Ophthalmic Department Research Articles

Retropupillary iris claw intraocular lens implantation in aphakia for dislocated intraocular lens.

BackgroundNowadays, dislocated intraocular lenses (IOLs) and inadequate capsular support are becoming a challenge for every ophthalmic surgeon. Explantation of dislocated IOL and iris claw IOL (ICIOL) are the techniques that have been used in our ophthalmic department. The aim of this study is to report our technique for retropupillar ICIOL.MethodsThis study is a retrospective case series. A total of 105 eyes with dislocated IOL from the patients at the Department of Ophthalmology in Santa Maria Hospital, a tertiary reference hospital in Lisbon, Portugal, from January 2012 until January 2016, had been analyzed. Of these 105 eyes, 66 eyes had dislocated one-piece IOL and 39 eyes had dislocated three-piece IOL. The latter underwent iris suture of the same IOL and were excluded from this study. The remaining 66 eyes with dislocated one-piece IOL underwent pars plana vitrectomy, that is, explantation of dislocated IOL through corneal incision and an implantation of retropupillary ICIOL. Operative data and postoperative outcomes included best corrected visual acuity, IOL position, intraocular pressure, pigment dispersion, clinical signs of endothelial cell loss, and anterior chamber depth.ResultsThe mean follow-up was 23 months (range: 6–48 months). The mean preoperative best corrected visual acuity was 1.260±0.771 logMAR, and postoperative best corrected visual acuity was 0.352±0.400 logMAR units. Mean vision gain was 0.909 logMar units. The patients had the following complications: 1) retinal detachment was found in one patient, 2) corneal edema was found in three patients, 3) high intraocular pressure was observed in twelve patients, 4) subluxation of the IOL was observed in one patient, and 5) macular edema was found in three eyes.ConclusionThe results demonstrate that retropupillary ICIOL is an easy and effective method for the correction of aphakia in patients not receiving capsule support. The safety of this procedure must be interpreted in the context of a surgery usually indicated in complicated cases.

Patient Perception and Emotional Disturbance in Out-of-Hour Ophthalmic Emergency Care

ABSTRACTPurpose: To investigate patient’s perception of the severity of their symptoms, reasons for attending an ophthalmic emergency department (ED) out of hours, and to review the prevalence of anxiety and depression. Methods: We carried out a prospective analysis of the cases presenting out of hours (8:30 PM to 8:30 AM) over a four-month period. We also conducted two questionnaire studies. First, patient’s perception of the severity of their symptoms (graded from 1–10). A score of 7 or above was defined as significant. A second questionnaire study used the Hospital Anxiety and Depression Scale (HADS), with a maximum score of 21. Patients who scored between 7–10 points on either anxiety or depression scales are defined as borderline; above 10 as pathological. Results: A total of 1,531 patients attended the out-of-hours service. The most common diagnoses were trauma (22.8%), infective conjunctivitis (10.2%), and contact-lens-related problems (6.6%). Of 175 completed questionnaires, worry about sight impairment and pain were the most common concerns for attendance. A total of 91% of patients believed their conditions were emergencies that require medical review within 24 hours. 127 HADS questionnaires were completed, showing that 18.9% and 15.0% of patients were suffering from borderline and pathological anxiety, respectively, with a mean HADS-A score of 6.5, SD=3.9. The prevalence of possible and pathological depression was 14.2% and 6.3%, mean=4.9 (SD=3.6). There was no statistical significance difference of score with the time of patient presentation. Conclusion: The prevalence of anxiety and depression is relatively high in patients who attended the ophthalmic ED and awareness of psychological impact should be raised amongst healthcare professionals.

RETROSPECTIVE STUDY OF WORK RELATED OCULAR INJURIES IN A TERTIARY HOSPITAL, EGYPT

Introduction: Ocular trauma is a major cause of visual impairment and morbidity worldwide. Aim of work: This study aimed to use discharge records of a tertiary hospital in Egypt to analyze the patterns of work related ocular injuries and prospectively document safety advice. Materials and Methods: Hospital-based, retrospective study conducted on admitted cases of work related ocular injuries in Menoufia University Hospital, Egypt over a period of two years from January 2012 to December 2013. A total of 160 patients of ocular trauma were included. Demographic data, cause and type of injury were recorded as well as visual outcome was assessed. Results: Work related ocular injuries constituted (38.5%) of all admitted cases of eye injury in the Ophthalmic department in the hospital. Most of the injuries that occur appear to be relatively minor and most involve foreign bodies on the eye (46.1%). The majority had good final visual acuity outcomes. Eye injuries were predominant in construction workers (23.1%) followed by factory workers (21.9%) and farmers (19.4%). Grinding and drilling are the two most common tasks being performed when an eye injury developed. Deficient protective measures in workplaces seem to be the major cause of ocular injury. Conclusion: Work related eye injuries remain an important problem. Deficient protective measures in workplaces seem to be the major cause of ocular injury. It can be assumed that health education, as well as application of safety measures and regulations, will significantly reduce the incidence of work related eye injuries.

