RESUMO
PURPOSE: To determine the number of cases required to achieve competency in phacoemulsification in terms of the posterior capsule rupture rate. SETTING: Singapore National Eye Centre, Singapore. DESIGN: Retrospective cohort study. METHODS: The posterior capsule rupture rate of the first 300 phacoemulsification cases performed by each trainee in the Singapore National Eye Centre (2004 to 2012) was charted using cumulative sum graphs. Competency was primarily defined as a posterior capsule rupture rate of 2% or lower and secondarily as 5% or lower. RESULTS: Twenty trainees fulfilled the inclusion criteria. Four trainees (20%) and 19 trainees (95%) achieved a posterior capsule rupture rate of 2% and 5%, respectively. At least 41 cases were required to achieve a 5% posterior capsule rupture rate (mean 106, median 83). CONCLUSIONS: There was considerable variation in the trainees' abilities. Only 20% of the trainees achieved a posterior capsule rupture rate of 2% or lower and required at least 212 cases.
Assuntos
Extração de Catarata , Competência Clínica , Facoemulsificação , Humanos , Estudos RetrospectivosRESUMO
PURPOSE: To describe the pattern of uveitis among Chinese, Malays, and Indians at a tertiary referral institution in Singapore. METHODS: Charts between January 1997 and December 2010 were retrospectively reviewed. Charts between January 2014 and December 2014 were prospectively reviewed. RESULTS: A total of 1249 and 148 charts were retrospectively and prospectively reviewed, respectively. The top causes of anterior uveitis (AU) were HLA-B27, idiopathic, and CMV AU. The top known causes of intermediate uveitis were tuberculosis, primary intraocular lymphoma, and sarcoidosis. The top causes of posterior uveitis were CMV retinitis, toxoplasmosis, and dengue maculopathy. The top causes of panuveitis were VKH, idiopathic panuveitis, tuberculosis, and Behçet disease. HLA-B27 and CMV AU were more frequent among Chinese (21% vs 9% (non-Chinese); p<0.001; 10% vs 5% (non-Chinese); p<0.001, respectively). Tuberculous uveitis was more frequent among Malays and Indians (12% (non-Chinese) vs 5% (Chinese), p<0.001). CONCLUSIONS: Different uveitis patterns were encountered among patients of different races.
Assuntos
Povo Asiático/etnologia , Uveíte/etnologia , Adolescente , Adulto , Distribuição por Idade , Idoso , Criança , Pré-Escolar , China/etnologia , Feminino , Humanos , Índia/etnologia , Lactente , Recém-Nascido , Malásia/etnologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Distribuição por Sexo , Singapura/epidemiologia , Centros de Atenção Terciária/estatística & dados numéricos , Uveíte/classificação , Uveíte/etiologiaRESUMO
PURPOSE: To compare enhanced depth imaging (EDI-OCT) and swept source optical coherence tomography (SS-OCT) in assessment of Vogt-Koyanagi-Harada (VKH) disease. METHODS: All consecutive VKH patients seen at Singapore National Eye Centre during 2012-2013 were imaged using both modalities. Subfoveal choroidal thickness (SFCT) was measured by one masked trained observer. RESULTS: A total of 137 pairs of scans were obtained from 48 patients. SFCT was more likely to be measurable on SS-OCT than EDI-OCT (112, 81.8%; 84, 61.3%; p<0.001 Fisher's Exact test). There was good inter-OCT correlation of SFCT when both scans were measureable (mean of the difference in SFCT ± 2 standard deviations (SD) of -14.5 ± 21.0 µm). CONCLUSIONS: SS-OCT images are superior to EDI-OCT but the SFCT measurements are comparable when both are readable.
