a special niche in myopia retardation for patients with low lags of accommodation.
  1,333 346 -
REVIEW ARTICLES
Immunoglobulin G4-related ophthalmic disease
Wei-Kuang Yu, Chieh-Chih Tsai, Shu-Ching Kao, Catherine Jui-Ling Liu
January-March 2018, 8(1):9-14
DOI:10.4103/tjo.tjo_12_17  PMID:29675343
Immunoglobulin G4-related disease (IgG4-RD) is a recently recognized inflammatory disease of unknown etiology. It characterized by distinctive histopathological appearance of dense IgG4-positive lymphoplasmacytic infiltrates, storiform fibrosis, and obliterative phlebitis in one or more organs, simultaneously or subsequently. In cases of ocular adnexal involvement, unique clinicohistopathological features were delineated by recent studies, and IgG4-related ophthalmic disease (IgG4-ROD) is generally recognized as the disease name. A significant proportion of previous labeled idiopathic orbital inflammations and Mikulicz's disease are now consistent with a diagnosis of IgG4-ROD. Increasing studies have accumulated regarding its epidemiology, diagnosis, clinical features, treatment, and the association between lymphoma. In this review, we summarize our present understanding of IgG4-ROD.
  1,376 244 -
Update on ocular myasthenia gravis in Taiwan
Chao-Wen Lin, Ta-Ching Chen, Jieh-Ren Jou, Lin-Chung Woung
April-June 2018, 8(2):67-73
DOI:10.4103/tjo.tjo_39_17  PMID:30038884
Myasthenia gravis (MG) is an autoimmune disease involving the neuromuscular junction. Autoantibodies to the acetylcholine receptor or, less frequently, to muscle-specific kinase, attack against the postsynaptic junctional proteins, resulting in fluctuating and variable weakness of muscles. Extraocular, levator palpebrae superioris, and orbicularis oculi muscles are particularly susceptible. The majority of patients with MG present with purely ocular symptoms including ptosis and diplopia initially. About half of these patients progress to generalized disease within 2 years. The prevalence of MG in Taiwan is 140 per million with male to female ratio of 0.7. The incidence rate is higher in the elderly. Several immune-related diseases such as lymphoid malignancy, diabetes, and thyroid diseases are associated with MG in the national population-based studies in Taiwan. Ice pack test, rest test, Tensilon/neostigmine test, circulating antibody measurement, and electrophysiological studies are useful diagnostic tools with variable sensitivity and specificity. For the patients with ocular MG, acetylcholinesterase inhibitors are usually the first-line treatment. Corticosteroids and immunosuppressant could provide better disease control and may reduce the risk of conversion to generalized form although there is still some controversy. A thymectomy is also beneficial for ocular MG, especially in refractory cases. The correction of ptosis and strabismus surgery could improve the visual outcome but should be performed only in stable disease.
  1,366 197 -
Surgical treatment of unilateral severe simple congenital ptosis
Ju-Hyang Lee, Yoon-Duck Kim
January-March 2018, 8(1):3-8
DOI:10.4103/tjo.tjo_70_17  PMID:29675342
Unilateral congenital ptosis with poor levator function of ≤4 mm continues to be a difficult challenge for the oculoplastic surgeon. Surgical correction can be accomplished with unilateral frontalis suspension, maximal levator resection, or bilateral frontalis suspension with or without levator muscle excision of the normal eyelid. Bilateral frontalis suspension was proposed by Beard and Callahan to overcome the challenge of postoperative asymmetry, allowing symmetrical lagophthalmos on downgaze, postoperatively. However, most surgeons and patients prefer unilateral correction on the abnormal eyelid either with a frontalis suspension or maximal levator resection. Frontalis suspension may be performed through the various surgical techniques using different autogenous or exogenous materials. Autogenous fascia lata is considered the material of choice with low recurrence rates but carries the drawbacks of the difficulty of harvesting and postoperative morbidity from the second surgical site. Recent reports have suggested that maximal levator resection provides improved cosmesis, a more natural contour, and avoids brow scars. Although both treatments have shown to have similar success rates, there is much debate about what the most favorable method for treating severe unilateral ptosis. We review the literature on the various surgical treatments for unilateral severe congenital ptosis, including the rationale, advantages and disadvantages of each technique.