Divide and conquer versus chopping in phacoemulsification: study of the operation events and early results

Objectives The aim of the study is to evaluate the efficacy and safety of the divide-and-conquer technique versus chopping technique in phacoemulsification. Background Kelman in 1967 introduced ultrasonic phacoemulsification for cataract removal, aiming to find a safer and more effective way of removing the lens. At present, phacoemulsification is the procedure of choice for cataract extraction for most ophthalmologists. Materials and methods This prospective study included 30 eyes of 30 patients attending the outpatient clinic of Menoufia Ophthalmic Department. Patients aged 40-60 years old with senile cataract nuclear grades from 2 to 4 underwent detailed history taking, full ophthalmic examination, A-B scan ultrasonography, corneal pachymetry and endothelial cell density measurements, and nuclear grading. All patients were operated by the same surgeon using Geuder megatron s3 machine. Results There was statistically significant endothelial cell loss (ECL) following all studied techniques 3 months postoperatively (12.4 and 10.5% in groups I and II, respectively). There was no significant difference between all studied groups. The nuclear grade and absolute phaco time had positive correlation with higher ECL, whereas age, sex, and axial length did not affect ECL. A significant increase in the central corneal thickness (CCT) was observed at the immediate postoperative week among the two studied groups (14 and 10.5%, respectively). There was no statistically significant difference between the two groups. The postoperative CCT pachymetry values were returned to near preoperative values at 3 months postoperatively. Conclusion Significant and equal ECLs occur after the two studied techniques. Absolute phaco time and nuclear grade have a positive correlation with higher ECL. Age, sex, and axial length do not affect ECL. CCT increases significantly and equally postoperatively following the two techniques.

Clinical presentations of Herpes Zoster Ophthalmicus (diagnosis and therapy)

To study and summarize clinical features of HZO (including the rate of complications and their nature) and to determine the relationship between clinical and laboratory data from these patients. The study included 133 patients with ophthalmic and neurological complications of HZO (group 1 (n=28) - retrospective analysis of outpatient records for the period 1995-2005; group 2 (n=95) - a prospective study for the period 2005-2015), who received a course of conservative treatment in either the Botkin City Hospital, branch № 1, or in the ophthalmic department of the Moscow herpes centre (Gerpeticheskiy Tsentr Ltd.). Laboratory tests were performed only in patients from group 2 and included: examination of biological fluids for six types of herpes viruses by polymerase chain reaction, examination of tears and urine for DNA of Chlamydia, Mycoplasma, and Ureaplasma, and serological blood testing for markers of herpes virus infection. Patients from group 1 were prescribed topical antiviral, antibacterial, and anti-inflammatory therapy, in rare cases - acyclovir per os. In group 2, the treatment included systemic antiviral medications and immune correction therapy. Anti-inflammatory therapy consisted of local and systemic non-steroidal agents (NSAIDs). The most common ophthalmic complications of HZO in both groups were stromal keratitis and keratoiridocyclitis, neurological - III and VI cranial nerves palsies. The duration of the disease in the first group ranged from 2 months to 3 years; in the second group, patients were divided into two subgroups: subgroup A with the disease duration of no more than one month (n=81) and subgroup B with the disease duration from 1.5 to 9 months (n=14). Varicella-zoster virus (VZV) DNA was present in tears and/or other biological fluids of patients from group 2 in more than 70% of cases (n=67). Particularly, in 27.4% of cases the virus was isolated in two fluids and in 7.4% of cases - in three fluids. The duration of virus production in tears and other biological fluids (saliva, blood, and urine) ranged from 10 days to 4 months. Topical non-steroidal anti-inflammatory drugs and systemic etiological treatment in case of intraocular inflammation in HZO patients may reduce the risk of severe consequences of VZV reactivation and help avoid recurrences later in life.

