Descemet’s membrane detachment in a corneal graft after removal of a Baerveldt Shunt Intraluminal Stent

Objective@#We reported a case of Descemet's membrane detachment (DMD) following ripcord removal of a Baerveldt shunt in a post-corneal transplant eye, and the interventions done.@*Method@#This is a case report@*Results@#A 65-year-old male with multiple surgeries (phacoemulsification, two corneal transplants, and Baerveldt shunt implantation) in the right eye developed increased intraocular pressures, prompting removal of the intraluminal stent (ripcord) of the shunt. This was complicated by hypotony and DMD. Ripcord reinsertion and viscoelastic injection were performed to reattach the Descemet's membrane (DM) but failed. 0.1mL of 14% perfluoropropane (C3F8) gas was injected into the anterior chamber that successfully reattached the DM with return to pre-operative best-corrected visual acuity after 1 week. @*Conclusion@#Injection of an expansive gas (C3F8) was effective in repairing a corneal graft DMD in an eye with a Baerveldt shunt.

Bilateral Iridocorneal Endothelial Syndrome

Objectives@#We presented a case of bilateral iridocorneal endothelial (ICE) syndrome with secondary glaucoma and discussed its clinical presentation and management.@*Study design@#This is a case report.@*Results@#A 12-year old female consulted for a one-year history of progressive blurring of vision in both eyes associated with abnormal pupils and occasional eye pain. Polycoria, shallow anterior chambers, increased intraocular pressures (IOP), areas of closed angles on gonioscopy, and increased cup-to-disc ratio in both eyes indicative of ICE syndrome were present. Management included anti-glaucoma medications and implantation of glaucoma drainage devices (GDD).@*Conclusion@#Early detection with regular follow-ups leading to prompt management of the ICE syndrome are necessary. IOP control may be challenging due to the nature of the disease and may require multiple surgeries including GDD implantation to achieve successful outcomes. Early use of GDD may be beneficial for pediatric patients with ICE and glaucoma, and may require additional surgeries to adequately manage the IOP.

The effect of wearing N95 respirator masks on intraocular pressure of health care workers

Objective@#We determined if there was a significant change in the intraocular pressure (IOP) of healthcare workers with extended use of N95 masks.@*Methods@#This was a prospective time-series study involving 58 eyes of 29 healthcare workers who were assigned to 3 groups: surgical mask (control) and 2 intervention arms consisting of valved N95 (8511, 3M, USA) and non-valved N95 (8210, 3M, USA) masks. Each participant underwent IOP measurements of both eyes by Goldmann applanation tonometry at baseline, 5 minutes, 1 and 4 hours of mask use on three separate days. The primary outcome was the difference in IOP between the N95 and surgical mask groups.@*Results@#Mean baseline IOP of the cohort was 13.85 ± 1.11 mmHg with no significant difference among the groups. Compared to surgical mask use, mean IOP was increased at the 1 hour and 4 hour time points with valved N95 use (+0.88, p<0.001; +1.48, p<0.001 respectively) and increased at the 5 minute, 1 hour and 4 hour time points with nonvalved N95 use (+0.52, p=0.01; +1.07 p<0.001; +1.62, p<0.001, respectively).@*Conclusion@#There was a statistically significant increase in IOPs with prolonged N95 mask use. However, the levels of IOP increase were less than 2 mmHg and may be not clinically significant.

Diagnostic accuracies of a Smartphone-Based Fundus photography and tablet-based visual field testing

Objective@#We determined the diagnostic accuracies of the mydriatic, monoscopic, iPhone 6s+ optic nerve photographs with a 20D lens and the Melbourne Rapid Fields (MRF) visual fields iPad application.@*Methods@#This was a prospective, cross-sectional, single-center study involving 47 non-glaucomatous and 49 glaucomatous eyes. Each eye underwent 2 visual field tests: MRF iPad application and the Humphrey Field Analyzer (HRF). Mydriatic photographs of the fundus were taken with two devices: an iPhone 6s+ combined with a 20 D lens and the Visucam 500 fundus camera. All printouts were evaluated by 2 independent, masked glaucoma specialists. Diagnostic accuracies between the modalities were computed. Agreements between different parameters of both devices were analyzed using Cohen’s kappa test.@*Results@#Smartphone-based (iPhone 6s+) fundus photos had an overall sensitivity of 100%, specificity of 89.36%, positive predictive value (PPV) of 89.36% and negative predictive value (NPV) of 100%, with all kappa values between graders of each parameter above 0.61. Tablet-based Melbourne Rapid Fields test had a sensitivity of 81.82%, specificity of 86.54%, PPV of 83.72% and NPV of 84.91%, showing good agreement with the HRF with a kappa value of 0.68 ± 0.07.@*Conclusion@#Smartphone-based fundus photography and tablet-based visual field tests are comparable to the standard fundus photos and visual field tests in evaluating the optic nerve and visual field. These portable devices are reliable and appropriate tools for diagnosing glaucoma and can be used for documentation and testing in remote areas and in a wider range of settings.@*@#

Comparison of the clinical profile of patients with glaucoma between private and government clinics in the Philippines

@#<p style="text-align: justify;"><strong>OBJECTIVE</strong>: To describe the demographic and clinical characteristics of patients with glaucoma managed at private and government institutions in the Philippines between 2009 and 2014.</p><p style="text-align: justify;"><strong>METHODS</strong>: A research team from two private and two government institutions in the Philippines reviewed the case records of 1246 patients seen who met the following criteria: intraocular pressure of >21 mmHg, optic nerve and nerve fiber layer abnormalities, and visual field defects. For bilateral cases, we selected the eye with worse glaucoma parameters.</p><p style="text-align: justify;"><strong>RESULTS</strong>: There were 600 and 646 patients in the private and government groups (mean age at presentation, 60.51 and 55.88 years), respectively, with the majority being Filipino (91%). Patients with visual acuity (VA) of 20/20 to 20/40 were more frequently observed in private centers (58.7% vs. 41.3%), while a VA worse than counting fingers was more frequently observed in government centers (66.1% vs. 33.9%). Within-group analysis showed that primary angle-closure glaucoma was the most frequent glaucoma subtype in both private (27.3%) and government institutions (37.8%). In between-group analysis showed the following to be more common in private than government centers: primary open-angle glaucoma (61.3% vs. 38.7%), normal-tension glaucoma (63.9% vs. 36.1%), ocular hypertension (92.3% vs. 7.7%), and glaucoma suspects (80.4% vs. 19.6%) while government institutions registered a larger number of primary angle-closure glaucoma (59.8% vs. 40.2%) and secondary glaucoma (70.3% vs. 29.7%) cases. Medical treatment using a single drug and multiple drugs was employed for 245 (23%) and 825 (77%) patients, respectively. Within-group analysis showed that laser iridotomy and trabeculectomy were the most commonly performed laser and surgical procedures in both institution types.</p><p style="text-align: justify;"><strong>CONCLUSION</strong>: There is a contrasting profile of glaucoma between clinical institutions in the Philippines with openangle glaucoma being more predominant in private centers while closed-angle glaucoma and secondary glaucoma being more frequent in government centers. Our findings may provide important preliminary information that can aid future health studies or training programs.</p>