The Effect of Combined Phacoemulsification and Endo-Cyclophotocoagulation on Intraocular Pressure Fluctuation Assessed by the Water Drinking Test in Patients with Primary Open Angle Glaucoma.

INTRODUCTION: The aim of this study was to assess the effect of phacoemulsification and endo-cyclophotocoagulation (phaco-ECP) on intraocular pressure (IOP) fluctuation as assessed by the water drinking test (WDT) in primary open angle glaucoma (POAG). METHODS: This was a prospective observational study carried out at a tertiary referral centre. POAG patients on topical antiglaucoma medications and planned for phaco-ECP were recruited. WDT was performed before surgery and 6 weeks postoperatively by drinking 10 mL/kg of water in 5 min followed by serial IOP by Goldmann applanation tonometry measurements at 15, 30, 45, and 60 min. Mean IOP, IOP fluctuation (difference between highest and lowest IOP), IOP reduction, and factors affecting IOP fluctuation were analysed. RESULTS: Twenty eyes from 17 patients were included. Baseline IOP was similar before (14.7 ± 2.7 mm Hg) and after (14.8 ± 3.4 mm Hg, p = 0.90) surgery. There was no difference in mean IOP (17.6 ± 3.4 mm Hg vs. 19.3 ± 4.7 mm Hg pre- and postoperative, respectively, p = 0.26) or peak IOP (19.37 ± 3.74 mm Hg vs. 21.23 ± 5.29 mm Hg, p = 0.25), albeit a significant reduction in IOP-lowering medications (2.2 ± 1.15 vs. 0.35 ± 0.93, p < 0.001) postoperatively. IOP fluctuation was significantly greater (6.4 ± 3.2 mm Hg vs. 4.6 ± 2.1 mm Hg, p = 0.015) with more eyes having significant IOP fluctuation of ≥6 mm Hg (11 eyes [55%] vs. 4 eyes [20%], p < 0.001) postoperatively. Factors that were significantly associated with increased postoperative IOP fluctuations were higher preoperative IOP fluctuation (ß = 0.69, 95% CI 0.379-1.582, p = 0.004) and more number of postoperative antiglaucoma medications (ß = 0.627, 95% CI 0.614-3.322, p = 0.008). CONCLUSION: Reducing aqueous production with phaco-ECP does not eliminate IOP fluctuation in POAG patients. The increase in postoperative IOP fluctuation suggests increased outflow resistance after phaco-ECP.

Clinical and Histopathological Effects of Intracameral Ranibizumab in Experimental Trabeculectomy.

Post-surgical scarring is a known cause of trabeculectomy failure. The aim of this study was to investigate the effectiveness of ranibizumab as an adjuvant anti-scarring agent in experimental trabeculectomy. Forty New Zealand white rabbits were randomised into four eye treatment groups: groups A (control), B (ranibizumab 0.5 mg/mL), C (mitomycin C [MMC] 0.4 mg/mL), and D (ranibizumab 0.5 mg/mL and MMC 0.4 mg/mL). Modified trabeculectomy was performed. Clinical parameters were assessed on post-operative days 1, 2, 3, 7, 14, and 21. Twenty rabbits were euthanised on day 7, and the other twenty were euthanised on day 21. Eye tissue samples were obtained from the rabbits and stained with haematoxylin and eosin (H&E). All treatment groups showed a significant difference in IOP reduction compared with group A (p < 0.05). Groups C and D showed a significant difference in bleb status on days 7 (p = 0.001) and 21 (p = 0.002) relative to group A. H&E staining showed significantly low fibrotic activity (p < 0.001) in group C on both days and inflammatory cell grade in group B on day 7 (p < 0.001). The grade for new vessel formation was significantly low in groups B and D on day 7 (p < 0.001) and in group D on day 21 (p = 0.007). Ranibizumab plays a role in reducing scarring, and a single application of the ranibizumab-MMC combination showed a moderate wound-modulating effect in the early post-operative phase.

Accuracy of Using Generative Adversarial Networks for Glaucoma Detection: Systematic Review and Bibliometric Analysis.