Criterion validity of a computer-assisted instrument of self-triage (ca-ISET) compared to the validity of regular triage in an ophthalmic emergency department

ObjectivesThe computer-assisted version of a self-triage tool (ca-ISET) for an ophthalmic emergency department (ED) was developed to increase the validity of the triage procedure when trained ED staff is absent. MethodsWe tested whether sensitivity, specificity, Negative Predictive Value (NPV) and Positive Predictive Value (PPV) of the ca-ISET deviated from regular triage. Patients ≥18 years visiting the ED of the Rotterdam Eye Hospital in the Netherlands were invited to participate in this prospective study. This ED focuses on eye-related problems. Patient recruitment was carried out during working hours. The ca-ISET is a touch operated software application and the algorithm of the triage is based in the Manchester triage system. For all participants three triage scores were determined by (1) the participant using the ca-ISET; (2) triage by a regular, trained triage assistant and (3) triage by one physician who was specially trained in ophthalmic triage. The diagnosis of the physician was chosen as the reference standard to define criterion validity. The order of triage administration was alternated per patient. Only cases with triage scores from the two triage systems and the reference standard were included. The outcome variables, four triage colours, were transformed into a binary score: high urgent and low urgent. The difference between the ca-ISET and regular triage in terms of sensitivity, specificity, NPV and PPV was tested by Z-scores. ResultsOf 247 eligible patients, data was elicited from 189 patients (average age 54 years, range 18–89). The sensitivity of the ca-ISET (0.89, CI: 0.75–0.96) did not differ from the sensitivity of the regular triage (0.69, CI: 0.53–0.82, Z=1.74, p=0.08). The ca-ISET was less specific (0.78, CI: 0.71–0.84) than the regular triage (0.92, CI=0.86–0.95, Z=3.04, p=0.00). We found no significant difference between the ca-ISET and regular triage for PPV (Z=0.19, p=0.85) and NPV (Z=0.03, p=0.98). ConclusionsThe sensitivity, PPV and NPV of the ca-ISET does not differ from the sensitivity of the regular triage, while the ca-ISET retained a reasonable level of specificity. Therefore the ca-ISET can be recommended as a tool for ophthalmic emergency departments, and could be used when trained ED staff is absent.

From pen-and-paper questionnaire to a computer-assisted instrument for self-triage in the ophthalmic emergency department: Process and validation

Background/AimsThe ISET (Instrument for SElf-Triage) is a validated pen-and-paper instrument for patient self-triage in ophthalmic emergency departments. The aim of the present study is to develop a validated computer-assisted ISET (ca-ISET) with a touch screen. MethodsIn the emergency department of the Eye Hospital Rotterdam, the Netherlands, successive computer-assisted versions of the ISET were tested by patients visiting the emergency department. The versions were developed by iteratively prototyping, testing, analysing and refining the computer-assisted ISET. In three test cycles, 16, 53 and 75 patients ≥18 years old, visiting the emergency department for the first time with their ophthalmic complaint, were monitored while using the ca-ISET. They were debriefed, and their input was used to adapt the computer-assisted ISET. To validate the ca-ISET, a sensitivity outcome of .80 and a specificity of .70 was required (CI=95%). The ca-ISET sensitivity and specificity were tested by comparing ca-ISET triage outcome to triage outcome as decided by the regular triage assistant. ResultsISET accuracy increased from 0.69 in the first test to 0.79 in the third test. Sensitivity increased from 0.66 (CI 0.13–0.98) to 0.80 (0.51–0.95). Specificity increased from 0.69 (0.39–0.90) to 0.78 (0.65–0.88). To improve validity and usability, several adjustments were made in the text and the flow chart of the computer-assisted ISET. ConclusionsA ca-ISET prototype was developed, with minor textual modification of the pen-and-paper version. The new ca-ISET was validated by comparing against triage decided by the regular triage assistant.