Assuntos
Corioide/patologia , Tomografia de Coerência Óptica/métodos , Síndrome Uveomeningoencefálica/diagnóstico , Adulto , Feminino , Angiofluoresceinografia , Humanos , Masculino , Pessoa de Meia-Idade , Tamanho do Órgão , Estudos Retrospectivos , Singapura , Acuidade VisualRESUMO
AIMS: To determine the role of enhanced depth imaging optical coherence tomography (EDI-OCT) in chronic Vogt-Koyanagi-Harada (VKH) disease. METHODS: Records of all consecutive patients with VKH seen at the Singapore National Eye Centre were retrospectively reviewed for concurrent EDI-OCT and indocyanine green angiograms (ICGAs) obtained six or more months after disease onset, demographics and duration of disease. The ICGAs were scored based on the following signs: early choroidal stromal vessel hyperfluorescence and leakage, hypofluorescent dark dots, fuzzy vascular pattern of large stromal vessels and disc hyperfluorescence, and correlated with the subfoveal choroidal thickness (SFCT) measured using EDI-OCT. Only images of one eye were analysed. RESULTS: 105 pairs of EDI-OCT and ICGA of 52 patients were included. Mean age was 51.7â years. Half of the patients (26) were male and the majority were Chinese (39 patients, 75.0%). Mean duration of disease was 106.3â months. There were 79 ICGA active episodes. Mean SFCT was thinner when ICGA was quiet (mean=187.31â µ), than when the ICGA was active (mean=272.38â µ, p=0.002). There was a positive correlation of the SFCT with the ICGA score but a negative correlation with age and duration of disease. Multivariate analysis showed that age, duration of disease and ICGA were the main factors affecting SFCT. CONCLUSIONS: The positive correlation of SFCT measurements with ICGA score suggests that it may be used to monitor disease activity in chronic VKH in addition to ICGA, possibly reducing the number of ICGAs required.
Assuntos
Doenças da Coroide/diagnóstico por imagem , Tomografia de Coerência Óptica/métodos , Síndrome Uveomeningoencefálica/diagnóstico por imagem , Adulto , Idoso , Corioide/irrigação sanguínea , Doença Crônica , Feminino , Angiofluoresceinografia , Humanos , Verde de Indocianina , Masculino , Pessoa de Meia-Idade , Estudos RetrospectivosRESUMO
PURPOSE: To assess the role of femtosecond laser technology in the management of severely subluxated cataracts. DESIGN: Retrospective, interventional case series. METHODS: All eyes with subluxated cataract seen between July 2012 and June 2015 were assessed for suitability for femtosecond laser-assisted cataract surgery, with the use of capsular tension devices. Participants with subluxated cataracts of at least 6 clock hours of zonular weakness were included in the study. Data collected included patient demographics, preoperative and postoperative best-corrected visual acuity (BCVA), nuclear density, extent of zonular weakness, completeness of capsulotomy, and complications. Poor visual outcome was defined as BCVA of worse than 20/40. Main outcome measure was the retention of the capsular bag. RESULTS: Of the 72 eyes with subluxated cataracts undergoing surgery during the study period, 47 eyes of 47 patients were eligible for analysis. Mean age of the patients was 60.7 years (standard deviation [SD] 13.2 years). The majority were male (32, 68.1%) and Chinese (38, 80.8%). The mean duration of follow-up was 8 months (SD 5.6 months). The main identifiable cause of lens subluxation was trauma (11 eyes). Almost two thirds (30 eyes) had more than 9 clock hours of zonular weakness. Seventy percent of cataracts (33) were nuclear sclerosis grade 3 and above. The capsular bag was preserved in 43 eyes (91.5%). The intraocular lens was stable and centered at the last follow-up in all these 43 eyes. An anterior capsule tear occurred in 6 eyes, all of which had cataracts of nuclear sclerosis grade 3 and above, with posterior extension occurring in 3 eyes. Primary posterior capsule rupture occurred in 1 eye. At 1 month 37 eyes (80.4%) had a BCVA of 20/40 or better. There was significant improvement in BCVA at 1 month (mean of 0.92 logMAR units [SD 0.88] to 0.22 [SD 0.38] [P < .001, paired samples t test]), which was maintained at 1 year. CONCLUSIONS: Selected cases of severely subluxated cataracts may be managed using femtosecond laser technology to perform the capsulotomy and nuclear fragmentation, with successful preservation of the capsular bag in 90% of eligible cases, especially in eyes with soft cataracts.