BACKGROUND: Glaucoma leads to irreversible blindness. Globally, it is the second most common retinal disease that leads to blindness, slightly less common than cataracts. Therefore, there is a great need to avoid the silent growth of this disease using recently developed generative adversarial networks (GANs). OBJECTIVE: This paper aims to introduce a GAN technology for the diagnosis of eye disorders, particularly glaucoma. This paper illustrates deep adversarial learning as a potential diagnostic tool and the challenges involved in its implementation. This study describes and analyzes many of the pitfalls and problems that researchers will need to overcome to implement this kind of technology. METHODS: To organize this review comprehensively, articles and reviews were collected using the following keywords: ("Glaucoma," "optic disc," "blood vessels") and ("receptive field," "loss function," "GAN," "Generative Adversarial Network," "Deep learning," "CNN," "convolutional neural network" OR encoder). The records were identified from 5 highly reputed databases: IEEE Xplore, Web of Science, Scopus, ScienceDirect, and PubMed. These libraries broadly cover the technical and medical literature. Publications within the last 5 years, specifically 2015-2020, were included because the target GAN technique was invented only in 2014 and the publishing date of the collected papers was not earlier than 2016. Duplicate records were removed, and irrelevant titles and abstracts were excluded. In addition, we excluded papers that used optical coherence tomography and visual field images, except for those with 2D images. A large-scale systematic analysis was performed, and then a summarized taxonomy was generated. Furthermore, the results of the collected articles were summarized and a visual representation of the results was presented on a T-shaped matrix diagram. This study was conducted between March 2020 and November 2020. RESULTS: We found 59 articles after conducting a comprehensive survey of the literature. Among the 59 articles, 30 present actual attempts to synthesize images and provide accurate segmentation/classification using single/multiple landmarks or share certain experiences. The other 29 articles discuss the recent advances in GANs, do practical experiments, and contain analytical studies of retinal disease. CONCLUSIONS: Recent deep learning techniques, namely GANs, have shown encouraging performance in retinal disease detection. Although this methodology involves an extensive computing budget and optimization process, it saturates the greedy nature of deep learning techniques by synthesizing images and solves major medical issues. This paper contributes to this research field by offering a thorough analysis of existing works, highlighting current limitations, and suggesting alternatives to support other researchers and participants in further improving and strengthening future work. Finally, new directions for this research have been identified.

Evaluation of Three-Dimensional Heads up Ophthalmic Surgery Demonstration From the Perspective of Surgeons and Postgraduate Trainees.

BACKGROUND: To evaluate the satisfaction of surgeons and trainees with three-dimensional (3D) ophthalmic surgery during a demonstration compared to traditional surgery. METHODS: This validated questionnaire-based study was conducted over 1-month during which Ngenuity 3D surgery was demonstrated. All surgeons and trainees exposed were recruited to complete a questionnaire comprising visualization, physical, ease of use, teaching and learning, and overall satisfaction. RESULTS: All 7 surgeons and 33 postgraduate students responded. Surgeons reported no significant difference except overall (P = 0.047, paired t-test). Postgraduate trainees reported significantly better experience with 3D for illumination (P = 0.008), manoeuvrability (P = 0.01), glare (P = 0.037), eye strain (P = 0.008), neck and upper back strain (P = 0.000), lower back pain (P = 0.019), communication (P = 0.002), comfortable environment (P = 0.001), sharing of knowledge (P = 0.000), and overall (P = 0.009). CONCLUSIONS: During early experience, surgeons and trainees reported better satisfaction with 3D overall. Trainees had better satisfaction with 3D in various subcomponents of visualization, physical, ease of use, and education.

Phenotypic characterization of culture expanded rabbit limbal corneal keratocytes.