  1,250 195 -
Glaucoma suspects: A practical approach
Syed Shoeb Ahmad
April-June 2018, 8(2):74-81
DOI:10.4103/tjo.tjo_106_17  PMID:30038885
Glaucoma suspects are controversial clinical dilemmas. These individuals harbor certain risk factors or demonstrate some clinical features suggestive of an increased probability to develop glaucomatous optic atrophy in the future. These characteristics range from high intraocular pressure; optic disc, visual field, or retinal nerve fiber layer abnormalities; or abnormal angles to a positive family history of glaucoma and other risk factors. Individuals having these characteristics should be assessed diligently before a diagnosis of glaucoma is made. Glaucoma is a chronic, lifelong condition, having a negative impact on the quality of life, with an increased risk of medication-related side-effects, adverse economic impacts, and the need for lifestyle changes in the patient. Overdiagnosis and unnecessary treatment of such individuals is bereft of any advantage. This review aims to provide a practical blueprint for the proper diagnosis and management of such glaucoma suspects.
  1,098 241 -
ORIGINAL ARTICLES
Dexamethasone implant (0.7 mg) in Indian patients with macular edema: Real-life scenario
Manish Nagpal, Navneet Mehrotra, Rakesh Juneja, Hardik Jain
July-September 2018, 8(3):141-148
DOI:10.4103/tjo.tjo_62_17  PMID:30294527
Context: Role of Ozurdex in macular edema due to various posterior segment pathologies. AIM: The aim of this study is to report outcome of Ozurdex implant in macular edema (ME) secondary to various posterior segment pathologies. SETTINGS AND DESIGN: This was a single-center, retrospective, interventional study. SUBJECTS AND METHODS: Patients of ME were treated with one or more Ozurdex implants (0.7 mg). Data collection included demographic details, best-corrected visual acuity (BCVA), central foveal thickness (CFT), duration of efficacy, and record of adverse events (if any) within 24 weeks. STATISTICAL ANALYSIS USED: Paired sample t-test, Stata data analysis, and statistical software, version 12.1, StataCorp, College Station, TX, USA, were used in the study. RESULTS: One hundred and sixteen eyes of 104 patients were studied which had a diagnosis of diabetic ME (n = 46), retinal vein occlusion (n = 40), and uveitis (n = 30). The average age of patients (mean ± standard deviation) was 50.2 ± 21.9 years. Baseline mean ± SD (standard deviation) logMAR BCVA, CFT, and intraocular pressure (IOP) were 0.636 ± 0.4, 527.8 ± 210.1 μm, and 15.3 ± 3.8 mmHg, respectively. The reinjection interval was around 12–18 weeks. Ozurdex proved its efficacy in improving mean logMAR visual acuity and reduction of CFT from baseline till 12 weeks' follow-up period (0.414 ± 0.5 and 301.5 ± 278.5, respectively; P < 0.05), and after 12 weeks' follow-up, it started worsening (0.530 ± 0.9 and 444.8 ± 375.2, respectively; P > 0.05). The most common reported adverse event was significant rise of IOP (>5 mmHg), with a total of 12 cases followed by cataract 9 cases. CONCLUSION: Ozurdex implant leads to a significant improvement in BCVA and CFT values till 12 weeks, followed by a gradual decline for all the pathologies studied together. No new safety concerns were observed with the Ozurdex implant. The duration of efficacy was found to be <24 weeks.