Assuntos
Extração de Catarata/métodos , Catarata/complicações , Terapia a Laser/métodos , Cápsula do Cristalino/cirurgia , Subluxação do Cristalino/cirurgia , Cristalino/cirurgia , Idoso , Catarata/diagnóstico , Feminino , Seguimentos , Humanos , Subluxação do Cristalino/complicações , Subluxação do Cristalino/diagnóstico , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Tomografia de Coerência Óptica , Resultado do Tratamento , Acuidade VisualRESUMO
Primary angle closure glaucoma (PACG) is a major cause of blindness worldwide. We conducted a genome-wide association study (GWAS) followed by replication in a combined total of 10,503 PACG cases and 29,567 controls drawn from 24 countries across Asia, Australia, Europe, North America, and South America. We observed significant evidence of disease association at five new genetic loci upon meta-analysis of all patient collections. These loci are at EPDR1 rs3816415 (odds ratio (OR) = 1.24, P = 5.94 × 10(-15)), CHAT rs1258267 (OR = 1.22, P = 2.85 × 10(-16)), GLIS3 rs736893 (OR = 1.18, P = 1.43 × 10(-14)), FERMT2 rs7494379 (OR = 1.14, P = 3.43 × 10(-11)), and DPM2-FAM102A rs3739821 (OR = 1.15, P = 8.32 × 10(-12)). We also confirmed significant association at three previously described loci (P < 5 × 10(-8) for each sentinel SNP at PLEKHA7, COL11A1, and PCMTD1-ST18), providing new insights into the biology of PACG.
Assuntos
Predisposição Genética para Doença , Estudo de Associação Genômica Ampla , Glaucoma de Ângulo Fechado/genética , Linhagem Celular , Mapeamento Cromossômico , Feminino , Expressão Gênica , Loci Gênicos , Genótipo , Humanos , MasculinoRESUMO
PURPOSE: To identify differences between cytomegalovirus (CMV)-positive and CMV-negative eyes presenting as suspected endothelial graft rejection after penetrating keratoplasty (PK). METHODS: A retrospective consecutive case-control series. Aqueous humor samples of all eyes with corneal stromal edema and keratic precipitates (KPs) after PK, seen at the Singapore National Eye Centre from 2007 to 2010, were analyzed for CMV DNA by polymerase chain reaction. Their charts were reviewed for demographic data, medical and ocular history, best-corrected visual acuity, intraocular pressure, anterior segment clinical findings, and therapy. RESULTS: Of 11 eligible eyes (11 patients), 7 were CMV positive. All eyes were negative for herpes simplex virus and varicella zoster virus. The 2 groups were similar in age, gender, and previous ocular surgery. The main differences were the presence of extensive heavily pigmented KPs, Descemet membrane folds, and the absence of vascularization of the donor in CMV-positive eyes (100% vs. 0%, P = 0.003, Fisher exact test). All the CMV-positive eyes were treated with ganciclovir (5 systemic, 2 topical), and the control eyes received immunosuppression. However, all the grafts failed. Best-corrected visual acuity at the last visit was worse than 20/400 in all except 1 control eye, which had a follow-up of 30 months. CONCLUSIONS: There is a high prevalence of CMV infection in eyes that develop corneal stromal edema with KPs after PK. Heavy endothelial pigmentation, Descemet membrane folds, and the absence of donor vascularization may aid in the diagnosis of CMV in the event that aqueous analysis is not possible.
Assuntos
Substância Própria/virologia , Infecções por Citomegalovirus , Infecções Oculares Virais/virologia , Ceratoplastia Penetrante , Idoso , Idoso de 80 Anos ou mais , Antivirais/uso terapêutico , Humor Aquoso/virologia , Estudos de Casos e Controles , Edema da Córnea/patologia , Edema da Córnea/cirurgia , Edema da Córnea/virologia , Substância Própria/patologia , Citomegalovirus/isolamento & purificação , Infecções por Citomegalovirus/tratamento farmacológico , Infecções por Citomegalovirus/patologia , Infecções Oculares Virais/tratamento farmacológico , Infecções Oculares Virais/patologia , Feminino , Ganciclovir/uso terapêutico , Rejeição de Enxerto/patologia , Humanos , Imunossupressores/uso terapêutico , Pressão Intraocular , Masculino , Pessoa de Meia-Idade , Reação em Cadeia da Polimerase , Estudos Retrospectivos , Acuidade VisualRESUMO
AIMS: To compare outcomes of indocyanine green angiography (ICGA) versus clinically monitored immunotherapy in Vogt-Koyanagi-Harada (VKH) disease. METHODS: Consecutive patients of Singapore National Eye Centre with VKH receiving high-dose corticosteroids within 4 weeks of onset of symptoms had therapy titrated to clinical signs of activity (controls) or ICGA findings (ICGA). Charts were reviewed for demographics, interval to treatment, duration of therapy and number of systemic immunosuppressants required. Outcome measures were best corrected acuity, disease activity, presence of sunset glow (SSG) fundus and peripapillary atrophy (PPA) at 2 years. RESULTS: 52 patients were included (38 controls, 14 ICGA). Duration of treatment was shorter in the control group (17 vs 42 months, p<0.001) and they required fewer systemic immunosuppressants than the ICGA group (16% vs 96%, p<0.001). The majority (49 eyes, 96.1%) had 6/12 or better vision and were clinically quiet (43 eyes, 84.3%) in both groups. SSG fundus and PPA were similar in both groups. Treatment within 2 weeks of onset was the main factor affecting their occurrence on multivariate analysis (OR 0.18, 95% CI 0.03 to 0.9, p=0.047; OR 0.08, 95% CI 0.01 to 0.51, p=0.007, respectively). CONCLUSIONS: ICGA-guided immunotherapy did not result in significantly better outcomes with respect to visual acuity and disease activity in VKH eyes treated within 1 month of onset.
