The Effect of Tube Location on Corneal Endothelial Cells in Patients with Ahmed Glaucoma Valve.

PURPOSE: To compare the effects of the Ahmed glaucoma valve (AGV; New World Medical, Rancho Cucamonga, CA) with sulcus versus anterior chamber (AC) tube placement on the corneal endothelial density and morphology over time. DESIGN: Nonrandomized, interventional study. PARTICIPANTS: This study included 106 eyes from 101 pseudophakic patients who had the AGV tube placed in the AC (acAGV) and 105 eyes from 94 pseudophakic patients who had the AGV tube placed in the ciliary sulcus (sAGV). METHODS: All patients underwent preoperative specular microscopy, which was repeated postoperatively in 2019. The patients' demographic information, glaucoma diagnoses, and basic ocular information were obtained on chart review. Anterior segment OCT was conducted for patients who underwent sAGV to evaluate the sulcus tube position. Gonioscopy was performed to document peripheral anterior synechiae (PAS). Linear mixed-effects models were used to compare the different ocular and endothelial measurements between the 2 groups and to identify risk factors for endothelial cell density (ECD) loss over time. MAIN OUTCOME MEASURES: Monthly change in corneal endothelial measurements, including ECD and coefficient of variation (CV), calculated as the difference between preoperative and postoperative measurements divided by the number of months from the time of surgery to postoperative specular microscopy. RESULTS: The acAGV and sAGV groups were comparable in all baseline characteristics except that the acAGV group had longer follow-up (37.6 vs. 20.1 months, respectively, P < 0.001). Mean monthly loss in central ECD was significantly more in the acAGV group (mean ± standard deviation: 29.3±29.7 cells/mm2) than in the sAGV group (15.3±20.7 cells/mm2, P < 0.0001). Mean monthly change in CV was similar between the 2 groups (P = 0.28). Multivariate analyses revealed that younger age and tube location in the AC were associated with faster central ECD loss (P = 0.02, P < 0.0001, respectively). For patients with sAGV, while PAS was associated with faster central ECD loss (P = 0.002), a more forward tube position tenting the iris was not (P > 0.05). CONCLUSIONS: Compared with anterior segment placement, ciliary sulcus tube implantation may be a preferred surgery approach to reduce endothelial cell loss in pseudophakic patients.

Effect of general anaesthesia on intraocular pressure in paediatric patients: a systematic review.

OBJECTIVES: Assessment of the impact of general anaesthetic agents on intraocular pressure (IOP) in children via systematic review. METHODS: Pubmed, Embase, and CENTRAL databases were systematically searched to identify randomised controlled trials, prospective, and interventional studies. The search included all studies through October 5, 2018 with no date or language restrictions. A linear mixed-effects regression analysis was performed to study the change in IOP after general anaesthesia (GA). RESULTS: The strategy identified 518 studies that met search criteria. Six studies (531 eyes) were included for quantitative synthesis. Seven categories of mixed and non-mixed induction and maintenance agents were compared. When assessing all agents utilising a model of mean IOP as a function of time, IOP decreased after induction phase at a rate of -0.59 ± 0.19 mmHg/min (P value = 0.006). CONCLUSIONS: This systematic review showed that most anaesthetic agents significantly decrease IOP over time after the induction phase of general anaesthesia in children. An understanding of the effects of GA on IOP is critical for those performing paediatric ophthalmic examinations under anaesthesia.

Aeromonas hydrophila Panophthalmitis in Pemphigus Vulgaris: A Case Report.

A 47-year-old Thai man, who had recently been diagnosed with active pemphigus vulgaris (PV) and treated with oral prednisolone together with intravenous dexamethasone, presented with severe ocular pain and light perception vision of the left eye for 4 days. Ophthalmic examination revealed periorbital soft tissue swelling with marked intraocular inflammation in the left eye. Severe panophthalmitis was diagnosed. Enucleation was performed after failure of intravenous antibiotics administration. Vitreous culture revealed Aeromonas hydrophila but no primary source of infection was clearly identified. An immunocompromised status accompanied with corticosteroid treatment is a risk factor for septicemia. A. hydrophilapanophthalmitis was detected in the PV patient, and this organism caused a rapid disease progression with poor visual prognosis.