The in vivo quiescent corneal stroma keratocytes need to be transformed to activated state in order to obtain sufficient number of cells either for monolayer evaluation or corneal stroma reconstruction. This study aimed to investigate the phenotypic characterization of corneal stromal cells during culture expansion from the limbal region of the cornea. Isolated corneal keratocytes from limbal tissue of New Zealand White Strain rabbits' corneas (n = 6) were culture expanded until three passages. Keratocytes morphology was examined daily with viability, growth rate, number of cell doubling and population doubling time were recorded at each passage. The expression of collagen type 1, aldehyde dehydrogenase (ALDH), lumican and alpha smooth muscle actin (α-SMA) were detected by RT-PCR. Immunocytochemistry was also used to detect ALDH, α-SMA, collagen type I and Cytokeratin-3 (CK3). Growth kinetic study revealed that the growth rate was low at the initial passage but increase to about two folds with concomitant reduction in population doubling time in later passages. Freshly isolated and cultured keratocytes expressed collagen type 1, ALDH and lumican but α-SMA expression was absent. However, α-SMA was expressed along with the other genes during culture expansion. Keratocytes at P1 expressed all the proteins except CK3. These results suggest that cultured keratocytes maintained most of the gene expression profile of native keratocytes while the emergence of α-SMA in serial passages showed a mix population of various phenotypes. The phenotypic characterization of monolayer keratocytes provides useful information before reconstruction of bioengineered tissue or in vitro pharmaceutical applications.

Reversal of Peripheral Anterior Synechiae After Trabeculectomy With Argon Laser Synechiolysis.

We report a case of successful argon laser synechiolysis as a non-invasive alternative for peripheral anterior synechiae release after trabeculectomy in a young patient with steroid-induced ocular hypertension. Steroid-induced ocular hypertension is a known complication of vernal keratoconjunctivitis due to prolonged treatment with steroids. In refractive conditions, augmented trabeculectomy becomes the surgery of choice in these patients. In this article, we report successful treatment of iris tissue plugging the internal ostium with an argon laser and reinstatement of aqueous flow.

Cisplatin-Induced Toxic Optic Neuropathy in a Patient With Hodgkin's Lymphoma.

Hodgkin's lymphoma (HL) is commonly treated with multi-agent chemotherapy, with cisplatin being a key component due to its effectiveness in inducing DNA crosslinking and causing cancer cell death. Despite its therapeutic benefits, cisplatin can lead to serious ocular complications, including a rare but severe condition known as cisplatin-induced toxic optic neuropathy. This condition, while uncommon, has the potential to cause significant and irreversible visual impairment, particularly in pediatric patients, even when cisplatin is administered at standard therapeutic doses. The lack of specific guidelines for ocular monitoring during cisplatin therapy exacerbates the challenge of managing this complication, highlighting the importance of monitoring, early detection and intervention. This case report describes a 16-year-old male pediatric patient with stage IVA HL who was admitted for dexamethasone, high-dose cytarabine, and platinum (DHAP) chemotherapy to treat relapsed disease. He developed sudden, painless bilateral vision loss three days after the discontinuation of the DHAP regimen, which had been stopped due to tumor lysis syndrome and acute kidney failure. The patient presented with severely reduced visual acuity and optic disc swelling in both eyes. Despite receiving high-dose intravenous methylprednisolone, visual improvement was minimal. Unfortunately, the patient did not survive due to disease progression. This case report emphasizes the critical need for careful ocular monitoring and the prompt involvement of ophthalmologists to manage and prevent severe and irreversible ocular complications associated with cisplatin therapy.

A Tetrad Catastrophe: Paraneoplastic Syndrome With Abducens Palsy, Intracranial Hypertension, and Optic Neuropathy in Primary Lung Cancer.

We report a unique case of paraneoplastic syndrome (PS) associated with primary lung cancer. A 57-year-old woman experienced headaches and bilateral visual loss one month after the onset of isolated right abducens palsy. Examination revealed bilateral poor visual acuity (VA), papilledema, and persistent right abducens palsy. Neuroimaging was normal. Lumbar puncture revealed high cerebrospinal fluid (CSF) opening pressure and protein levels. She was started on acetazolamide and pulse methylprednisolone followed by oral corticosteroids. Her abducens nerve palsy resolved, but her VA deteriorated. Anti-Hu and anti-CV2 were positive. A positron emission tomography (PET) scan revealed primary lung cancer, and she died six months after her initial presentation. This case demonstrated that PS poses a diagnostic challenge and may be associated with poor prognosis.