Assuntos
Angiofluoresceinografia , Glucocorticoides/uso terapêutico , Imunossupressores/uso terapêutico , Imunoterapia/métodos , Verde de Indocianina , Monitorização Fisiológica/métodos , Síndrome Uveomeningoencefálica/diagnóstico , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Corantes , Feminino , Seguimentos , Fundo de Olho , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento , Síndrome Uveomeningoencefálica/tratamento farmacológico , Acuidade Visual , Adulto JovemRESUMO
BACKGROUND: To determine treatment outcome and risk factors for visual loss in Cytomegalovirus (CMV) endotheliitis. METHODS: Retrospective case-note review of all CMV positive endotheliitis patients seen at the Singapore National Eye Center, for demographics, visual acuity (VA), extent of corneal edema, anterior chamber (AC) activity, ocular history, glaucomatous optic neuropathy (GON), and ganciclovir therapy. Outcome measures were VA, corneal edema, and AC activity. RESULTS: Median age at diagnosis of the 19 patients (21 eyes) was 57 years. Median duration of follow up was 37 months. Sixteen eyes received systemic ganciclovir, and four eyes received ganciclovir gel. The AC inflammation resolved in 19 eyes. The corneal edema resolved in eight eyes, but persisted in 12 eyes. One patient resolved spontaneously. Pre-treatment corneal edema exceeding 75%, older age, GON, and previous corneal graft were risk factors for persistent corneal edema post treatment (P = < 0.001, 0.001, 0.02 and 0.02 respectively, Fisher's exact test), and VA worse than 6/60. CONCLUSIONS: Anterior chamber inflammation resolves with ganciclovir therapy, but severe pre-treatment corneal edema, older age, previous corneal graft, and GON are associated with a poor visual outcome.
Assuntos
Cegueira/epidemiologia , Infecções por Citomegalovirus/tratamento farmacológico , Citomegalovirus/isolamento & purificação , Endotélio Corneano/virologia , Infecções Oculares Virais/tratamento farmacológico , Ceratite/tratamento farmacológico , Administração Oral , Adulto , Idoso , Idoso de 80 Anos ou mais , Anticorpos Antivirais/sangue , Antivirais/uso terapêutico , Humor Aquoso/virologia , Citomegalovirus/genética , Citomegalovirus/imunologia , Infecções por Citomegalovirus/virologia , DNA Viral/análise , Infecções Oculares Virais/virologia , Feminino , Seguimentos , Ganciclovir/análogos & derivados , Ganciclovir/uso terapêutico , Anticorpos Anti-HIV/sangue , Humanos , Infusões Intravenosas , Ceratite/virologia , Masculino , Pessoa de Meia-Idade , Reação em Cadeia da Polimerase , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento , Valganciclovir , Acuidade Visual/fisiologiaRESUMO
PURPOSE OF REVIEW: With improvements in molecular diagnostics tests, viruses are increasingly being found to be associated with what was previously described as idiopathic anterior uveitis. This review presents the clinical features of viral anterior uveitis. RECENT FINDINGS: Herpes simplex virus/varicella zoster virus (HSV/VZV) are important causes of anterior uveitis, but other viruses including cytomegalovirus (CMV) and rubella are also found in a significant number of cases. The various viral anterior uveitides have similar features and should be suspected in eyes with diffuse, fine, stellate keratic precipitates, iris atrophy or ocular hypertension. Acyclovir remains the mainstay of therapy in HSV/VZV infections. CMV responds to ganciclovir, but the relapse rate is high and prolonged therapy may be required. Cataract and glaucoma are the main complications of viral anterior uveitis requiring appropriate management. SUMMARY: There is considerable overlap between clinical manifestations of the different viral anterior uveitides as well noninfectious hypertensive anterior uveitis syndromes. Hence, corticosteroids should be used with caution in these eyes if virus diagnostic tests are not available.
