Eye Department Research Articles

Incidence and baseline risk factors for pseudoexfoliation in Sweden: a long-term follow-up study.

To estimate the incidence of pseudoexfoliation (PEX) and its associated risk factors in a defined population in Sweden. The development of PEX was studied in a cohort of 489 residents aged 65-74years, examined in a population survey in the municipality of Tierp 1984-1986. To expand the sample size, 576 people were recruited by means of glaucoma case records established at the Eye Department in Tierp in 1978-2007. In this way, the cohort comprised 1065 subjects, representing nearly 10500 person-years at risk. Incidence rates with 95% confidence intervals (CIs) were calculated. Survival analyses were performed to identify predictors for PEX. Those with a follow-up time shorter than 1year were excluded. By the end of the study in November 2018, 179 new cases of PEX had been found. Of these, 78 had participated in the population survey, equal to an incidence rate of 14.8 per 1000 person-years (95% CI 11.5-18.1). The development of PEX was associated with higher age (hazard ratio 1.08 per year; 95% CI 1.03-1.13) and female gender (hazard ratio 1.59; 95% CI 1.16-2.18). In this study on a Swedish population, the incidence of PEX was high. Increasing age and female gender were the only predictors for PEX identified.

Public-Private Partnership in Health Care and Its Impact on Health Outcomes: Evidence from Ruharo Mission Hospital in South Western Uganda

Background: Uganda’s government embraced private provision of social services including health care. The involvement of private providers is an indicator that the public facilities are not sufficient enough to meet the high demands of the ever-increasing population. This has been done through partnership arrangements. This paper discusses the impact of Public-Private Partnership (PPP) on health care outcomes of the local population and opportunities for improving health outcomes, challenges facing private providers in a low-income setting like Uganda. Methodology: This was a qualitative study, data were collected using qualitative methods in January 2017 through interview (using semi-structured questions) at Ruharo Mission Hospital (RMH) administration, health workers, district health office and used a structured questionnaire for patients/clients. This was a nascent study, with a sample size of 22 respondents. The hospital has three departments; Organized Useful Rehabilitation Services (OURS), General Medical Services (GMS) and Eye Department (ED). All the departments of the hospital were represented in this study. Results: The hospital is a Church of Uganda founded, and runs a budget of 5 billion shillings ($ 1,351,351.4) annually, has multiple sources of funding including PHC funding annually and that, health services were delivered adequately to clients. Much as some services were accessed at no costs, other services like eye treatment were found expensive on the side of clients. The hospital’s hybrid mode of delivering health services through outreaches and facility-based services was cherished, however it had no ambulance and relied only on a hospital van. Conclusions and Recommendations: Our study concludes that if private providers are supported under the partnership arrangement, they can adequately deliver services to the clients and decongest the public facilities. We recommend that the government devote more funds to support the hospital through employing more sub-seconded staff, procuring medicines, and ambulances to enable it to subsidize services especially eye treatment and other services not supported under the partnership.

Evaluation of eye prescriptions for appropriateness and rationality in indoor patients: an observational prospective study

Background: In the branch of ophthalmology, there have been many developments of new ocular therapeutic agents. Indiscriminate use of topical drugs can lead to various unwanted effects. In order to improve drugs therapeutic efficacy, minimize adverse effects, and delay development of resistance, drug utilization trends and patterns need to be evaluated periodically. The objective of the study was to evaluate drug utilization pattern, appropriateness of use and rationality in indoor patients attending ophthalmology department.Methods: A prospective, observational study was conducted over a period of 15 months in the Ophthalmology Department of Tertiary care teaching Hospital after obtaining permission from IEC. Information of patients collected included age, sex, duration of stay, diagnosis, income per capita per month, information about drugs given- their dose, frequency, route and duration were recorded from the day of admission till discharge.Results: A total of 150 patients were enrolled in the study with M:F was 1.43:1. Mean hospitalization was 3.00±1.17 days. Most common disease were cataract (108, 72%) followed by pterygium (15, 10%). Mean of 16.35±4.25 medicines were prescribed. On most occasions (2274, 92.70%) the medicines were prescribed using brand names. Injection gentamicin 147 (98%) and flurbiprofen eye drops 145 (96.67%) were the most common drugs used. Majority (83.20%) of medicines were rational. Out of 125 medicines, 35 (28%) were FDC and 90 (72%) were single ingredient. All 100% medicine uses were appropriate with respect to dosage form, route of administration, dosage, frequency of administration and duration of therapy.Conclusions: Polypharmacy is common practice in eye department which increases inappropriateness and irrational use.