Family of juvenile X-linked retinoschisis with varied presentation: a case series with RS1 genetic analysis.

RS1 gene mutations are known to be a direct cause of the hereditary retinopathy known as retinoschisis. We describe a group of 3 siblings with the same RS1 gene mutation who presented with different retinopathy phenotypes. Genetic testing confirmed the RS1 genotypes. Clinical ophthalmoscopy, color fundus photography, optical coherence tomography, and fundus fluorescein angiography identified manifestations of Coats-like exudative vitreoretinopathy, retinal detachment, and retinoschisis.

Neovascular Glaucoma Complicating Central Retinal Artery Occlusion Despite Cilioretinal Artery Sparing.

This case report aims to describe a case of unilateral central retinal artery occlusion (CRAO) with cilioretinal artery sparing, which was complicated by neovascular glaucoma (NVG). A 75-year-old Indian woman with underlying normal tension glaucoma presented with the sudden onset of painless generalized blurring of the right eye's vision for a week. Her right eye vision was hand motion with the presence of a right relative afferent pupillary defect. Fundus examination revealed retinal whitening over the macula sparing the papillomacular bundle with generalized retinal arteriolar attenuation, which was suggestive of right CRAO with cilioretinal artery sparing. Systemic examination revealed high blood pressure (175/75 mmHg) without ocular bruit or audible murmur on auscultation. Optical coherence tomography of the macula showed inner retinal thickening over the temporal macula. Ultrasound carotid Doppler and computed tomography angiography of the carotid showed more than 75% stenosis over the right distal internal carotid artery. Unfortunately, she developed rubeosis iridis over her right eye two weeks after her presentation, which required pan-retinal photocoagulation. She subsequently progressed to NVG, requiring maximum anti-glaucoma medications to stabilize intraocular pressure. In conclusion, CRAO is a sight-threatening medical emergency. Thorough investigations are required to determine the underlying cause so that early intervention can be done to reduce the risk of a similar attack in the fellow eye and the risk of a cerebrovascular event or cardiac ischemia, which could be life-threatening. The presence of a cilioretinal artery does not prevent ocular neovascularization in CRAO. Hence, patients should also be closely monitored after the initial diagnosis to prevent devastating complications such as NVG.

Bilateral Open Globe Injury Secondary to the King of Fruits: Durian Fall.

We report a case of bilateral open globe injury that resulted from a durian fruit falling on a 62-year-old woman's unprotected face during durian picking in her orchard. On presentation, the bilateral vision was light perception. The right eye sustained a curvilinear corneal laceration with expelled intraocular content. Meanwhile, the left eye sustained a corneoscleral laceration with expelled uvea and retina. Additionally, the right upper lid margin was lacerated. Emergency wound exploration, primary toilet, and suturing were performed on bilateral eyes. Preoperatively, she received intramuscular anti-tetanus toxoid and intravenous ciprofloxacin. Intravitreal ceftazidime and vancomycin were given intraoperatively as endophthalmitis prophylaxis. Postoperatively, the vision remained as light perception. There were no signs of endophthalmitis in both eyes. Although traumatic globe injury due to durian is uncommon, individuals should wear protective gear while in a durian orchard to avoid such unprecedented accidents. Prompt yet scrupulous action should be taken to save the globe and further possible complications.

Quality of Life of Older Adults with Primary Open Angle Glaucoma using Bahasa Malaysia Version of Glaucoma Quality of Life 36 Questionnaire.