  1,184 131 -
Knowledge and practices of teachers associated with eye health of primary school children in Rawalpindi, Pakistan
Ume Habiba, Gail M Ormsby, Zahid Ahmad Butt, Tayyab Afghani, Muhammad Asif
January-March 2017, 7(1):28-33
DOI:10.4103/tjo.tjo_11_17  PMID:29018751
Purpose: Teachers' perspectives on eye health can be limited, particularly in developing countries. The aim of this study was to assess teachers' knowledge and practices associated with eye health of primary students in Rawalpindi, Pakistan. Methods: This was a cross-sectional survey of primary school teachers. Simple random sampling technique was used to select 443 participants from 34 private and 17 public schools. A self-administered questionnaire was used. Results: Teachers' knowledge ranged from “high” (35.89%), “moderate” (49.89%), and “low” (14.22%). Teachers' practices associated with students' eye health ranged from “high” (10.16%), “moderate” (23.02%), and “low” (66.82%). The teachers' knowledge index scores increased 4.28 points with successive age groups and increased 2.41 points with each successive level of education. For teachers whose close relatives experienced eye disease, their knowledge index score was 4.51 points higher than those teachers whose relatives never had any eye disease. Teachers' age, education level, and their close relatives experiencing eye disease were significant predictors of their knowledge (R2 = 0.087, P< 0.001). Female teachers' practices index score was 10.35 points higher than the male teachers and public school teachers had 10.13 points higher than the private school teachers. Teachers' gender and type of school were significant predictors of their practices (R2 = 0.06, P< 0.001). Conclusion: There was a significant gap among primary school teachers' knowledge and practices related to students' eye health. Innovative strategies are needed to improve how teachers address students' eye health issues in the classroom.
  1,123 148 -
CASE REPORTS
Vitrectomy for macular hole following Nd:YAG laser injury
Gregory E Stein, Jesse J Jung, Steven Bodine, Stephen L Trokel, Stanley Chang
October-December 2016, 6(4):195-198
DOI:10.1016/j.tjo.2016.05.005  PMID:29018741
The Q-switched Nd:YAG laser can cause significant ocular injury, because it can emit an invisible and powerful load of energy in a short period of time. One of these injuries is macular hole formation. We report the case of a 21-year-old woman who presented with acute floaters in her left eye after exposure to a Q-switched Nd:YAG laser. Her initial best-corrected visual acuity (BCVA) in the left eye was 20/80. Examination demonstrated an acute vitreous hemorrhage, and spectral-domain optical coherence tomography (SD-OCT) confirmed a full-thickness macular hole (FTMH). Four months after her injury, her BCVA deteriorated to 20/400, and she underwent vitrectomy, internal limiting membrane peeling, and gas injection. Three weeks following the procedure, her FTMH was closed, however, her BCVA remained 20/150. At her last office visit, 19 months after the surgery, the examination was unchanged. There are few reports of vitrectomy to close an FTMH after Nd:YAG laser exposure, and the factors that contribute to visual recovery remain unclear. The aim of this case report is to emphasize the importance of early diagnosis and surgical repair, and to review the literature and surgical outcomes of cases of Nd:YAG laser-induced macular holes. Imaging with SD-OCT was essential in evaluating the visual outcome, as it was dependent on the degree of photoreceptor and retinal pigment epithelium injury.