Predictive Value of Headache for Screening of Refractive Errors in the Pediatric Age Group

This article aims to study the predictive value of headache for screening of refractive errors in the pediatric age group. This is a cross-sectional study conducted in the outpatient setting of the Department of Ophthalmology of Lala Lajpat Rai Hospital, associated with Ganesh Shanker Vidyarthi Memorial Medical College, Kanpur (India), during a period of 1 year, including 5,398 children in the age group of 5 to 15 years. Data were collected using a predesigned, pretested questionnaire which included demographic data and chief complaints. All the subjects underwent visual acuity and refractive error testing. Visual acuity was conducted using Snellen's chart and Landolt's C chart. Thereafter, refractive testing was done under cycloplegia and corrective spectacles were prescribed to the patient. Data were analyzed using statistical package for social sciences version 16.0. Chi-square test was applied to analyze the discrete variables. Data were also used to calculate the sensitivity, specificity, positive predictive value, and negative predicative value of headache as a screening tool for the predicting refractive errors in children. Twelve percent of the total population attending the ophthalmic outpatient department belonged to the age group of 5 to 15 years. The male:female ratio was 1.3:1. Out of the total, 58.8% of the subjects had refractive errors. Myopia was the most common refractive error (46.4%) followed by astigmatism (31.3%) and then hyperopia (22.3%). Gender difference was significant (p

Cataract: Effect of designed nursing guidelines on patients to minimize postoperative complications

Cataract is the opacification of the normally clear lens of the eye. Aim: to determine the educational needs of patients with cataract, to design nursing guidelines and to evaluate the effect of designed nursing guidelines on patient outcomes. Subjects and methods: the study was conducted in the ophthalmic department at Assiut university hospital. Study design: Quasi-experimental research design was utilized in this study. Tools: three tools was used, tool one patient with cataract assessment, it was divided into two parts concerning: patients` socio-demographic data, assessment patient’s knowledge, tool two designed nursing guidelines, tool three post operative complications for assessment patients with cataract observation checklist. Results: the majority of both the study and control groups (60.0% and 66.7%) were female, (73.4%, 33.3%) were illiterate, (56.7% and 63.3%) were house wife, (43.3%, 60.0%) their ages were between 41-60 years of age, The results also revealed that, there was significant statistical difference between pre and post application of guidelines for the study groupConclusions: knowledge level of the study group patients after application of nursing guidelines was higher than knowledge level of control group. Recommendation: Providing a written instruction booklet is of great important for the patients before discharge to minimize postoperative complications

The role of principal and secondary diagnoses of hospitalized eye trauma: a nationwide cohort in Taiwan, 1996-2010.

PurposeTo estimate the rate of hospitalized eye trauma in Taiwan and investigate the role between principal and secondary diagnoses of such trauma.MethodsNationwide fixed cohort study of 1,000,000 beneficiaries from the Taiwan Longitudinal Health Database was used and 4819 patients who were hospitalized for eye trauma during 1996-2010 were analyzed.ResultsDuring 1996-2010, the incidence rates of hospitalized eye trauma (per 100 000 person-years) were 35.0 (95% confidence interval (CI), 34.0 to 36.0) for total diagnosis, 9.8 (95% CI, 9.3 to 10.3) for a principal diagnosis, and 25.3 (95% CI, 24.4 to 26.1) for a secondary diagnosis. The sex risk ratio was 3.1 for a principal diagnosis and 2.1 for a secondary diagnosis. The main causes of eye trauma were traffic accident, work accident, assault (among males <60 years of age), and falls (among elderly men and women). The proportion admitted to an ophthalmic department among those with a principal diagnosis of eye trauma (64.8%) was significantly higher than among those with a secondary diagnosis (2.3%) (p<.0001). Patients with a principal diagnosis of eye trauma had shorter hospital stays (7.1±10.2 days) and lower fatality (0.07%) than those with a secondary diagnosis of eye trauma (10.0±31.6 days and 0.3%, respectively).ConclusionData only from ophthalmic admissions tends to underestimate the true incidence rate of hospitalized eye trauma. Patients with a principal diagnosis of eye trauma had less severe injuries than did those with a secondary diagnosis.

Sensitivity and specificity of the AdenoPlus point-of-care system in detecting adenovirus in conjunctivitis patients at an ophthalmic emergency department: a diagnostic accuracy study.

To estimate the diagnostic accuracy (sensitivity and specificity) of the AdenoPlus point-of-care adenoviral test compared to PCR in an ophthalmic accident and emergency service. These findings were compared with those of a previous study. This was a prospective diagnostic accuracy study on 121 patients presenting to an emergency eye unit with a clinical picture of acute adenoviral conjunctivitis. AdenoPlus testing was carried out on one eye of each patient and a PCR analysis was also performed on a swab taken from the same eye. AdenoPlus and PCR results were interpreted by masked personnel. Sensitivity and specificity for the AdenoPlus test were calculated using PCR results as the reference standard. 121 patients were enrolled and 109 met the inclusion criteria. 43 patients (39.4%) tested positive for adenovirus by PCR analysis. The sensitivity of the AdenoPlus swab in detecting adenovirus was 39.5% (17/43, 95% CI 26% to 54%) and specificity was 95.5% (63/66, 95% CI 87% to 98%) compared to PCR. The AdenoPlus test has a high specificity for diagnosing adenoviral conjunctivitis, but in this clinical setting, we could not reproduce the high sensitivity that has been previously published.