Clinical and experimental evaluation of new back-flow hydrodissection technique

To assess the efficacy and safety of a new technique, back-flow hydrodissection. Hirota Eye Clinic, Yamaguchi, and Department of Ophthalmology, University of Tsukuba, Ibaraki, Japan. Prospective case series and experimental study. For back-flow hydrodissection, the irrigation line was connected to the aspiration port of an irrigation/aspiration handpiece using a female-female connector with the irrigation port open. The balanced salt solution was irrigated from the aspiration tip opening with constant pressure, hydrodissection was performed, and the excess fluid was evacuated via the sleeve lumen. In a clinical study, 200 eyes were randomly assigned to conventional hydrodissection with an irrigation cannula or back-flow hydrodissection. In experimental studies, intraocular pressure (IOP) fluctuation and fluid dynamics in the anterior and posterior chamber were evaluated in porcine eyes. The lens became freely mobile in the capsular bag in 99 (99%) of 100 eyes and in 96 (96%) of 100 eyes in the back-flow hydrodissection group and conventional hydrodissection group, respectively (P=.369). There were no between-group differences in any other surgery-related parameters, including surgical time and the complication rate. In porcine eyes, conventional hydrodissection induced a significantly larger increase in IOP than back-flow hydrodissection (P<.0001). Conventional hydrodissection immediately washed out fluorescein-stained ophthalmic viscosurgical device (OVD) from the anterior chamber, while there was little leakage of OVD from the eye with back-flow hydrodissection. The endoscopic view showed that conventional hydrodissection induced rapid and severe bulging of the posterior capsule; however, bulging was gentle and mild with back-flow hydrodissection. Back-flow hydrodissection was safe and effective in disengaging the lens from the capsule, ensuring a freely mobile lens.

Disability-Disaggregated Data Collection: Hospital-Based Application of the Washington Group Questions in an Eye Hospital in Paraguay.

Disability-disaggregated data are increasingly considered important to monitor progress in Universal Eye Health Care. Hospital-based data are still elusive because of the cultural ambiguities of the term disability, especially in under-resourced Health Information Systems in low-and middle-income countries. The aim of this study was to estimate the hospital-based rate of disability in patients presenting at an eye department of a rural hospital in Paraguay and to discuss implications for the management of access barriers. Therefore, we introduced two standardized sets of the Washington Group (WG) Questions as a pilot project. In total, 999 patients answered the self-report WG short set (WG-SS) questionnaire with six functional domains, and 501 of these patients answered an extended set, which included additional domains for “anxiety” and “depression” (WG-ES3). Overall, 27.7% (95% Confidence Interval (CI) 24.9–30.3) were categorized as having a disability. A total of 9.6% (95% CI 7.9–11.6) were categorized as having a disability because of communication difficulties, which was second only to visual difficulties. The odds ratio for disability for patients aged 70 years and older was 8.5 (95% CI 5.0–14.4) and for male patients, it was 0.83 (95% CI 0.62–1.1). Of those patients who answered the WG-ES3, 3.4% were categorized as having a disability because of being worried, nervous or anxious and 1.4% because of feeling depressed. An analysis of the questions of the “depression” domain was impeded by a high rate of measurement errors. The results of the different domains can now be used to inform the identification and mitigation of potential access barriers to eye health services for different types of impairments.