  1,150 61 -
ORIGINAL ARTICLES
Factors affecting surgical outcome of intermittent exotropia
Chee-Ming Lee, Ming-Hui Sun, Ling-Yuh Kao, Ken-Kuo Lin, Meng-Ling Yang
January-March 2018, 8(1):24-30
DOI:10.4103/tjo.tjo_44_17  PMID:29675346
PURPOSE: The purpose of this study was to investigate the factors affecting surgical outcome in intermittent exotropia. DESIGNS: This was a retrospective interventional study. METHODS: Intermittent exotropic patients who had undergone surgical correction with a postoperative follow-up period of 1 month or more were included in the study. Surgical success was defined as an alignment between 10 prism diopters (PD) of exotropia or 5 PD of esotropia at 1 month. After data collection, data were analyzed in SPSS version 23 software. The main outcome measures were the factors affecting surgical outcome. RESULTS: We included 101 patients, including 52 (51.5%) male and 49 (48.5%) female. Among them, 62 (61.4%) patients achieved surgical success. Undercorrection was the primary reason of surgical failure. Multivariate regression analysis showed that a larger preoperative angle of deviation was associated with unfavorable surgical outcome (P = 0.053, odds ratio [OR] =0.97, 95% confidence interval [CI] = 0.94–1.00), and the presence of postoperative day 1 (POD 1) diplopia correlated significantly with higher surgical success (P = 0.001, OR = 4.54, 95% CI = 1.80–11.43). The presence of POD 1 diplopia was highly associated with POD 1 esotropia (P = 0.005, OR = 7.26, 95% CI = 1.84–28.58). CONCLUSION: In intermittent exotropia, larger preoperative angle of deviation may predict a lower surgical success rate. Despite a worrisome issue, the presence of diplopia on first POD is associated with immediate postoperative alignment of esotropia and predicts a higher surgical success.
  1,085 109 -
Visual performance after excimer laser photorefractive keratectomy for high myopia
Yu-Ling Liu, Chien-Chi Tseng, Chang-Ping Lin
April-June 2017, 7(2):82-88
DOI:10.4103/tjo.tjo_6_17  PMID:29018762
Purpose: To evaluate the efficacy, safety, predictability, and visual performance of excimer laser photorefractive keratectomy (PRK) for myopia greater than −8 diopters (D). Methods: Fifty-four patients (104 eyes) with myopia from −8D to −13D and cylinder up to −4D received surface ablation technique with the Allegretto wave version 1009-1 excimer laser to correct their refractive error. The patients were examined on days 1, 3, 7, and 14 and 1, 3, 6, and 12 months postoperatively. Visual acuity, manifest refraction, corneal haze, topography, intraocular pressure, contrast sensitivity, and wavefront aberration were evaluated. Results: Twelve months postoperatively, 95% of eyes were within 1D of the intended correction. In addition, 94% of eyes had attained uncorrected distance visual acuity of 20/25 or better, and 98% of eyes had improved or remained their corrected distance visual acuity. All eyes exhibited barely detectable corneal haze which peaked during the 1st month with a gradual reduction in the 3rd month. Ninety-five percent of patients had no or only mild degree of night glare. Conclusions: Excimer laser PRK is an effective and predictive treatment for high myopia greater than −8D with or without astigmatism up to −4D. The incidence of complication is low. All patients who are candidates for laser in situ keratomileusis can be candidates for surface ablation, especially those with preoperative thinner cornea or higher risk of corneal flap complications.
  1,004 182 1
REVIEW ARTICLES
Neovascular glaucoma: Handling in the future
Hongfang Yang, Xiaobo Yu, Xinghuai Sun
April-June 2018, 8(2):60-66
DOI:10.4103/tjo.tjo_39_18  PMID:30038883
Neovascular glaucoma (NVG), which is refractory to both medical management and surgical intervention, is a disastrous ocular disease for it always ends up with intolerable pain and extinguishing patients' residual visual function. Since insufficient acknowledge of the pathophysiological and molecular mechanisms of NVG, it has been laying a challenging dilemma of managing NVG in clinical practice for a long time. Along with the progression on some new agents and surgical options targeting certain possible roles in the NVG process, there seems having been some new sights but still much unknown and to be revealed. This review discusses the underlying etiologic diseases of NVG, molecular findings and characteristics of its pathogenic process, as well as the management of NVG in detail. In addition, here represents some of our hypothesis regarding the interesting findings about NVG in clinical practice, aiming to provide some new enlightenment for future research.