Citation Characteristics of Research Articles under the Center of Cleft Lip-Cleft Palate and Craniofacial Deformities, Khon Kaen University.

Center of Cleft Lip-Cleft Palate and Craniofacial Deformities, Khon Kaen University, has cooperated with the Medical Association of Thailand in publishing the special five issues of JMT (Journal of the Medical Association of Thailand) during the years 2010-2014 in order to promote research activities and working network of related fields in cleft lip-cleft palate and craniofacial deformities. This study aimed to examine the features of 106 research articles in terms of authors and disciplines, and analyze the citations considering sources, country and years after publication. The scope of study also included citations in the form of journal, which was presented as journal ranking compared with impact factors and Bradford's Law on journal citation. The results of study will be useful in developing multidisciplinary research activities of the center and especially assist in the acquisition of academic journals for essential sources of reference.

Accuracy of Intraocular Lens Calculation by SRK/T Formula in Pediatric Cataracts.

OBJECTIVE: To examine the accuracy of the intraocular lens calculation by SRK/T formula in pediatric cataract patients, by means of the prediction error after the cataract surgery. MATERIAL AND METHOD: A retrospective review of pediatric patients requiring cataract extraction with intraocular lens implantation, between January 2006 and December 2013 was performed. Post-operative spherical equivalent was compared with the predicted calculation value from pre-operative SRK/T measurement, defined as prediction error (PE). RESULTS: 139 eyes from 106 patients were studied. The median age of patients at surgery was 4.56 years (IQR, 14). The two most common causes of cataract were idiopathic and traumatic; 85 eyes (61.2%) and 36 eyes (25.9%), respectively. Primary intraocular lens (IOL) implantation was performed in 87 (62.6%) eyes. The mean PE was -1.32±1.89 D (-7.78, 2.24). At one to three months after surgery, the mean PE of IOL in bag and sulcus were -0.87 D and -2.02 D, respectively. In non-traumatic group, the mean PE of IOL in bag and sulcus were -1.1 D and 2.28 D, respectively, whilst the traumatic group was -0.33 D and -1.16 D, respectively. Post-operative PE within ±1 diopter was found in 30 eyes (37.97%) at one to three months of follow-ups. CONCLUSION: The majority of post-operative refraction was more myopic than the taigeted refractive error, which was calculated by SRK/T formula. Aiming for a more hyperopic target and IOL implantation in the bag would decrease the post-operative prediction error in the use of the SRK/T formnula in pediatric cataract patients.

Advanced exudative retinopathy with neovascular glaucoma as the clinical presentation of diabetes mellitus and severe combined hyperlipidemia: a case report.

UNLABELLED: A 50-year-old man presented with bilateralprogressive visual loss for 5 months. Visual acuity was reduced to countingfingers in the right eye and light perception in the left. Although neovascularizations were detected in the angles of the eyes, neovascular glaucoma and rubeosis iridis were demonstrated only in the left. Fundus examination showed bilateral advanced exudative retinopathy in both eyes. Severe attenuated retinal arteries and enlarged cupping with disc pallor were observed in the left eye. Generalized eruptive xanthomas were found on the back and extremities. Extreme dyslipidemia (serum cholesterol 1311 mg/dl and triglycerides 6356 mg/dl) and diabetes mellitus (fasting plasma glucose 325 mg/dl and HbA1 c 12.1%) were first diagnosed. The serum lipid profiles and glucose levels were dramatically decreased within a month after treatment with subcutaneous insulin injections and oral hypolipidemic agents; notwithstanding, his vision was not significantly improved, even after treatment with intravitreal anti-VEGF injection, intravitreal steroid injection and panretinal photocoagulation. CONCLUSION: The principle causes of advanced exudative retinopathy are severe breakdown of the blood-retinal barrier due to diabetes mellitus and altered retinal pigment epithelium lipid metabolism. In ourpatient, central retinal vascular occlusion was also the suspected cause ofneovascular glaucoma.