Evaluation of MEWDS-like lesions with fluorescein angiography and its frequency at an ophthalmic emergency department in Rio de Janeiro.

To characterize multiple evanescent white dot syndrome (MEWDS)-like lesions as diagnosed by clinical exam and fluorescein angiography (FA) to build an epidemiological profile of this disease and highlight the most common angiographical aspects. It is important to emphasize the existence of this syndrome and improve patients' information about the natural good course of this disease. A cross-sectional study including all FA performed from July 2006 to October 2012 (6,111 exams analyzed) in patients at our ophthalmic emergency department, with analysis of the different angiographic aspects of the MEWDS-diagnosed cases. Among the 6,111 angiographies analyzed, 15 MEWDS cases were detected; the patients ranged in age from 13 to 42 years old, and the male/female ratio was 60% to 40% (nine male and six female). The most common FA aspects included hyperfluorescent dots, dots and spots in the retinal mid-periphery, and foveal granularity in 46% of the cases. MEWDS has a good prognosis, with spontaneous involution, which makes it difficult to diagnose because of the delayed access to ophthalmological assistance, in special FA examination, which highlights the lesions. This study was possible due to the quick access facility at a private ophthalmic emergency department and examination by an experienced ophthalmologist, along with complementary diagnosis by FA and better perception of the patients, thus ensuring good prognosis.

Epidemiological Characteristics and Laboratory Diagnosis of Fungal Keratitis in Patients with Corneal Ulcer in Riyadh, Saudi Arabia

Corneal blindness is a major health problem worldwide and infectious keratitis is one of the predominant causes. The incidence of fungal keratitis has increased over the last few years. Keeping this in mind, this study was conducted to evaluate the frequency of positive fungal cultures in infectious keratitis and of the various fungal species identified as etiologic agents in patients with corneal ulcer attending the ophthalmic departments of 3 hospitals in Riyadh. Corneal scrapings from 100 patients of corneal ulcer with suspected fungal etiology were subjected to direct examination by 10% KOH and lacto-phenol cotton blue mount. Also swabs of diseased eyes were taken with sterilized swabs. The specimens were also inoculated directly on to Sabouraud’s dextrose agar in C-shaped streaks. From 100 patients of corneal ulcer investigated, only 52% of patients were positive. Males were more commonly affected than females (69.23% and 30.76%), respectively. The age of patients was ranged from 28-55 years. 18 (34.61%) patients with fungal keratitis were laborers, 15 (28.84%) teachers, 7 (13.46%) housewives, 6 (11.53%) shepherds and 6 (11.53%) were civil engineers. Corneal trauma with stone chips and metal splinters appeared to be the most common predisposing factors of fungal keratitis (30.76%) followed by ocular surgery and corneal disease (26.92%). Of 52 positive patients with corneal ulcer surveyed the most important causative agents of fungal keratitis were Aspergillus spp. (44.23%), followed by Candida spp. (17.30%) and Fusarium spp. (17.30%). Because of serious consequences of infectious keratitis, it is important to know the exact etiology of fungal keratitis to institute appropriate therapy in time. Laboratory confirmation should be before pre scribing corticosteroids and antifungal.

麻布大学眼科に来院した緑内障症例の随伴症の分類

麻布大学眼科に来院した緑内障症例の随伴症の分類

Economic burden of diabetes in urban indians.