Assuntos
Uveíte Anterior/virologia , Humanos , Uveíte Anterior/diagnóstico , Uveíte Anterior/tratamento farmacológico , Uveíte Anterior/fisiopatologiaRESUMO
PURPOSE: To describe immune ring (IR) formation as a manifestation of cytomegalovirus (CMV) endotheliitis. DESIGN: Retrospective observational case series. METHODS: Review of all consecutive CMV anterior uveitis and endotheliitis patients seen at the Singapore National Eye Centre for the occurrence of an IR. CMV infection was diagnosed by polymerase chain reaction analysis of the aqueous. RESULTS: None of the 72 eyes with CMV anterior uveitis had an IR formation. Four episodes of IR formation were seen in 3 eyes (14.3%) of 21 cases of CMV-positive endotheliitis. All were unilateral and all 3 patients were human immunodeficiency virus negative middle-aged Chinese males. The IR developed 2 to 7 months after occurrence of the endotheliitis and the aqueous was positive for CMV during 2 of the episodes of IR formation. In 2 eyes, the IR occurred at the completion of a course of systemic ganciclovir when the aqueous was negative for CMV. The immune rings resolved with combination therapy of topical prednisolone acetate 0.12% and ganciclovir. Patient 1 had a recurrence of the IR 4 months after stopping treatment but again resolved following treatment with ganciclovir and topical corticosteroids. CONCLUSION: Corneal immune rings can occur as a result of CMV infection. Hence CMV infection may have to be considered in such cases.
Assuntos
Infecções por Citomegalovirus/diagnóstico , Endotélio Corneano/imunologia , Infecções Oculares Virais/diagnóstico , Uveíte Anterior/diagnóstico , Administração Tópica , Adulto , Antivirais/administração & dosagem , Antivirais/uso terapêutico , Humor Aquoso/virologia , Citomegalovirus/genética , Citomegalovirus/isolamento & purificação , Infecções por Citomegalovirus/tratamento farmacológico , Infecções por Citomegalovirus/imunologia , DNA Viral/análise , Quimioterapia Combinada , Infecções Oculares Virais/tratamento farmacológico , Infecções Oculares Virais/imunologia , Feminino , Ganciclovir/administração & dosagem , Ganciclovir/uso terapêutico , Glucocorticoides/administração & dosagem , Glucocorticoides/uso terapêutico , Soronegatividade para HIV , Humanos , Masculino , Pessoa de Meia-Idade , Reação em Cadeia da Polimerase , Precipitinas/imunologia , Prednisolona/administração & dosagem , Prednisolona/análogos & derivados , Prednisolona/uso terapêutico , Estudos Retrospectivos , Resultado do Tratamento , Uveíte Anterior/tratamento farmacológico , Uveíte Anterior/imunologiaRESUMO
PURPOSE: To determine outcome of cataract surgery in severely subluxated traumatic cataracts. DESIGN: Noncomparative case series. METHODS: Retrospective review of cataract surgery in all consecutive eyes with at least 6 clock hours of zonulysis, for patient demographics, presenting best-corrected visual acuity (BCVA) and postoperative BCVA at various time points, extent of zonulysis, and type and timing of insertion of capsular tension device. Main outcome measures were retention of the capsular bag and BCVA at last visit. Secondary outcome measures included IOL stability and centration, and perioperative complications. RESULTS: There were 41 eyes (41 patients). Mean age at time of surgery was 57 years and the mean duration of follow-up was 21.4 months. The capsular bag was preserved with aid of a Cionni modified capsular tension ring (CTR) in 36 eyes (87.8%) and a combination of a capsular tension segment (CTS) and CTR in 2 eyes. In 3 eyes with total zonulysis, the bag could not be preserved despite the use of a CTS in 2 eyes. Preoperatively only 9 of the 41 eyes (22.0%) had a BCVA of 20/40 or better, as compared to 38 eyes at the last visit (92.7%, P < .001, χ(2) test). Posterior capsule rupture occurred in 3 eyes, 2 of which occurred during fixation of the CTR. CONCLUSIONS: The capsular bag can be successfully preserved even in severely subluxated traumatic cataracts with the aid of fixated capsular tension devices.