Changes in total, anterior, and posterior corneal surface higher-order aberrations after 1.8 mm incision and 2.8 mm incision cataract surgery

To evaluate changes in corneal higher-order aberrations (HOAs) on the anterior and posterior corneal surfaces after 1.8mm microincision cataract surgery (MICS) and 2.8mm small-incision cataract surgery (SICS). Eye Department, First Affiliated Hospital, School of Medicine, Zhejiang University, China. Prospective case series. Right eyes of patients had MICS or SICS. The preoperative and 1-week and 3-month postoperative distance visual acuity (CDVA) and dry eye-related indices were determined. The corneal total HOAs and Zernike coefficients (3rd and 4th order) over 4.0 and 6.0mm zones, corneal volume, central corneal thickness (CCT), and anterior and posterior corneal astigmatism were measured using a Pentacam HR analyzer. The MICS group comprised 126 eyes and the SICS group 70 eyes. The MICS and SICS groups had similar postoperative CDVA; however, the MICS group had quicker recovery of CCT, corneal volume, and corneal astigmatism. Significantly increased anterior corneal total HOAs were observed in the SICS group over a 6.0mm zone (P<.001). Both groups showed significantly increased posterior corneal total HOAs over both zones (P<.001). Similar changing patterns in individual Zernike terms were observed. The MICS group had quicker recovery of posterior corneal surface coma and trefoil than the SICS group, especially over the 6.0mm zone. Changes in posterior corneal surface total HOAs were correlated with corneal volume changes (P<.01). The data suggest quicker corneal recovery and less change in total and anterior corneal surface corneal HOAs after MICS. Changes in posterior corneal surface HOAs were more pronounced in both surgical groups.

Artificial intelligence for diabetic retinopathy screening in Africa

Artificial intelligence for diabetic retinopathy screening in Africa

Case Report on Horner�s Syndrome Following Thyroidectomy

We report a case of 37-year-old Pakistani Punjabi woman who visited the Eye department of DHQ teaching hospital Sahiwal with complaint of drooping of right upper eyelid following the thyroidectomy. This is to highlight the importance of proximity of Thyroid gland and sympathetic trunk. Hence, to make surgeon more vigilant to avoid risk of injury to sympathetic trunk so that potentially stressing cosmetic disfigurement can be avoided. Moreover, this would help the surgeon to undertake measures to lessen the risk of injuring the sympathetic runk while doing the thyroidectomy.&#x0D; Key words: Horner’s syndrome, miosis, ptosisthyroidectomy.

Going paperless: improved cataract surgery outcome data quality in a new fully electronic unit.

To report outcome data on the first 5000 consecutive cataract cases at a new paperless eye unit and benchmark against the Royal College of Ophthalmologists' National Ophthalmology Database (RCOphth NOD). Using the in-built audit tool of the electronic medical records system, data from all cataract operations performed between 1 April 2014 and 13 January 2017 were compiled. Five thousand and eight cases were recorded of which the overall intra-operative complication rate was 2.4%, the most common being posterior capsular rupture-1.14%. Follow-up data on post-operative complications were recorded in 98.6% of cases. Pre- and post-operative visual acuities was measured in 98.0% of cases. In all, 40.8% of eyes achieved a visual acuity of 6/6 or better and 90.7% achieved 6/12 or better. A data set of >5000 consecutive cataract operations was obtained in this eye department. The recording of pre- and post-operative visual acuity in 98% of cases compare very favourably to the RCOphth NOD Audit Report 2017 where pre- and post-operative visual acuities were recorded in only 57.1% of operations. Despite this difference, the outcome measures from this unit and RCOphth NOD were very similar, validating the results of the RCOphth NOD audit reports. Significantly, when applying the RCOphth NOD audit criteria for measuring post-operative visual acuity, approximately 15% of cases were excluded from the data set, reducing the completeness of the data set. Paperless ophthalmology units are feasible in today's NHS and can produce near complete cataract data sets; this can ultimately lead to more comprehensive and reliable aggregate cataract outcome data.

Public-Private Partnership in Health Care and Its Impact on Health Outcomes: Evidence from Ruharo Mission Hospital in Uganda