  914 260 -
Management of macular edema due to central retinal vein occlusion – The role of aflibercept
William Rhoades, Drew Dickson, Quan Dong Nguyen, Diana V Do
April-June 2017, 7(2):70-76
DOI:10.4103/tjo.tjo_9_17  PMID:29018760
Central retinal vein occlusion (CRVO) can cause vision loss. The pathogenesis of CRVO involves a thrombus formation leading to increased retinal capillary pressure, increased vascular permeability, and possibly retinal neovascularization. Vision loss due to CRVO is commonly caused by macular edema. Multiple treatment modalities have been used to treat macular edema. Currently, the most common therapy used is intravitreal inhibition of vascular endothelial growth factor (VEGF). The three most widely used agents are aflibercept, bevacizumab, and ranibizumab and they are effective at blocking VEGF. In addition, intraocular steroids can be used to treat macular edema. This review will briefly cover the treatment options and discuss in greater detail the efficacy and safety of aflibercept.
  923 239 3
EDITORIAL
Therapy for Amblyopia: A newer perspective
May-Yung Yen
April-June 2017, 7(2):59-61
DOI:10.4103/tjo.tjo_56_17  PMID:29018758
  900 215 -
ORIGINAL ARTICLES
Management of diplopia with visual-field defects
Ling-Yuh Kao, Chun-Hsiu Liu, Meng-Ling Yang
January-March 2017, 7(1):22-27
DOI:10.4103/tjo.tjo_5_17  PMID:29018750
Purpose: The management of diplopia can be challenging in patients with a concurrent visual-field (VF) defect. We conducted a retrospective chart review to analyze and compare treatment outcomes for different types of VF defects. Methods: A retrospective chart review. Results: Seven patients with diplopia and VF defects were identified during the study. Four had bitemporal hemianopia, one had homonymous hemianopia, and two had a constricted central VF. A favorable or satisfactory outcome was achieved in all but two patients with bitemporal hemianopia. Conclusions: The hemifield-slide diplopia may develop in patients with bitemporal hemianopia or heteronymous altitudinal visual defects. Sensory abnormalities usually persist, even after elimination of ocular misalignment.
  994 120 -
REVIEW ARTICLES
Historical review of inferior oblique muscle surgery
Miho Sato
January-March 2017, 7(1):12-14
DOI:10.4103/tjo.tjo_21_17  PMID:29018748
Surgery on inferior oblique muscle has a long history and various surgical techniques have been developed. The historical review of the surgery starting in 1840's to date is performed. The surgical effectiveness between simple myectomy and recession is still controversial.
  936 164 -
ORIGINAL ARTICLES
The relationship between optic atrophy 1 polymorphism and normal tension glaucoma in Taiwan
Yan-Ting Chen, San-Ni Chen, Chin-San Liu
April-June 2018, 8(2):82-86
DOI:10.4103/tjo.tjo_92_17  PMID:30038886
PURPOSE: The purpose of this research is to evaluate the relationship between of optic atrophy 1 (OPA1) polymorphism and normal tension glaucoma (NTG) by surveying patients from central Taiwan. This study finding could help us to understand the impact of OPA1 polymorphism on glaucoma. METHODS: We try to identify the effect of OPA1 polymorphism by comparing the clinical presentation in three catalogs of gene polymorphism in patients with NTG. Our research team includes patients with NTG from central Taiwan and assesses the OPA1 intervening sequence 8 (IVS8) + 4 C->T and IVS8 + 32 T->C polymorphism. We divide these patients into three OPA1 IVS8 + 4 subgroups, CC, CT, TT, and three IVS8 + 32 subgroups, TT, TC, CC. By collecting their ocular clinical data, systemic background, and other possible factors related to the presentation of glaucoma, we can compare these characters of each polymorphism subgroup. RESULTS: We find that all patients do not have OPA1 IVS8 + 4 C->T polymorphism while some of them do have IVS8 + 32 T->C polymorphism. NTG with OPA1 IVS8 + 32 T->C polymorphism inclines to have more nasal-step type visual field defect (P = 0.016) and inferior nerve fiber layer thickness loss (P = 0.098) in comparison to NTG with IVS8 + 32 wild type. CONCLUSIONS: The OPA1 IVS8 + 32 T->C polymorphism partake to the phenotype and prognosis of NTG in central Taiwan. Even though our findings are far from clear enough to serve as guides for the differentiation of NTG etiologies, they still give us a glimpse of the impact of OPA1 in chronic optic neuropathy.