Purpose : To find out the average economic burden of medical care on a patient with diabetes in Pune, IndiaMethods : A semi-open ended questionnaire followed by interview was conducted with patients attending diabetes and ophthalmic out-patient departments. They were asked regarding the duration of diabetes, methods undertaken for blood sugar control and the amount they spend on consultations, laboratory tests, medicines and procedures if any within past year. Expenditure was classified as direct cost (cost of medicines, doctor’s fees, investigations, lasers and surgery) and indirect cost (travel, diet control, health classes and loss of wages). Data was collected regarding the socioeconomic status according to Kuppaswamy classification.Results : 219 patients participated of whom 129 were males (58.9%). Average annual direct cost of diabetes treatment was Rs 8,822 of which 52.1% was spend on medicines, 3.2% was spend on lasers, 12.6% was spend on surgical procedures, 11.6% spent on investigations and 10.4% was spend on clinician fees. Average annual indirect cost was Rs. 3949 of which 3.4% was spend on travelling purpose, 0.4% was spent on health classes, 4.9% was spent on diet control and 91.3% was loss of wages. Average expenditure done by lower middle class was 23.7% of their income. Average percentage of income for direct and indirect cost was 3.6% and 1.4% respectively. The cost of the treatment formed1.3% of the annual income for those in Socio-economic class I, 1.7% in class II, 3.7% in class III and 23.7% in class IV.Conclusion : The cost of managing diabetes was a significant proportion of the patients’ income, especially for those on lower socio-economic scale (class IV).

The role of multidetector computed tomography and magnetic resonance recent imaging techniques in the evaluation of intra-conal orbital lesions

ObjectiveThe purpose of our study was to assess the role of multi-detector computed tomography and magnetic resonance recent imaging techniques in the evaluation of intra-conal orbital lesions. Subjects and methods30 patients presented to the Ophthalmic and Radiology Departments at El-Minia University Hospital and El Minia Oncology Center with clinical diagnosis of visual loss and proptosis. They presented during the period from June 2012 to October 2013. Their ages range from 5 to 73years. All patients subjected to MDCT and MRI. Also, contrast injection was injected on some cases. 24 patients were subjected to surgery and histopathology to confirm the radiological diagnosis. ResultsA total of 30 patients were included (their mean age 26years). 8 lesions were diagnosed inflammatory in nature (4 were orbital abscess and 4 were idiopathic orbital inflammatory disease i.e. pseudo tumors). 10 lesions were diagnosed as vascular lesions (2 lesions were carotid cavernous fistula and 8 lesions were cavernous hemangiomas). 6 lesions were diagnosed as optic nerve gliomas and other 6 lesions were diagnosed optic nerve sheath meningiomas. ConclusionThe use of MDCT and MRI recent techniques are mandatory for accurate diagnosis of the nature of intra-conal orbital mass lesions.

Stereo imaging in ophthalmology

Stereo imaging in ophthalmology is an important diagnostic modality and a task not often undertaken in many ophthalmic photography departments. Origins of retinal stereo imaging date back to over 100 years ago. Stereo imaging is recommended, for example, for all photographs of the optic nerve head and for ocular angiography intended to determine clinically significant macular oedema. It is also useful in determining sub types of wet-form age-related macular degeneration. Stereo fundus photography and angiography facilitate the diagnostic process by clearly defining retinal structure and elevation. This allows the clinician to assess the patient's retina, presenting a 3D image that does not move and is not light sensitive. Stereo imaging of the fundus is useful for follow-up management of the patient, and is used extensively in clinical trials. This article will look at the history of stereo photography, its application and rationale to ophthalmology, and the different methods of attaining stereo images of the retina.

Safety and efficacy of bimatoprost/timolol fixed combination in Chinese patients with open-angle glaucoma or ocular hypertension.