BACKGROUND: Primary Open-Angle Glaucoma (POAG) is an age-related chronic optic neuropathy causing progressive constriction of visual field, which compromised quality of life (QoL) of older adults. OBJECTIVE: The study aims to determine the QoL according to the severity of visual field using Bahasa Malaysia version of the Glaucoma Quality of Life- 36 (Glau-QoL 36) in older adults with POAG in Malaysia. METHODS: A cross-sectional study was conducted in two tertiary hospitals in Malaysia: Hospital Universiti Sains Malaysia, Kelantan, and Hospital Selayang, Selangor. POAG patients who were ≥ 60 years old at the time of recruitment had minimal cataract, underwent cataract or trabeculectomy surgery at least 3 months prior and were on medical and surgical treatment. The severity of POAG was based on the modified Advanced Glaucoma Intervention Study (AGIS) score on two reliable reproducible Humphrey visual field SITA program 24-2 analysis. Face to face, one-on-one interview was conducted using validated Bahasa Malaysia version of GlauQol 36. RESULTS: A total of 360 older adults with POAG were recruited. Majority were between ages 60-67 (38.3%) with 64 (17.8%) mild, 93 (25.8%) moderate, 115 (31.9%) severe POAG and 88 (24.4%) end-stage severity of POAG. The majority of the recruited patients were not working (88.9%) and live with their families (68.1%). There was a significant association between GlauQoL 36 score of all domains: daily living, driving, physiological well-being, self-image, anxiety, burden of treatment and confidence in healthcare with the severity of POAG (p<0.001). Increased severity of POAG was associated with decreased QoL in all GlauQoL 36 domains except confidence in healthcare. There was also a significant increase in dependency, with a majority of the end-stage were living with their families (p<0.001). CONCLUSION: QoL and independency of older adults with POAG decrease with worsening of visual field defect. Addressing the problem of visual-related activities in older adults with POAG may reduce their dependency and improve QoL. Happy living is important to lead to healthy living among older adults with POAG.

Post-Cataract Surgery Iridodialysis Repair: A Simple Modified Ab Externo Technique.

Iridodialysis occurs less commonly due to ocular surgeries as compared to trauma. Several approaches to iridodialysis repair have been described in the literature. In this report, we describe a novel technique to treat iridodialysis that occurred due to complicated extracapsular cataract extraction (ECCE). This technique utilizes pre-existing ECCE wounds by making use of common materials found in the usual operation theaters and is relatively easy to master. Improved cosmetic appearance and visual acuity was the final outcome as demonstrated in our patient.

Primary Basal Cell Carcinoma of the Conjunctiva.

Epithelial conjunctival malignancies are one of the most prevalent ocular surface tumors. Primary basal cell carcinoma (BCC) of the conjunctiva is extremely rare. We report the case of a 67-year-old Indian gentleman who presented with a fleshy conjunctival lesion for one year on his right eye. Examination revealed a lightly pigmented conjunctival mass adjacent to the limbus. The surface was irregular and non-ulcerated with few feeder vessels. The working diagnosis was ocular surface squamous neoplasia (OSSN). A wide excisional biopsy using the no-touch technique and double-freeze-thaw cryotherapy to the conjunctival margins was performed. The bare scleral area was covered with an amniotic membrane. Histopathological examination revealed a basaloid cell neoplasm favoring BCC, and a tumor-free margin was achieved. Three cycles of topical mitomycin-C 0.02% were prescribed as adjunct chemotherapy postoperatively. There was no evidence of recurrence three months after treatment. The primary BCC of the conjunctiva is unusual and can resemble OSSN. Therefore, it should be considered in the differential diagnosis of patients presenting with atypical features of OSSN.

Objective Assessment of Retinal Artery Macroaneurysm With Optical Coherence Tomography Angiography.

Retinal artery macroaneurysm (RAM) is an acquired retinal arteriole dilatation with vision-threatening complications. Diagnosis of this condition can be made clinically, supported by multi-modal imaging modalities, commonly optical coherence tomography (OCT) and dye-based angiography studies which show the lesion itself and the complications to the adjacent retina. We report a case of an 83-year-old patient with renal impairment who had the diagnosis and monitoring of RAM done using optical coherence tomography angiography (OCT-A) as an alternative to conventional fluorescein angiography. This case highlighted the use of OCT-A using Cirrus 5000 with AngioPlex (Zeiss, Jena, Germany) as a useful diagnostic and monitoring tool for RAM with its features that enables objective quantification of the disease activity via vessel and perfusion density pre- and post-laser treatment.

