Diagnosis, Management, and Treatment of Vernal Keratoconjunctivitis in Asia: Recommendations From the Management of Vernal Keratoconjunctivitis in Asia Expert Working Group.

Vernal keratoconjunctivitis (VKC) is an underdiagnosed and underrecognized ocular surface disease with limited epidemiological data in Asia. It is more prevalent in warm, dry, and windy climates, and often has a substantial impact on a patient's quality of life. In rare cases, VKC can be associated with vision loss, either through corticosteroid overuse or inadequate treatment of persistent inflammation. As a potentially severe and complex disease, there is variability with how VKC is managed across Asia and among the various allergic eye diseases. Diagnosis and treatment of patients with VKC is a challenge for many ophthalmologists, since no precise diagnostic criteria have been established, the pathogenesis of the disease is unclear, and anti-allergic treatments are often ineffective in patients with moderate or severe disease. In addition, the choice of treatment and management strategies used for patients varies greatly from country to country and physician to physician. This may be because of a lack of well-defined, standardized guidelines. In response, the Management of Vernal Keratoconjunctivitis in Asia (MOVIA) Expert Working Group (13 experts) completed a consensus program to evaluate, review, and develop best-practice recommendations for the assessment, diagnosis, and management of VKC in Asia. The expert-led recommendations are summarized in this article and based on the currently available evidence alongside the clinical expertise of ophthalmologists from across Asia with specialism and interest in the ocular surface, VKC, and pediatric ophthalmology.

Comparative evaluation of aspheric toric intraocular lens implantation and limbal relaxing incisions in eyes with cataracts and ≤3 dioptres of astigmatism.

PURPOSE: To compare the visual outcomes of aspheric toric intraocular lens (IOL) implantation and limbal relaxing incisions (LRI) for management of coexisting age-related cataracts and astigmatism. METHODS: In this prospective study, sixty eyes of 60 patients with visually significant cataract and coexisting corneal astigmatism ≤3 dioptres (D) were randomised to undergo phacoemulsification with either aspheric toric IOL or aspheric monofocal IOL with LRI. The main outcome measures were postoperative 3-month uncorrected visual acuity (UCVA), contrast sensitivity, rotational stability of the toric IOL and spectacle independence. RESULTS: The postoperative UCVA, contrast sensitivity and refractive astigmatism were significantly better than the baseline measurements for both groups (p≤0.001). There was no significant difference detected for these parameters between LRI and toric IOL groups postoperatively (p≥0.119). At both postoperative month 1 and 3, the percentages of eyes in need of spectacles were lower in toric group than LRI group (p≤0.030). IOL misalignment was noted in three eyes in the toric IOL group (mean misalignment 7.67±4.04°). On vector analysis, magnitude of error (ME) was negative in the LRI group indicating undercorrection, whereas the ME was close to zero for toric group. CONCLUSIONS: Both toric IOL implantation and LRI were effective in correcting corneal astigmatism ≤3 D during phacoemulsification, while LRI tended to undercorrect astigmatism.

The Association of Delayed Corneal Surface and Visual Recovery After Corneal Transplantation With Longer Donor Storage Time-A Prospective Analysis.

PURPOSE: This study aimed to assess the influence of donor corneal storage time on endothelial cell count (ECC), corneal epithelial recovery, and visual rehabilitation after corneal transplantation in the first postoperative year. DESIGN: A collaborative prospective study involving a local eye bank and a tertiary ophthalmic unit was conducted. METHODS: Donor cornea buttons were stored in Optisol-GS (Chiron Ophthalmics Inc, Irvine, Calif) storage media for a maximum of 14 days before transplantation. Before corneal distribution, the eye bank collected information on death-to-harvesting time, death-to-surgery time, donor central corneal thickness, and donor ECC at various time points. Subjects who underwent penetrating keratoplasty and endothelial keratoplasty were recruited and monitored for 1 year. Postoperative epithelial healing, visual acuity, ECC, and hospital stay were evaluated. RESULTS: Thirty-one eyes of 31 patients completed the study. There was a significant positive correlation between donor storage time and epithelial healing (Spearman ρ = 0.39, P = 0.031). Faster epithelial healing was significantly correlated with posttransplantation visual improvements at months 1, 3, and 6 and shorter hospital stay (Spearman ρ = 0.74, P < 0.001). Mean ECC loss was 23.8% at 12 months posttransplantation. There was no significant correlation between storage time and ECC loss preoperatively and posttransplantation. CONCLUSIONS: The duration of graft storage in Optisol-GS storage media up to 14 days had no significant effects on long-term visual acuity and ECC postoperatively. Shorter storage time had significant correlation with earlier epithelial healing and faster visual rehabilitation.