Lowering intraocular pressure (IOP) is currently the only therapeutic approach in primary open-angle glaucoma. and the fixed-combination medications are needed to achieve sufficiently low target IOP. A multicenter prospective study in the Chinese population was needed to confirm the safety and efficacy of Bimatoprost/Timolol Fixed Combination Eye Drop in China. In this study, we evaluated the safety and efficacy of Bimatoprost/Timolol Fixed Combination with concurrent administration of its components in Chinese patients with open-angle glaucoma or ocular hypertension. In this multicenter, randomized, double-masked, parallel controlled study, patients with open-angle glaucoma or ocular hypertension who were insufficiently responsive to monotherapy with either topical β-blockers or prostaglandin analogues were randomized to one of two active treatment groups in a 1:1 ratio at 11 Chinese ophthalmic departments. Bimatoprost/timolol fixed combination treatment was a fixed combination of 0.03% bimatoprost and 0.5% timolol (followed by vehicle for masking) once daily at 19:00 P.M. and concurrent treatment was 0.03% bimatoprost followed by 0.5% timolol once daily at 19:00 P.M. The primary efficacy variable was change from baseline in mean diurnal intraocular pressure (IOP) at week 4 visit in the intent-to-treat (ITT) population. Primary analysis evaluated the non-inferiority of bimatoprost/ timolol fixed combination to concurrent with respect to the primary variable using a confidence interval (CI) approach. Bimatoprost/timolol fixed combination was to be considered non-inferior to concurrent if the upper limit of the 95% CI for the between-treatment (bimatoprost/timolol fixed combination minus concurrent) difference was ≤ 1.5 mmHg. Adverse events were collected and slit-lamp examinations were performed to assess safety. Between-group comparisons of the incidence of adverse events were performed using the Pearson chi-square test or Fisher's exact test. Of the enrolled 235 patients, 121 patients were randomized to receive bimatoprost/timolol fixed combination and, 114 patients were randomized to receive concurrent treatment. At baseline the mean value of mean diurnal IOP was (25.20 ± 3.06) mmHg in the bimatoprost/timolol fixed combination group and (24.87 ± 3.88) mmHg in the concurrent group. The difference between the treatment groups was not statistically significant. The mean change from baseline in mean diurnal IOP (± standard deviation) in the bimatoprost/timolol fixed combination group was (-9.38 ± 4.66) mmHg and it was (-8.93 ± 4.25) mmHg in the concurrent group (P < 0.01). The difference between the two treatment groups (bimatoprost/timolol fixed combination minus concurrent) in the change from baseline of mean diurnal IOP was -0.556 mmHg (95% CI: -1.68, 0.57, P = 0.330). The upper limit of the 95% CI was less than 1.5 mmHg, the predefined margin of non-inferiority. Adverse events occurred in 26.4% (32/121) of the bimatoprost/timolol fixed combination patients and 30.7% (35/114) of the concurrent patients. The most frequent adverse event was conjunctival hyperemia, which was reported as treatment related in 16.5% (20/121) in the bimatoprost/timolol fixed combination group and 18.4% (21/114) in the concurrent group (P > 0.05). Bimatoprost/Timolol Fixed Combination administered in Chinese patients with open-angle glaucoma or ocular hypertension was not inferior to concurrent dosing with the individual components. Safety profiles were similar between the treatment groups.

Towards patient self‐triage in the ophthalmic emergency department: sensitivity and specificity of a self‐triage instrument

Trained ophthalmic triage staff may not constantly be available in the emergency department of a specialized ophthalmic hospital, particularly at night. To support the current triage process, the aim of this study was to develop an ophthalmic instrument of patient self-triage (ISET). A preliminary ISET, in the form of a pen-and-paper questionnaire, was refined and validated in a two-step procedure. In a first explorative step, we compared the results of the ISET with the results of the regular triage process during the day, that is, triage by a trained triage assistant in a specialized ophthalmic hospital. As several patients needed guidance completing the questionnaire, the ISET was subsequently refined. The second step was to test the validity of the refined ISET by again comparing the outcome of this triage with that of the triage assistant in the emergency department. The first explorative step involved 279 patients and the final validation step 298. During the validation step, sensitivity of the ISET was 94.3% and specificity 76.4%. The results show that the ISET is a sensitive and specific instrument for ophthalmic triage compared with a trained ophthalmic triage assistant.

Unusual presentation of ciliary body melanoma - a case report

Background: Ciliary body melanoma rarely grows transclerally by direct extension and can metastasize locally into the orbit or conjunctiva. Objective: To report a case of ciliary body melanoma presenting clinically as a mass in the lacrimal gland region. Case: A 40-year-old female presented to the ophthalmic out-patient department with the complaint of a swelling in the right upper and outer lid region for 4 years. Ocular examination revealed a phthisical right eye. A firm, non-tender mass was palpable in the temporal quadrant of the right supraorbital region. Ultrasonography showed retinal detachment of the right eye. The CT-scan of the orbit was reportedly suggestive of a right lacrimal gland mass. Superolateral transperiosteal orbitotomy was planned for excision of the lacrimal gland mass. Intraoperatively, a well defined mass arising from the supero-temporal region of the right globe was noticed. The procedure was converted to enucleation of the right eye. Histopathological examination of the mass showed features of ciliary body melanoma. Conclusion: Extrascleral extension of ciliary body melanoma can present as a mass in the lacrimal gland region. DOI: http://dx.doi.org/10.3126/hren.v11i3.9657 Health Renaissance 2013;11(3):287-289