Assuntos
Extração de Catarata , Catarata/etiologia , Traumatismos Oculares/cirurgia , Subluxação do Cristalino/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Traumatismos Oculares/etiologia , Feminino , Humanos , Cápsula do Cristalino/lesões , Implante de Lente Intraocular , Subluxação do Cristalino/etiologia , Cristalino/lesões , Ligamentos/lesões , Masculino , Pessoa de Meia-Idade , Próteses e Implantes , Estudos Retrospectivos , Ruptura , Resultado do Tratamento , Acuidade Visual/fisiologiaRESUMO
AIM: To determine risk factors for poor visual outcome following cataract surgery in Vogt-Koyanagi-Harada (VKH) disease. METHODS: Retrospective review of all VKH patients who underwent cataract surgery, for demographics, initial corticosteroid dose, treatment outcome, quiescence at time of cataract surgery, perioperative corticosteroid prophylaxis, preoperative best-corrected visual acuity (BCVA), cataract surgery technique, intraocular lens implanted, additional surgical procedures, complications and BCVA at 6 and 12 months postsurgery. RESULTS: 28 of 105 VKH patients (50 eyes) had cataract surgery. The mean age at surgery was 55 ± 13 years. The mean duration of postoperative follow-up was 89.8 months (range 8-252 months). At 12 months postsurgery, no patients lost more than two lines of their preoperative acuity. Forty-one eyes (82%) improved by two or more Snellen lines. Thirty-four eyes (68%) had a BCVA of 20/40 or better. Sixteen eyes (32%) had a poor visual acuity, nine (18%) from pre-existing macular lesions, two from cystoid macular oedema, one from posterior capsule opacification and four from disease recurrence. Recurrent inflammation was the only significant risk factor for poor visual outcome (p=0.004, χ(2) test). CONCLUSION: Recurrent inflammation is a critical poor prognostic factor for cataract surgery in VKH, but with appropriate management, good visual outcomes can be achieved.
Assuntos
Extração de Catarata/efeitos adversos , Catarata/etiologia , Síndrome Uveomeningoencefálica/complicações , Adolescente , Adulto , Idoso , Catarata/complicações , Catarata/fisiopatologia , Extração de Catarata/métodos , Métodos Epidemiológicos , Feminino , Glucocorticoides/uso terapêutico , Humanos , Implante de Lente Intraocular/métodos , Masculino , Pessoa de Meia-Idade , Assistência Perioperatória/métodos , Prognóstico , Recidiva , Resultado do Tratamento , Transtornos da Visão/etiologia , Transtornos da Visão/fisiopatologia , Acuidade Visual/fisiologia , Adulto JovemRESUMO
OBJECTIVES: To describe the type of complications related to contact lens wear seen in a hospital setting in Singapore. METHODS: Data were collated over a 2-year period from April 1999 to March 2001, from all public hospitals in Singapore. A standardized clinical record form was completed by the attending doctor when a patient presented for contact lens-related complications. RESULTS: Nine hundred and fifty-three contact lens-related complications were recorded. The mean age of presentation was 26.4 years. Women made up the majority n=491 (68%). Most patients were Chinese (555, 77%). Six hundred and seventy-six (93.7%) patients were soft contact lens wearers. Most patients, 585 patients (85.2%) wore their lenses on a daily basis. Two hundred and forty-four cases (25.6%) of infective keratitis were seen, with 55 patients requiring hospital admission for management of the infection. Soft disposable contact lens wear was associated with the majority of the infective keratitis (178, 73%). Epithelial keratitis occurred in 229 patients (24.0%) with punctuate epithelial erosions being the commonest presentation in 139 (14.6%). Allergic conjunctivitis occurred in 179 (18.8%) of the cases with giant papillary conjunctivitis accounting for 147 (15.4%) of them. Dry eyes (77, 8.1%), sterile infiltrates (71, 7.5%) and neovascularization of the cornea (75, 7.9%) were the next commonest complications seen. Corneal edema, solution- and lens-related complications occurred in small numbers, accounting for less than 5% of the complications reported. CONCLUSION: Infective keratitis secondary to soft lens wear was the most common complication, followed by epithelial keratitis and allergic conjunctivitis seen in public hospitals in Singapore.