Simultaneous Oculomotor and Trochlear Nerve Palsy in Herpes Zoster Ophthalmicus.

Simultaneous oculomotor and trochlear nerve palsy in Herpes Zoster Ophthalmicus (HZO) is rare. We report a 78-year-old lady who presented with right ptosis while receiving treatment for HZO keratouveitis. Examination showed crusted vesicular lesions on the right V1 dermatome with right complete ptosis and limited right eye extraocular movement on adduction, supraduction, infraduction, and intorsion. There was mild right eye anterior chamber inflammation, while bilateral fundus examinations were normal. Other neurological and systemic examinations were unremarkable. Neuroimaging was also normal. Corticosteroids treatment was started, in addition to oral acyclovir, given for a total course of six weeks. Her ocular motor cranial neuropathy (OMCN) was partially resolved during the follow-up at one year. OMCN can be an isolated complication of HZO, or it may be associated with other neurological complications. Although recovery for OMCN is anticipated, the patient should be closely monitored for the possibility of developing other devastating neurological complications.

Interpretation of change scores for the National Eye Institute Visual Function Questionnaire-25: the minimally important difference.

AIM: To estimate the minimally important difference (MID) in change in National Eye Institute Visual Function Questionnaire-25 (VFQ-25) composite score using methods aligned with patient perception. METHODS: Retrospective analysis of prospectively collected data from adults with primary angle closure or primary angle closure glaucoma enrolled in the Effectiveness, in Angle-closure Glaucoma, of Lens Extraction study. We included data from 335 participants with patient reported visual function (VFQ-25) and health status measured by the EQ-5D-3L over 36 months. We used the recommended anchor-based methods (receiver operating characteristic (ROC), predictive modelling and mean change) to determine the MID of the VFQ-25. EQ-5D-3L anchor change was defined as none (<0.065); minimal (0.065≤EQ-5D-3L change ≤0.075 points) and greater change (>0.075 points). RESULTS: Mean baseline VFQ-25 score was 87.6 (SD 11.8). Estimated MIDs in the change in VFQ-25 scores (95% CI) were 10.5 (1.9 to 19.2); 3.9 (-2.3 to 10.1); 5.8 (1.9 to 7.2) and 8.1 (1.7 to 14.8) for the 'within-patient', 'between-patient' change, ROC and predictive modelling anchor methods respectively. Excluding estimates from the methodologically weaker 'within-patient' method, the MID of a change in VFQ-25 composite score is 5.8 (median value). CONCLUSIONS: Estimates of the MID using multiple methods assist in the interpretation of the VFQ scores. In the context of early glaucoma related visual disability, a change score of around six points on the VFQ-25 is likely to be important to patients. Further confirmatory research is required. Studies comparing changes in patient-reported outcome measure scores with a global measure of patients' perceived change are required.

Pharmacological and non-pharmacological management of spinocerebellar ataxia: A systematic review.

Spinocerebellar ataxias (SCA) comprise a rare, genetic subgroup within the degenerative ataxias and are dominantly inherited, with up to 48 recognized genetic subtypes. While an updated review on the management of degenerative ataxia is published recently, an evidence-based review focussed on the management of SCA is lacking. Here, we reviewed the pharmacological and non-pharmacological management of SCA by conducting a systematic review on Medline Ovid and Scopus. Of 29,284 studies identified, 47 studies (pharmacological: n = 25; non-pharmacological: n = 22) that predominantly involved SCA patients were included. Twenty studies had a high risk of bias based on the Cochrane's Collaboration risk of bias tool. As per the European Federation of Neurological Societies 2004 guideline for therapeutic intervention, the remaining 27 studies were of Class I (n = 4) and Class II (n = 23) evidence. Only two therapies had Level A recommendations for the management of ataxia symptoms: riluzole and immediate in-patient neurorehabilitation. Ten therapies had Level B recommendations for managing ataxia symptoms and require further investigations with better study design. These include high dose valproate acid, branched-chain amino acid, intravenous trehalose; restorative rehabilitation using cycling regimen and videogame; and cerebellar stimulations using transcranial direct current stimulation and transcranial magnetic stimulation. Lithium and coaching on psychological adjustment received Level B recommendation for depressive symptoms and quality of life, respectively. Heterogeneous study designs, different genotypes, and non-standardized clinical measures alongside short duration and small sample sizes may hamper meaningful clinical translation. Therefore, rating of recommendations only serve as points of reference.