Background: Uganda’s government has embraced private provision of social services including health care. The involvement of private providers is an indicator that the public facilities are not sufficient enough to meet the high demands of the ever-increasing population. This has been done through partnership arrangements. This paper discusses the impact of Public-Private Partnership (PPP) in health care outcomes of the local population and opportunities for improving health outcomes, challenges facing private providers in a low income setting.Methodology: Data were collected using qualitative methods in January 2017 through interview (using semi-structured questions) at Ruharo Mission Hospital (RMH) administration, health workers, district health office and used a structured questionnaire for patients/clients. This was a nascent study, with a sample size of 22 respondents. The hospital has three departments; Organized Useful Rehabilitation Services (OURS), General Medical Services (GMS) and Eye Department (ED). All the departments of the hospital were represented in this study.Results: The hospital is a Church of Uganda project and runs a budget of 5 billion shillings ($ 1,351,351.4) annually, had multiple sources of funding including PHC funding annually and that, health services were delivered adequately to clients. Much as some services were accessed at no costs, other services like eye treatment were found expensive on the side of clients. The hospital’s hybrid mode of delivering health services through outreaches and facility-based services was cherished, however it had no ambulance and relied only on a hospital van.Conclusions and Recommendations: Our study concluded that if private providers are supported under the partnership arrangement, they can adequately deliver services to the clients and decongest the public facilities. We recommend that the government devote funds to support the hospital through employing more sub-seconded staff, procuring medicines, and ambulances to enable it to subsidize services especially eye treatment and other services not supported under the partnership.

Robin Peter Bonner-Morgan

Robin Peter Bonner-Morgan (“Rob”) was one of the last of the generalists—consultant ophthalmologists who covered all the surgical and medical needs of any eye patient. He always tried to simulate...

Étude PLANOPH : plaintes ophtalmologiques recueillies par le médecin généraliste

Little data concerning the management of eye disease in general medical practice is reported in the literature. The main objective of the study was the description and management of ophthalmologic symptoms encountered by the general practitioner. The study was a quantitative, longitudinal, prospective, multi-center trial conducted in 3 departments in France, with data gathered from medical residents' consultation results. The inclusion criteria were: any new ophthalmologic problem with or without complaint, regardless of the patient's age. The resident filled in an observatory questionnaire collecting data on: the complaint within its context; specific and non-specific reasons for the complaint; identification of the medical problem and the management offered. The consultation data were classified according to the CISP-2. From May 1, 2015 to April 30, 2016, 674 of the 53,463 consultations held by resident investigators were for an ophthalmologic problem, corresponding to a 1.3% incidence. In over 70% of the cases, the ocular complaint was the main reason for the consultation. The majority of the conditions were benign and managed without specialty consultation. Eighty-six percent of the consultations lead to medication prescription, including 47% topical antibiotics. Eleven percent of the consultations led to referral to a hospital emergency or eye department. Additional multidisciplinary studies could compliment this study and enable a global vision of patients' clinical care pathways.

Effect of 2% ganciclovir eye drops on cytomegalovirus positive Posner-Schlossman syndrome

Objective: To observe the effect of 2% ganciclovir eye drops on Posner-Schlossman syndrome (PSS) patients with positive cytomegalovirus (CMV) in aqueous humor. Methods: Prospective study. The cases clinically diagnosed as PSS with positive CMV were enrolled from August 2017 to January 2018 at Department of Ophthalmology, Eye & ENT Hospital of Fudan University. All patients underwent aqueous and serum analysis for CMV by the enzyme linked immunosorbent assay and polymerase chain reaction. The history and clinical signs were noted, 2% ganciclovir eye drops were prescribed for topical use (4 times per day), and the patients were followed up. The Pearson Chi-square test was used for the comparison of factors including keratic precipitates (KPs), and the Tyndall, and paired t test or Wilcoxon rank sum test was used for factors like intraocular pressure (IOP), corticoid dosage, and IOP lowering medication dosage. Results: Fifty cases (31 males and 19 females) clinically diagnosed as PSS with positive CMV had an average age of (38±13) years. Some characteristics could help to identify CMV-positive PSS: iris depigmentation (96%, 48/50), coin-shaped KPs, loss of corneal endothelium (an average loss rate of 10.8%±5.5%), and high IOP during attack[(47.8±9.9)mmHg,1 mmHg=0.133 kPa]. After topical antivirus therapy with the mean time of (5.4±2.7) weeks, the clinical manifestations of CMV positive PSS cases improved. The granulomatous or middle-sized KPs decreased from 94%(47/50) to 52%(26/50), the coin-shaped KPs almost disappeared [from 22%(11/50) to 2%(1/50)], and the Tyndall reaction disappeared [from 12%(6/50) to 0]. The mean IOP value decreased from (26.2±10.9) mmHg to (15.5±3.6) mmHg. Furthermore, corticoid use decreased (from 3 times per day to 0 time per day, by median value), the number of cases that did not use corticoids increased from 6% (3 cases) to 60% (30 cases), and 17 (65%) out of those 26 corticoid dependent patients could withdraw corticoids. The number of IOP lowering eye drops used also decreased (from 2 to 0, by median value), and the proportion of cases without IOP lowering medication increased from 24% (12 cases) to 58% (29 cases). There were statistical differences between post-treatment and pre-treameat (all P<0.05).Thirteen cases that accepted CMV re-test of aqueous humor were all CMV DNA negative after treatment. Conclusion: Topical treatment with 2% ganciclovir eye drops has a good short-term effect on CMV-positive PSS patients by contributing to inflammation and IOP control. (Chin J Ophthalmol, 2018, 54: 833-838).