Comparison of the Surgical Outcomes of Various Methods of Endothelial Keratoplasty.

PURPOSE: The objective of this study was to evaluate the outcomes of various techniques of endothelial keratoplasty (EK) including deep lamellar endothelial keratoplasty (DLEK), Descemet stripping endothelial keratoplasty (DSEK), and Descemet stripping automated endothelial keratoplasty (DSAEK). DESIGN: This was a retrospective comparative case series. METHODS: The medical records of 48 consecutive patients who have undergone EK in a tertiary eye center between January 2005 and June 2011 were reviewed. Information related to demographics, visual acuity, corneal endothelial cell count, and postoperative complications was recorded. RESULTS: The series included 11 eyes with DLEK, 11 eyes with DSEK, and 26 eyes with DSAEK. There was no significant difference in visual outcomes, endothelial cell loss, and postoperative complications between the 3 groups 1 year after surgery. The mean logMAR visual acuity at 12 months was 0.54 (SD, 0.26) for DLEK, 0.55 (SD, 0.47) for DSEK, and 0.63 (SD, 0.48) for DSAEK, respectively. The 6-month endothelial cell density loss was 48.4%, 39.2%, and 47.5% for the DLEK, DSEK, and DSAEK groups, respectively. Early postoperative graft dislocation occurred in 1 (9%) of the DLEK cases, 2 (18%) of the DSEK cases, and 1 (4%) of the DSAEK cases. All of these cases were successfully repositioned. CONCLUSIONS: Despite the various evolution and surgical modifications and development in EK in the past few years, the visual outcomes and postoperative complications between DLEK, DSEK, and DSAEK were comparable.

Comparison between central corneal thickness measurements by ultrasound pachymetry and optical coherence tomography.

PURPOSE: Measurement of central corneal thickness (CCT) plays an important role in both diagnostic and therapeutic assessment of ocular diseases. Although ultrasound pachymetry (U-PACH) is regarded as the golden standard for measurement of CCT, optical coherence tomography (OCT) may offer advantages as it can locate the central cornea with precision with no corneal touch. Nevertheless, the agreement of OCT with U-PACH has not yet been gauged by Bland-Altman analysis. This study compares CCT measurement by OCT with that by U-PACH. METHODS: Healthy subjects without ocular abnormality (except refractive errors less than or equal to -6.0 D), contact lens wear or ocular surgery were recruited. CCT was measured in one eye of normal subjects using OCT and U-PACH. Results were compared using correlation and Bland-Altman plots. RESULTS: Fifty subjects were recruited. Mean +/- SD CCT measured by OCT was 565 +/- 33 microm. This was highly correlated (Pearson's coefficient = 0.934) with the mean thickness measured by U-PACH (543 +/- 33 microm). The coefficients of variation were good and comparable at 7.9% for U-PACH and 3.5% for OCT. Compared with U-PACH, OCT consistently overestimated the CCT by a mean of 23 microm as shown on Bland-Altman plot. CONCLUSION: CCT measured by OCT and U-PACH is highly correlated. With appropriate adjustment factor, OCT agrees well with U-PACH and is a reliable alternative for CCT measurement.

Galactosamine-induced fulminant liver failure--observation in a porcine model.

Fulminant hepatic failure can only be treated successfully by liver transplantation, which, however, is not always available. To "bridge" the patient with fulminant hepatic failure until a liver graft is available, various forms of liver support devices had been designed but they were not uniformly successful. To prove the efficacy of a liver support device for fulminant hepatic failure, testing in an animal model is necessary. We attempted to induce a pig model with fulminant hepatic failure by administering galactosamine into pigs and reported the observation. Three pigs were given a dose of 0.5 gm/kg of galactosamine and five pigs were given 1 gm/kg of galactosamine. One pig receiving 0.5 gm/kg galactosamine survived after manifestation of liver failure, while all the other pigs died. The two pigs receiving 0.5 gm/kg galactosamine survived longer than the five pigs receiving 1 gm/kg galactosamine. Before death, a significant elevation of parenchymal liver enzymes, lactate dehydrogenase, bilirubin, bile acid, ammonia, tumour necrosis factor-alpha, activated clotting time, a decrease of platelet concentration, ketone bodies ratio, blood glucose and plasma albumin, and serious impairment of indocyanine green clearance were indicated. At post-mortem, severe liver necrosis was observed. The model may be suitable for testing the efficacy of liver support device for fulminant hepatic failure, preferably 24-48 hours after administration of galactosamine.