Choosing appropriate patient-reported outcomes instrument for glaucoma research: a systematic review of vision instruments.

PURPOSE: To identify vision Patient-Reported Outcomes instruments relevant to glaucoma and assess their content validity. METHODS: MEDLINE, MEDLINE in Process, EMBASE and SCOPUS (to January 2009) were systematically searched. Observational studies or randomised controlled trials, published in English, reporting use of vision instruments in glaucoma studies involving adults were included. In addition, reference lists were scanned to identify additional studies describing development and/or validation to ascertain the final version of the instruments. Instruments' content was then mapped onto a theoretical framework, the World Health Organization International Classification of Functioning, Disability and Health. Two reviewers independently evaluated studies for inclusion and quality assessed instrument content. RESULTS: Thirty-three instruments were identified. Instruments were categorised into thirteen vision status, two vision disability, one vision satisfaction, five glaucoma status, one glaucoma medication related to health status, five glaucoma medication side effects and six glaucoma medication satisfaction measures according to each instruments' content. The National Eye Institute Visual Function Questionnaire-25, Impact of Vision Impairment and Treatment Satisfaction Survey-Intraocular Pressure had the highest number of positive ratings in the content validity assessment. CONCLUSION: This study provides a descriptive catalogue of vision-specific PRO instruments, to inform the choice of an appropriate measure of patient-reported outcomes in a glaucoma context.

Chronic endogenous fungal endophthalmitis: diagnostic and treatment challenges: A case report.

RATIONALE: Endogenous fungal endophthalmitis (EFE) is a sight-threatening complication of systemic fungemia. As the prevalence rises, treatment remains a challenge especially when there is a failure in first-line treatment or drug-resistant fungus. This case report studies a case of chronic EFE, focusing on the diagnostic procedures, treatment options, monitoring parameters and the treatment outcome. PATIENT CONCERNS: A 64-year-old man with underlying well controlled diabetes mellitus was treated with 2 weeks' course of intravenous antifungal fluconazole for pyelonephritis as his blood culture grew Candida albicans. Concurrently, he complained of 3 months of bilateral painless progressive blurring of vision. At presentation, his visual acuity (VA) was light perception both eyes. Ocular examination revealed non granulomatous inflammation with dense vitritis of both eyes. DIAGNOSIS: He was diagnosed with EFE but the condition responded poorly with the medications. INTERVENTIONS: He was treated with intravitreal (IVT) amphotericin B and fluconazole was continued. Vitrectomy was performed and intraoperative findings included bilateral fungal balls in the vitreous and retina with foveal traction in the left eye. Postoperatively, vision acuity was 6/24, N8 right eye and 2/60, N unable for left eye with extensive left macular scar and hole. Vitreous cultures were negative. He received multiple IVT amphotericin B and was started on topical steroid eye drops for persistent panuveitis with systemic fluconazole. Ocular improvement was seen after switching to IVT and topical voriconazole. Despite this, his ocular condition deteriorated and he developed neovascular glaucoma requiring 3 topical antiglaucoma agents. Panretinal photocoagulation was subsequently performed. OUTCOMES: At 3 months' follow-up, his vision acuity remained at 6/24 for right eye and 2/60 for the left eye. There was no recurrence of inflammation or infection in both eyes. LESSONS: Voriconazole could serve as a promising broad spectrum tri-azole agent in cases of failure in first-line treatment or drug-resistant fungus.