The function-structure impairment pattern of optic nerves in primary open-angle glaucoma and normal-tension glaucoma

The function-structure impairment pattern of optic nerves in primary open-angle glaucoma and normal-tension glaucoma

Small-incision lenticule extraction for the correction of myopic astigmatism

To report the outcomes of small-incision lenticule extraction (SMILE) in myopic eyes with astigmatism of 1.0 to 3.0 diopters (D). Center for Refractive Surgery, Eye Department, St. Francis Hospital, Muenster, Germany. Retrospective case series. Inclusion criteria were myopia of -0.5 D or more, astigmatism between -1.0 D and 3.0 D, and decimal corrected distance visual acuity (CDVA) of 1.0 or better. The study comprised 206 eyes. Preoperatively, the mean attempted spherical equivalent (SE) correction was -5.45±2.37 D (range -1.25 to -11.38 D) and the mean cylinder was -1.52±0.57 D (range -1.0 to -3.0 D). Three months postoperatively, the mean SE refraction was -0.07±0.38 D (range -1.25 to +1.00 D) and the mean cylinder was -0.32±0.29 D (range 0.0 to -1.5 D). The mean decimal uncorrected distance visual acuity (UDVA) was 1.13, the mean efficacy index was 0.87, and the mean safety index was 1.00. The UDVA was the same as or better than the CDVA in 67% of cases. The angle of error was ±5 degrees in 67% and ±15 degrees in 94% of cases, and the residual astigmatism was 0.5 D or less in 88% and 1.0 D or less in all patients. Small-incision lenticule extraction for the correction of myopic astigmatism was safe and effective, with outcomes comparable to those reported for laser insitu keratomileusis using modern eye-tracking systems.

How Cataract Extraction Helps in Improving Aqueous Outflow

Purpose: To assess changes in Anterior Chamber angle depth and width induced by phacoemulsification and intraocular lens implantation in normal population using anterior segment optical coherence tomography (AS-OCT). Study Design: Quasi experimental study. Study Place and Duration: Eye Department of DHQ-Teaching Hospital Gujranwala, from January, 2018 to June 2018. Material and Methods: All patients of both genders with senile cataract, having uneventful cataract surgery were randomly included in this study. After routine ophthalmic examination, pre-operative intraocular pressure (IOP) using Goldmann applanation tonometer along with anterior segment OCT for measuring angle parameters was done in the temporal quadrant of respected eye at the time of admission. Post-operatively the same procedure was repeated at the time of discharge. A P-value ? 0.05 was considered to be statistically significant. Results: Out of 82 patients, 44 (53.7%) were male and 38 (46.3%) were female. Mean Axial length recorded was 23 ± 1.2 mm with mean IOL power of 22.0 ± 3.2D. Mean Pre-op Trabecular Iris Angle (TIA) was 41.5 ± 8.7° that widened to 48.6 ± 8.3° post-operatively while Mean pre-op Angle opening distance (AOD-500 µm) recorded was 447.5 ± 149.8 µm that increased to 609.5 ± 169.8 µm post-operatively. Similarly, Mean pre-op IOP recorded was 16.8 ± 2.8 mm Hg that reduced to 15.1 ± 2.9 mm Hg post-operatively. P-value of all three parameters turned out significant (< 0.05). Conclusions: Cataract extraction and IOL implantation causes an increase in anterior chamber angle depth and width along with a reduction in intra-ocular pressure which is a direct evidence of improved aqueous outflow. Key Words: Anterior chamber, Trabecular Meshwork, Angle, OIptical coherence tomography.