  945 139 -
CASE REPORTS
Postoperative intraocular lens opacification
Shang-Te Ma, Chung-May Yang, Yu-Chih Hou
January-March 2018, 8(1):49-51
DOI:10.4103/tjo.tjo_78_17  PMID:29675350
Intraocular lens (IOL) opacification is rare but may occur after non-Descemet stripping automated endothelial keratoplasty (n-DSAEK) or intravitreal air injection after pars plana vitrectomy (PPV). We reported two cases of IOL opacification within the pupillary region. Chart was retrospectively reviewed. The predisposing factors and the visual acuity were analyzed. The opacification was evaluated by anterior segment optical coherence tomography (AS-OCT). A 68-year-old healthy woman with pseudophakic bullous keratopathy underwent uneventful n-DSAEK in the right eye. Postoperative vision was 20/40. Nine months after surgery, fine granular deposits were seen in the anterior surface of IOL. The vision decreased to 20/50 but remained stable during 3-year follow-up. A 61-year-old man with diabetes mellitus received PPV and silicone oil tamponade for retinal detachment and vitreal hemorrhage after cataract surgery in the right eye. Removal of silicone oil and intravitreal air injection was performed, and postoperative vision was 20/100. Granular deposits were observed in hydrophobic acrylic IOL 1 month after surgery. The visual acuity decreased to 20/120. AS-OCT revealed hyperreflective materials in the anterior surface of IOL in both cases. An uncommon phenomenon of IOL opacification in the pupil region may occur after n-DSAEK or PPV, which may be associated with intraocular air injection or systemic diseases.
  946 112 -
ORIGINAL ARTICLES
Comparison of endoscopic and external dacryocystorhinostomy for treatment of primary acquired nasolacrimal duct obstruction
Pei-Yuan Su
January-March 2018, 8(1):19-23
DOI:10.4103/tjo.tjo_10_18  PMID:29675345
PURPOSE: The purpose of this study is to compare the success rates of endoscopic endonasal dacryocystorhinostomy (EN-DCR) and external DCR (EX-DCR) for the treatment of primary acquired nasolacrimal duct obstruction (PANLDO). DESIGN: This was a retrospective, comparative, nonrandomized clinical study. METHODS: Reviewed medical records of PANLDO underwent DCR at Far-Eastern Memorial Hospital from May 2011 to June 2017. Data regarding the lacrimal passage system, comorbidities, surgical outcomes, and postoperative complications were analyzed. Anatomical success was defined as patency confirmed by intranasal endoscopic inspection of the ostium and successful lacrimal irrigation; functional success was defined as complete resolution of epiphora and positive fluorescein dye disappearance test, which were assessed at postoperative 6th months. RESULTS: One hundred and seventy patients (37 males, 133 females, mean age 57 years) underwent 178 DCR surgeries for PANLDO. The overall anatomical success rate was 94.4% (93.5% in EN-DCR vs. 95.8% in EX-DCR, P = 0.511) and functional success rate was 90.4% (90.7% in EN-DCR and 90.1% in EX-DCR, P = 0.909). Surgical outcomes were comparable between two groups. Complication rate was low in both groups, including 11 cases of early canalicular stent dislodge (7 in EN-DCR, 4 in EX-DCR), one case of postoperative nasal bleeding in EN-DCR, and two skin wound dehiscence and three cutaneous keloid formation in EX-DCR. None of these cases were concluded into surgical failure at the final visit. The time to symptoms relief was statistical significantly shorter in EN-DCR group (1.7 vs. 3.7 weeks in EX-DCR, P < 0.001). CONCLUSIONS: Success rate of DCR for PANLDO in our study was high, and complication rate was low for both endoscopic and external approaches. There was no statistically significant difference between them. EN-DCR provided higher satisfaction due to quicker recovery and lack of external incision. Endoscopic DCR should be considered as the primary treatment of choice for PANLDO.
