Seasonal and Temporal Trends of Infectious Keratitis in Northern Vietnam.

The epidemiology of corneal ulcers in Vietnam has not been well characterized. In this report, we reviewed retrospectively the microbiological data of patients with a clinical diagnosis of corneal ulcer at the microbiology laboratory of Vietnam National Eye Hospital from January 1, 2010 to March 31, 2023. We observed a seasonal pattern for fungal and microsporidial keratitis, with an annual peak in November, and an inverse relationship between fungal keratitis and inclement weather. The November peak coincided with one of the major harvesting seasons in Vietnam. We also observed increasing numbers of microsporidial and Acanthamoeba keratitis cases in recent years. Knowledge of these trends are helpful in guiding empirical treatment of corneal infections and preventing corneal blindness.

Comparing the Safety and Efficacy of Phacogoniosynechialysis With Phacotrabeculectomy in the Management of Refractory Acute Primary Closure Angle Glaucoma With Cataract: A Multicenter Randomized Trial.

PRCIS: Combined phacoemulsification-goniosynechialysis (phaco-GSL) and unaugmented phacotrabeculectomy were both found to be effective in treating eyes with significant cataract and medically unresponsive acute primary angle closure glaucoma (PACG). Phaco-GSL seemed to be safer, with fewer surgical complications, and achieved better visual acuity than phacotrabeculectomy. OBJECTIVES: To compare the results of combined phaco-GSL with unaugmented phacotrabeculectomy in the management of eyes with medically unresponsive acute PACG and cataract. PARTICIPANTS AND RESEARCH METHODS: This was a prospective randomized controlled trial involving patients with significant cataract and acute PACG who were not responsive to maximal medical therapy. Three ophthalmic centers in Hanoi, Vietnam, participated in this trial. Study subjects were randomized into 2 groups: phaco-GSL or phacotrabeculectomy. Of note, mitomycin-C or 5-fluorouracil were not used during trabeculectomy, but postoperative bleb needling with 5-fluorouracil injection(s) was allowed. The primary outcome of the study was the rate of postoperative surgical complications in the first 3 months after surgery. The secondary outcome, determined at 1 year, assessed whether treatment was completely successful [defined as intraocular pressure (IOP)<21 mm Hg without IOP-lowering drops], or partially successful (IOP<21 mm Hg with IOP-lowering drops). Treatment failure was defined as IOP≥21 mm Hg with maximal IOP-lowering drops. RESULTS: In total, 79 eyes from 79 patients (62 females, 17 males) were recruited (42 and 37 eyes in the phaco-GSL and phacotrabeculectomy groups, respectively). There were no statistically significant differences between the 2 groups at baseline in terms of age, visual acuity, IOP, anterior angle width, or preoperative ultrasound biomicroscopy index. Postoperative complications in the first 3 months were seen more frequently in the phacotrabeculectomy group (62.2%) than in the phaco-GSL group (14.3%, P<0.01). At 1 year postsurgery, treatment was 100% successful in both groups, with no difference in the mean IOP (15.38±3.42 vs. 15.72±4.47 mm Hg). The visual field index improved significantly following surgery in both groups, but there was also no significant difference between the 2 groups. However, there was a significant difference in the best corrected visual acuity at 1 year, with patients in the phaco-GSL group achieving better vision (0.45±0.21 logMAR in the phaco-GSL group vs. 0.64±0.27 logMAR in the phacotrabeculectomy group, P=0.04). The mean angle width was also significantly larger in the phaco-GSL group than the phacotrabeculectomy group (2.34±0.33 vs. 1.25±0.41 Shaffer degrees). Similarly, on ultrasound biomicroscopy, the anterior chamber was deeper after 12 months (2.87±0.28 to 2.48±0.33 mm), and the mean trabecular-iris angle area was wider at 12 months (21.88±7.07 vs. 14.95±4.39 degrees) in the phaco-GSL than the phacotrabeculectomy group. CONCLUSIONS: Phaco-GSL and phacotrabeculectomy were both effective in treating medically unresponsive cases of acute PACG with cataracts. However, phaco-GSL showed better visual outcomes, wider drainage angles postsurgery, and fewer complications than phacotrabeculectomy.

Novel Cytokine Multiplex Assay for Tear Fluid Analysis in Sjogren's Syndrome.

Purpose: Sjögren's syndrome (SS) is an autoimmune disease associated with ocular surface inflammation. The goals of this study were to establish a novel bead-based protein microarray for simultaneous analysis of 11 cytokines from tear fluid collected with Schirmer strips from patients with SS.Methods: Three to ten microliter of tear fluid was collected with Schirmer strips from both eyes of 13 healthy controls and 12 SS patients. Tear fluid was eluted from the Schirmer strips, total protein and concentrations of 11 different cytokines were analyzed.Results: The multiplex assay demonstrated high assay sensitivity with LoDs between 1.4 and 55.3 pg/µl with mean CVs between 3.7% and 9.7%. Statistically significant upregulation (p < .005) of eight cytokines was observed in SS patients compared to controls. Additionally, four patient cytokine values showed a significant inverse correlation (r<-0.7) with Schirmer strip readings.Conclusion: The assay offers analytical reliability for quantification of biomarkers in small amounts of tear fluid with potential utility for treatment monitoring of SS and other types of Dry Eye Disease.

Ultrasound Biomicroscopic Diagnosis of Angle-closure Mechanisms in Vietnamese Subjects With Unilateral Angle-closure Glaucoma.

OBJECTIVE: To identify the mechanisms of angle closure in the fellow eyes of Vietnamese subjects with unilateral primary angle-closure glaucoma (PACG) using ultrasound biomicroscopy (UBM) before and after prophylactic laser peripheral iridotomy (LPI). DESIGN: This is a prospective observational study. PARTICIPANTS: Patients diagnosed with PACG in one eye and primary angle-closure suspect (PACS) in the other eye were included in this study, conducted from January 2014 to October 2014 at Vietnam National Institute of Ophthalmology. MATERIALS AND METHODS: A total of 112 PACS fellow eyes of 112 patients presenting with unilateral PACG were evaluated. All subjects underwent standard ophthalmic clinical examination and UBM imaging a week before and after LPI. On the basis of UBM images, the angle-closure mechanism was defined according to the classification of Svend Vedel Kessing and John Thygesen as pupillary block (PB), plateau iris (PI), and mixed pattern. RESULTS: The proportion of PACS subjects who showed PB was 86.6%, while 13.4% showed a PI configuration before LPI. After LPI the pre-LPI PB group was reclassified, with 55.4% showing pure PB, and 31.3% showing mixed mechanisms (PB and PI). The proportion of patients with PI remained unchanged (13.4%) even after LPI. After the LPI, the angle opening significantly increased in the PB subgroup (14.01±2.43 degrees, P<0.01) and reclassified mixed group (6.34±1.71 degrees, P<0.01) but remained almost unchanged in the PI group (1.81±0.98 degrees, P>0.05). CONCLUSION: On the basis of the UBM criteria, PI was found in 13.4% of PACS fellow eyes of Vietnamese subjects with PACG. The clinical and UBM features of patients showing PI before LPI remained almost unchanged after the procedure. The proportion of patients showing PB pre-LPI reduced from 86.6% to 55.4% showing the important role of mixed mechanisms in PACG.