Pseudoexfoliation and aortic aneurysm: a long-term follow-up study.

To study the relationship between pseudoexfoliation (PEX) and aortic aneurysm in a population with a high prevalence of PEX. Survival analyses were performed in a cohort of 735 residents aged 65-74years, examined in a population survey in the municipality of Tierp, Sweden, 1984-1986. To expand the sample size, 1040 people were recruited by means of glaucoma case records established at the Eye Department in Tierp in 1978-2007. In this way, the cohort comprised 1775 subjects, representing more than 25400 person-years at risk. Medical records and autopsy reports were reviewed to identify subjects diagnosed with aneurysm. Those with a follow-up time shorter than 1year were excluded. By the end of the study in September 2017, 60 new cases of aortic aneurysm had been found. Of these cases, 23% (14 subjects) were affected by PEX at baseline, compared with 28% among subjects without aneurysm. No association between PEX and aortic aneurysm was found (hazard ratio 0.97; 95% confidence interval 0.53-1.77). In this population-based study, we were unable to verify a relationship between PEX and the development of aortic aneurysm.

Peter Copeman: medical dermatologist who pioneered new classification of skin diseases

In 1958 the Lancet published “Treatment of Recurrent Styes” by Peter Copeman, a house surgeon in the eye department at St Thomas’ Hospital, London. It was the start of a...

Phacoemulsification and endocyclophotocoagulation in uncontrolled glaucoma: Three-year results

To describe the 3-year outcomes of combined cataract surgery and 360-degree endocyclophotocoagulation (ECP) in eyes with uncontrolled glaucoma and no previous glaucoma drainage surgery. University Hospital Eye Department, Exeter, United Kingdom. Retrospective case series. The study included patients who had combined cataract surgery and 360-degree ECP. The primary outcome measure was intraocular pressure (IOP) reduction at 3years postoperatively. Secondary outcome measures were the cumulative probability of failure of the surgical procedure at 3years and the complications of surgery. Failure was defined by 1 of 2 criteria: (1) IOP higher than 21mm Hg or lower than 6mm Hg or not reduced by 20% from baseline at the 1-, 2-, or 3-year timepoint and (2) further laser or other surgery to reduce IOP at any timepoint. The study comprised 84 patients (84 eyes). The mean IOP dropped from 18.7mm Hg preoperatively to 13.3mm Hg, 13.8mm Hg, and 14.0mm Hg at 1, 2, and 3years postoperatively, respectively. By the 3-year timepoint, 58.3% had met the criteria for failure. The mean number of glaucoma medications was similar at 2.5 at 3years postoperatively compared with 2.6 preoperatively. Nine patients (10.7%) had a significant complication, but all resolved without long-term sequelae. At 3years postoperatively, combined cataract surgery and 360-degree ECP achieved a modest but significant drop in IOP in phakic patients with uncontrolled glaucoma and no previous drainage surgery. There was a low incidence of serious side effects but nearly 60% were classified as failures by 3years.

Toxic Optic Neuropathy secondary to Systemic Chloramphenicol for Septic Arthritis: Case Report

Introduction – Chloramphenicol is a broad-spectrum antibiotic with excellent tissue penetration. Systemic use was popularised in the 1950s due to its affordability andease of preparation. It is now rarely used in developed countries due to its significant side effect profile including toxic optic neuropathy.&#x0D; Case Description – A 68-year-old female presented to a neighbouring eye department with a 2-month history of bilateral visual deterioration, initially thought to be due to cataracts. However, due to the moderate cataract density and visual acuities of 6/60 and hand movements a medical history revealed that she had been taking systemic chloramphenicol for 6 months for chronic septic arthritis following a complicated total knee replacement. Following a normal ophthalmic examination besides reduced colour vision and constricted visual fields a diagnosis of toxic optic neuropathy secondary to chloramphenicol was made. Once systemic Chloramphenicol was stopped, her vision improved to 6/24 bilaterally although subjectively did not return to baseline.&#x0D; Conclusion – Cataracts are a common cause of visual reduction, however, if the amount of cataract does not correlate with the extent of loss of visual acuity then an alternative cause must be considered. Early recognition of toxic neuropathy is key, as withdrawal of Chloramphenicol often results in improvement of visual symptoms.