Assuntos
Conjuntivite/etiologia , Conjuntivite/terapia , Lentes de Contato/efeitos adversos , Doenças da Córnea/etiologia , Doenças da Córnea/terapia , Hospitalização , Doença Crônica , Conjuntivite/epidemiologia , Conjuntivite Alérgica/etiologia , Soluções para Lentes de Contato/efeitos adversos , Lentes de Contato de Uso Prolongado/efeitos adversos , Lentes de Contato Hidrofílicas/efeitos adversos , Doenças da Córnea/epidemiologia , Edema da Córnea/etiologia , Neovascularização da Córnea/etiologia , Equipamentos Descartáveis , Síndromes do Olho Seco/etiologia , Feminino , Hospitalização/estatística & dados numéricos , Hospitais Públicos , Humanos , Hipóxia/etiologia , Incidência , Ceratite/microbiologia , Masculino , SingapuraRESUMO
PURPOSE: To determine risk factors for poor visual acuity outcomes in patients with endogenous Klebsiella pneumoniae endophthalmitis. DESIGN: Retrospective case-control study. METHODS: We reviewed all consecutive patients diagnosed with endogenous Klebsiella pneumoniae endophthalmitis over 20 years. Data collected included patients' demographics, clinical findings, investigations, and therapeutic intervention. Main outcome measures were visual acuity (VA) at 3 months postinfection and/or evisceration. Poor vision was defined as VA worse than 4/200. RESULTS: Seventy-one eyes of 61 patients were studied. Mean age was 55.7 (standard deviation [SD] ± 13.1) years. Majority were male (49/61, 80.3%), Chinese (51/61, 83.6%), and had hepatobiliary sepsis (47/61, 77.5%). Mean time to ocular symptoms was 4.4 (± 3.0) days. Fifty-four of 71 eyes (80.2%) had poor vision and 19/71 eyes (26.8%) required evisceration. The most significant risk factor was hypopyon (41/71 eyes, 57.7%) on multivariate analysis (odds ratio [OR], 52.6; 95% confidence interval [CI], 1.7-1000; P = .01). Unilateral involvement (OR, 10.4; 95% CI, 1.2-90.2; P = .01) and patients that were managed before year 2000 (before routine screening was implemented) (OR, 5.2; 95% CI, 1.5-17.9; P = .037) were significant risk factors for evisceration on multivariate analysis. CONCLUSION: Patients presenting with hypopyon and unilateral involvement have a poorer prognosis.
Assuntos
Endoftalmite/microbiologia , Infecções Oculares Bacterianas/microbiologia , Infecções por Klebsiella/microbiologia , Klebsiella pneumoniae/isolamento & purificação , Antibacterianos/uso terapêutico , Estudos de Casos e Controles , Ceftazidima/uso terapêutico , Quimioterapia Combinada , Endoftalmite/diagnóstico , Endoftalmite/tratamento farmacológico , Evisceração do Olho , Infecções Oculares Bacterianas/diagnóstico , Infecções Oculares Bacterianas/tratamento farmacológico , Feminino , Humanos , Infecções por Klebsiella/diagnóstico , Infecções por Klebsiella/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Vancomicina/uso terapêutico , Acuidade Visual/fisiologia , Corpo Vítreo/metabolismoRESUMO
PURPOSE: To determine the prognostic value of fluorescein angiography (FA) and indocyanine green angiography (ICGA) in Vogt-Koyanagi-Harada disease (VKH). DESIGN: Retrospective noninterventional study. METHODS: Chart, FA, and ICGA review of VKH patients of Singapore National Eye Centre for age at onset, gender, race, timing of treatment, and angiographic features during the different phases of FA and ICGA. Outcome measure was disease outcome (acute resolved or chronic recurrent). RESULTS: Twenty-one of the 28 patients with pretreatment FA also had ICGA. Median follow-up duration was 3.6 years (range 0.94-13.42 years). Median age was 42.2 years (range 15.7-77.2 years). The majority (18, 64.3%) were Chinese. The most frequently observed FA features included early pinpoint hyperfluorescence in the posterior pole and disc hyperfluorescence. Large choroidal vessel hyperfluorescence (early and intermediate phase), areas of delayed choroidal perfusion (early phase), and persistent dark dots were the 3 most common ICGA features. Pinpoint peripapillary hyperfluorescence was found to be a significant prognostic FA factor on both univariate and multivariate analysis. None of the ICGA features were found to be significant prognostic factors. CONCLUSION: Early pinpoint peripapillary hyperfluorescence on pretreatment FA is a useful prognostic sign in VKH patients, whereas pretreatment ICGA has limited prognostic value.