  890 161 1
ORIGINAL ARTICLE
Endothelial cell loss in penetrating keratoplasty, endothelial keratoplasty, and deep anterior lamellar keratoplasty
Bo-I Ku, Yi-Ting Hsieh, Fung-Rong Hu, I-Jong Wan, Wei-Li Chen, Yu-Chih Hou
October-December 2017, 7(4):199-204
DOI:10.4103/tjo.tjo_55_17  PMID:29296552
PURPOSE: To compare endothelial cell density (ECD) loss rates in penetrating keratoplasty (PKP), Descemet's stripping automated endothelial keratoplasty (DSAEK), and deep anterior lamellar keratoplasty (DALK). DESIGN: Single-center, multiple-surgeon, retrospective cohort study. MATERIALS AND METHODS: Patients who received PKP, DSAEK, or DALK from 2009 to 2014 were analyzed (68 vs. 38 vs. 11 patients, respectively). We excluded patients with therapeutic PKP or regraft, infection, endothelial rejection, or uncontrolled glaucoma. Only clear grafts and initial ECD more than 1000 cell/mm2 were included in the study. The main outcome was ECD loss rate. The follow-up time period was divided into five subgroups: 0–1.5 months, 1.5–6 months, 6–12 months, 12–24 months, and longer than 24 months. RESULTS: Average ECD loss rate (cell/mm2/month) declined in all three groups (PKP group: −561.5, −113.2, −36.6, −31.4, and −53.7; DSAEK group: −686.4, −68.3, −21.8, −14.4, and −5.1; DALK group: −576.5, −68, −23.7, 5.9, and 18.3). Although DSAEK group showed faster ECD loss rate in the early postoperative period, it became slower compared to the PKP group within the postoperative 6th month and demonstrated significant difference within 2 years. No ECD loss developed in the DALK group after the 1st postoperative year; this was significantly different from the PKP group. CONCLUSIONS: Although ECD loss rate in the DSAEK group was initially larger than that in the PKP group, the DSAEK group possessed better long-term endothelial cell survival rate. The DALK group had a lower ECD loss rate than that of the other groups and maintained a stable ECD at 1 year after surgery.
  890 133 1
REVIEW ARTICLES
Aqueous shunt implantation in glaucoma
Jing Wang, Keith Barton
July-September 2017, 7(3):130-137
DOI:10.4103/tjo.tjo_35_17  PMID:29034151
Aqueous shunts or glaucoma drainage devices are increasingly utilized in the management of refractory glaucoma. The general design of the most commonly-used shunts is based on the principles of the Molteno implant: ie. a permanent sclerostomy (tube), a predetermined bleb area (plate) and diversion of aqueous humour to the equatorial region and away from the limbal subconjunctival space. These three factors make aqueous shunts more resistant to scarring as compared to trabeculectomy. The two most commonly used shunts are the Ahmed Glaucoma Valve, which contains a flow-restrictor, and the non-valved Baervedlt Glaucoma Implant. While the valved implants have a lower tendency to hypotony and related complications, the non-valved implants with larger, more-biocompatible end plate design, achieve lower intraocular pressures with less encapsulation. Non-valved implants require additional suturing techniques to prevent early hypotony and a number of these methods will be described. Although serious shunt-related infection is rare, corneal decompensation and diplopia are small but significant risks.
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